Clinical Efficacy of Repetitive Transcranial Magnetic Stimulation in Recovery of Hand Function Among Stroke Patients: A Scoping Review
DOI:
https://doi.org/10.32734/sumej.v9i2.21672Keywords:
hand function, hand recovery, non-invasive brain stimulation, post-stroke recovery, repetitive transcranial magnetic stimulationAbstract
Background: Delayed hand function recovery is common after stroke. Repetitive transcranial magnetic stimulation (rTMS) is an emerging non-invasive brain stimulation technique with potential for post-stroke recovery, particularly for hand function, an area with limited research. Objective: Therefore, the aim of this scoping review was to ascertain the clinical efficacy of rTMS in the recovery of hand function among stroke patients. Methods: A systematic search of PubMed, Cochrane, and ScienceDirect from 2005 to 2023 identified original research on rTMS, stroke, and hand function. The reviewers independently screened articles for eligibility, and data were extracted on rTMS intervention protocols and outcomes. Methodological quality was assessed using PEDro analysis. Results: Of 5423 titles screened, 13 studies met the inclusion criteria and were of excellent quality according to PEDro analysis. The studies used varied rTMS intervention parameters, such as frequencies (1 Hz to 20 Hz), stimulus duration (2 sec to 55 sec), numbers of stimuli (10-1000), and variable rest intervals. Conclusion: Overall, rTMS has a positive and clinically significant effect on hand function recovery, but its intervention parameters vary widely. Therefore, further research is needed to establish standardized treatment guidelines to determine the long-term effects of rTMS on motor hand function recovery.
Downloads
References
[1] Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W, et al. Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization–Lancet Neurology Commission. Lancet Neurol. 2023;22(12):1160–1206. https://doi.org/10.1016/S1474-4422(23)00277-6.
[2] Anwer S, Alghadir A, Abu Kassim MS, Towheed T, Ahmed H. Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies. Healthcare. 2022;10(2):190. https://doi.org/10.3390/healthcare10020190.
[3] Smith DB, Scott SH, Semrau JA, Dukelow SP. Impairments of the ipsilesional upper extremity in the first 6-months post-stroke. J Neuroeng Rehabil. 2023;20(1):106. https://doi.org/10.1186/s12984-023-01230-8.
[4] Poomalai G, Prabhakar S, Sirala Jagadesh N. Functional Ability and Health Problems of Stroke Survivors: An Explorative Study. Cureus. 2023;15(1):e33375. https://doi.org/10.7759/cureus.33375.
[5] Fu Y, Liao L, Liang JH, Ou HX, Ma XX, He J, et al. The effectiveness of theta burst stimulation for motor recovery after stroke: a systematic review. Eur J Med Res. 2024;29(1):568. https://doi.org/10.1186/s40001-024-02170-2.
[6] Nguyen TN, Broderick JP, Hill MD, Campbell BCV. Advances in Acute Ischemic and Hemorrhagic Stroke 2024. Stroke. 2025;56(1):194–7. https://doi.org/10.1161/STROKEAHA.124.046969.
[7] Kim WJ, Rosselin C, Amatya B, Hafezi P, Khan F. Repetitive transcranial magnetic stimulation for management of post-stroke impairments: An overview of systematic reviews. J Rehabil Med. 2020;52(2):jrm00012. https://doi.org/10.2340/16501977-2637.
[8] Li X, He Y, Wang D, Rezaei MJ. Stroke rehabilitation: from diagnosis to therapy. Front Neurol. 2024;15:1402729. https://doi.org/10.3389/fneur.2024.1402729.
[9] Shamli Oghli Y, Grippe T, Arora T, Hoque T, Darmani G, Chen R. Mechanisms of theta burst transcranial ultrasound induced plasticity in the human motor cortex. Brain Stimul. 2023;16(4):1135–1143. https://doi.org/10.1016/j.brs.2023.07.056.
[10] van Rooij SJH, Arulpragasam AR, McDonald WM, Philip NS. Accelerated TMS - moving quickly into the future of depression treatment. Neuropsychopharmacology. 2024;49(1):128–137. https://doi.org/10.1038/s41386-023-01599-z.
