"Effects of a Combined Repetitive Transcranial Magnetic Stimulation and Physical Therapy Protocol on Motor Function, Balance, and Quality of Life in Chronic Post-Stroke Hemiplegia: A Case Series"

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.

Inclusion Criteria: * 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 * Medically stable and able to participate in a rehabilitation program * Ability to understand study procedures and provide written informed consent * No contraindications to repetitive transcranial magnetic stimulation (rTMS), according to current safety guidelines. Exclusion Criteria: * 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 * Participation in other experimental neurorehabilitation interventions during the study period * Any condition judged by investigators to compromise safety or data valid