Chronic post-stroke hemiplegia frequently results in persistent motor deficits, impaired balance, and reduced quality of life. Conventional physical therapy is fundamental for functional recovery; however, motor improvement often plateaus during the chronic phase. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that has shown potential to enhance motor recovery by modulating cortical excitability and promoting neuroplasticity.
This case series aims to investigate the effects of a combined protocol of repetitive transcranial magnetic stimulation and conventional physical therapy on motor function, balance, and quality of life in individuals with chronic post-stroke hemiplegia. Participants will undergo rTMS applied to the motor cortex in conjunction with a structured physical therapy program. Clinical outcomes will be assessed before and after the intervention to explore feasibility, safety, and potential functional benefits of the combined approach.
Diagnosis of first-ever unilateral ischemic or hemorrhagic stroke confirmed by neuroimaging (CT or MRI)
Chronic post-stroke hemiplegia (≥ 6 months since stroke onset)
Moderate to severe motor impairment of the affected lower limb (FMA-LE score between 10 and 28 points)
Age between 18 and 75 years
History of epilepsy or seizures
Presence of pacemakers, cochlear implants, intracranial metallic implants, or other contraindications to rTMS
Severe cognitive impairment or communication deficits preventing participation
Progressive neurological disorders or unstable medical conditions