[11] Marín-Medina DS, Arenas-Vargas PA, Arias-Botero JC, Gómez-Vásquez M, Jaramillo-López MF, Gaspar-Toro JM. New approaches to recovery after stroke. Neurol Sci. 2024;45(1):55–63. https://doi.org/10.1007/s10072-023-07012-3.
[12] Kim J, Yim J. Effects of high-frequency repetitive transcranial magnetic stimulation combined with task-oriented mirror therapy training on hand rehabilitation of acute stroke patients. Med Sci Monit. 2018;24:743–750. https://doi.org/10.12659/MSM.905636.
[13] Arksey H, O'Malley L. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32. https://doi.org/10.1080/1364557032000119616.
[14] Daudt HML, van Mossel C, Scott SJ. Enhancing the scoping study methodology: A large, inter-professional team’s experience with Arksey and O’Malley’s framework. BMC Med Res Methodol. 2013;13:48. https://doi.org/10.1186/1471-2288-13-48.
[15] Levac D, Colquhoun H, O'Brien KK. Scoping studies: Advancing the methodology. Implement Sci. 2010;5:69. https://doi.org/10.1186/1748-5908-5-69.
[16] Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 2018;169(7):467–473. https://doi.org/10.7326/M18-0850.
[17] Vlietstra L, et al. Exercise interventions to improve physical frailty and physical frailty components in older adults with hypertension: A systematic review. Ageing Res Rev. 2025;107:102714. https://doi.org/10.1016/j.arr.2025.102714.
[18] Takeuchi N, Chuma T, Matsuo Y, Watanabe I, Ikoma K. Repetitive transcranial magnetic stimulation of contralesional primary motor cortex improves hand function after stroke. Stroke. 2005;36(12):2681–2686. https://doi.org/10.1161/01.STR.0000189658.51972.34.
[19] Malcolm MP, Triggs WJ, Light KE, Gonzalez Rothi LJ, Wu S, Reid K, et al. Repetitive transcranial magnetic stimulation as an adjunct to constraint-induced therapy: An exploratory randomized controlled trial. Am J Phys Med Rehabil. 2007;86(9):707–715. https://doi.org/10.1097/PHM.0b013e31813e0de0.
[20] Takeuchi N, Tada T, Toshima M, Matsuo Y, Ikoma K. Repetitive transcranial magnetic stimulation over bilateral hemispheres enhances motor function and training effect of paretic hand in patients after stroke. J Rehabil Med. 2009;41(13):1049–1054. https://doi.org/10.2340/16501977-0454.
[21] Barros Galvão SC, Borba Costa Dos Santos R, Borba Dos Santos P, Cabral ME, Monte-Silva K. Efficacy of coupling repetitive transcranial magnetic stimulation and physical therapy to reduce upper-limb spasticity in patients with stroke: A randomized controlled trial. Arch Phys Med Rehabil. 2014;95(2):222–229. https://doi.org/10.1016/j.apmr.2013.10.023.
[22] Rose DK, Patten C, McGuirk TE, Lu X, Triggs WJ. Does inhibitory repetitive transcranial magnetic stimulation augment functional task practice to improve arm recovery in chronic stroke? Stroke Res Treat. 2014;2014:305236. https://doi.org/10.1155/2014/305236.
[23] Kwon TG, Kim YH, Chang WH, Bang OY, Shin YI. Effective method of combining rTMS and motor training in stroke patients. Restor Neurol Neurosci. 2014;32(2):223–232. https://doi.org/10.3233/RNN-130313.
[24] Cassidy JM, Chu H, Anderson DC, Krach LE, Snow L, Kimberley TJ. A comparison of primed low-frequency repetitive transcranial magnetic stimulation treatments in chronic stroke. Brain Stimul. 2015;8(6):1074–1084. https://doi.org/10.1016/j.brs.2015.06.007.
[25] Noh JS, Lim JH, Choi TW, Jang SG, Pyun SB. Effects and safety of combined rTMS and action observation for recovery of function in the upper extremities in stroke patients: A randomized controlled trial. Restor Neurol Neurosci. 2019;37(3):219–230. https://doi.org/10.3233/RNN-180883.
