Efficacy of repetitive transcranial magnetic stimulation combined with soft robotic glove training for slight-to-moderate post-stroke upper limb spasticity: a randomized controlled trial

Background Post-stroke upper-limb spasticity can limit motor recovery and functional use of the affected arm. This randomized controlled trial investigated whether repetitive transcranial magnetic stimulation combined with soft robotic glove training improves wrist flexor spasticity and upper-limb motor function in patients with stroke.Methods Fifty-four patients were randomized to the rTMS + SRG group or the sham rTMS + SRG group. Four participants withdrew for reasons unrelated to the trial or early hospital discharge, and 50 participants completed the intervention and post-intervention assessment. Both groups received 12 treatment sessions over two weeks in addition to conventional rehabilitation. The primary outcome was wrist flexor spasticity assessed using the Modified Ashworth Scale (MAS). Secondary outcomes included the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and the Hmax/Mmax ratio.Results Wrist flexor spasticity decreased significantly in the rTMS + SRG group after treatment (p = 0.0051), but not in the sham rTMS+SRG group (p = 0.98). The between-group comparison of change scores also favored the rTMS+SRG group (p = 0.021). FMA-UE scores improved significantly in both groups (both p < 0.0001), with greater improvement in the rTMS + SRG group (p = 0.038). The Hmax/Mmax ratio decreased significantly in the rTMS + SRG group (p = 0.030), whereas the between-group difference in change scores was not statistically significant (p = 0.086).Conclusion Compared with sham rTMS combined with soft robotic glove training, rTMS combined with soft robotic glove training produced greater reductions in wrist flexor spasticity and greater improvements in upper-limb motor function after stroke.