The Effect of Non-invasive Brain Stimulation rTMS on Hand Muscles in Chronic Stroke Patients.

Eligibility Criteria

• 1. Age \>=21 years old of any race or gender
• 2. First-ever ischemic or hemorrhagic stroke (neuroimaging verified) at least 6 months from stroke onset
• 3. Unilateral arm weakness measured by FM-UM scale \<= 62/64
• 4. Inducible rest motor threshold and testing motor threshold recorded from the affected first dorsal interosseous (FDI) muscle from the study subject
• 1. Bilateral strokes (infarcts and/or hematoma)
• 2. Other co-existent neuromuscular disorders affecting upper extremity motor impairment.
• 3. History of medically uncontrolled depression or other neuropsychiatric disorders despite medications either before or after a stroke that may affect the subject's ability to participate in the study.
• 4. History of confirmed dementia or taking the following dementia drugs, such as Donepezil, Rivastigmine, Galantamine, Memantine, Aducanumab, Lecanemab, Donanemab that affecting their ability to follow study procedure.
• 5. Uncontrolled hypertension despite medical treatment(s) at the time of randomization, defined as SBP≥185 mmHg or DBP≥110 mmHg (patient can be treated, reassessed and randomized later).
• 6. Presence of any MRI/rTMS risk factors including but not limited to:
• 1. an electrically, magnetically, or mechanically activated metallic or nonmetallic implant including cardiac pacemaker, intracerebral vascular clips or any other electrically sensitive support system.
• 2. a non-fixed metallic part in any part of the body, including a previous metallic injury to the eye.
• 3. history of seizure disorder before stroke or seizure after stroke.
• 4. preexisting scalp lesion or bone defect or hemicraniectomy.
• 6. Concurrent enrollment in another interventional stroke recovery study. 7. Concerns that the subject cannot comply with study procedures and visits. 8. Pregnant individuals.