[26] Miller KJ, Schabrun SM, van den Hoorn W, Gillick BT, Burn MB. Effect of repetitive transcranial magnetic stimulation combined with robot-assisted training on wrist muscle activation post-stroke. Clin Neurophysiol. 2019;130(8):1271–1279. https://doi.org/10.1016/j.clinph.2019.04.712.
[27] dos Santos RBC, Galvão SCB, dos Santos PB, Cabral ME, Monte-Silva K. Cortical and spinal excitability changes after repetitive transcranial magnetic stimulation combined with physiotherapy in stroke spastic patients. Neurol Sci. 2019;40(6):1199–1207. https://doi.org/10.1007/s10072-019-03765-y.
[28] Yang Y, Pan H, Pan W, Liu Y, Song X, Niu C, et al. Repetitive Transcranial Magnetic Stimulation on the Affected Hemisphere Enhances Hand Functional Recovery in Subacute Adult Stroke Patients: A Randomized Trial. Front Aging Neurosci. 2021;13:636184. https://doi.org/10.3389/fnagi.2021.636184.
[29] Ni J, Wang J, Zhou J, Liu Z. Effect of rTMS intervention on upper limb motor function after stroke: A study based on fNIRS. Front Aging Neurosci. 2023;14:1077218. https://doi.org/10.3389/fnagi.2022.1077218.
[30] Kwon YG, Do KH, Park SJ, Chang MC, Chun MH. Effect of repetitive transcranial magnetic stimulation on patients with dysarthria after subacute stroke. Ann Rehabil Med. 2015;39(5):793–799. https://doi.org/10.5535/arm.2015.39.5.793.
[31] Tosun A, Ture S, Askin A, Yardimci EU, Demirdal US, Kurt M, et al. Effects of Low-Frequency repetitive transcranial magnetic stimulation and neuromuscular electrical stimulation on upper extremity motor recovery in the early period after stroke: A preliminary study. Top Stroke Rehabil. 2017;24(5):361–367. https://doi.org/10.1080/10749357.2017.1305644.
[32] Lieb A, Zittel S, Chieffo R, Grefen J, Spies C, Zrenner C, et al. Brain-oscillation-synchronized stimulation to enhance motor recovery in early subacute stroke: a randomized controlled double-blind three-arm parallel-group exploratory trial comparing personalized, non-personalized and sham repetitive transcranial magnetic stimulation. BMC Neurol. 2023;23(1):204. https://doi.org/10.1186/s12883-023-03235-1.
[33] Heide G, Witte OW, Ziemann U. Physiology of modulation of motor cortex excitability by low-frequency suprathreshold repetitive transcranial magnetic stimulation. Exp Brain Res. 2006;171(1):26–34. https://doi.org/10.1007/s00221-005-0262-0.
[34] Gustafsson LA, Turpin MJ, Dorman CM. Clinical utility of the chedoke arm and hand activity inventory for stroke rehabilitation. Can J Occup Ther. 2010;77(3):167–173. https://doi.org/10.2182/cjot.2010.77.3.6.
[35] Penta M, Tesio L, Arnould C, Zancan A, Thonnard JL. The ABILHAND questionnaire as a measure of manual ability in chronic stroke patients: Rasch-based validation and relationship to upper limb impairment. Stroke. 2001;32(7):1627–1634. https://doi.org/10.1161/01.STR.32.7.1627.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Sumatera Medical Journal
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The Authors submitting a manuscript do so on the understanding that if accepted for publication, copyright of the article shall be assigned to Sumatera Medical Journal (SUMEJ) and Faculty of Medicine as well as TALENTA Publisher Universitas Sumatera Utara as publisher of the journal.
Copyright encompasses exclusive rights to reproduce and deliver the article in all form and media. The reproduction of any part of this journal, its storage in databases and its transmission by any form or media, will be allowed only with a written permission from Sumatera Medical Journal (SUMEJ).
The Copyright Transfer Form can be downloaded here.
The copyright form should be signed originally and sent to the Editorial Office in the form of original mail or scanned document.
