Procedures
CARAS, Stroke
STROKE, BRAIN
Treatment was delivered in 10 daily sessions on consecutive working days. cTBS was delivered over the contralesional M1, which was defined as the position on the scalp at which motor-evoked potentials (MEPs) with the largest peak-to-peak amplitude could be evoked in the contralateral first dorsal interosseous (FDI) muscle by delivering TMS pulses and monitoring the electromyogram. A Neuro-MS/D advanced therapeutic magnetic stimulator and an angulated 100 mm figure-of-eight TMS coil (Neurosoft, Ivanovo, Russia) were used for stimulation. Electromyogram was recorded, amplified, and digitized at a sampling frequency of 20 kHz using a 4-channel Neuro-MEP amplifier (Neurosoft, Ivanovo, Russia). cTBS consisted of continuous delivery of 3 stimuli bursts at 50 Hz repeated at 5 bursts per second for a duration of 40 seconds with a biphasic TMS-induced current at 45° to the midline. Stimulation intensity was set at 70% of the RMT. TMS coil placement was recorded using a neuronavigation system (Brain Science Tools BV, De Bilt, the Netherlands) starting from the 16th patient. cTBS or sham cTBS was delivered 15 minutes before standard upper limb therapy, which consisted of a 60-minute group therapy session of individualized upper limb exercises, according to the Concise Arm and Hand Rehabilitation Approach in Stroke (CARAS).