The participant (C.S.) was a 63-year-old male who suffered a left hemisphere ischemic stroke 45 days prior to the study and was not receiving speech and language therapy. C.S.'s neurologist stated that he experienced mild expressive aphasia with short-term memory (STM) difficulties and verbal information processing difficulties. C.S.'s reported having difficulties remembering recent verbal information while having a conversation with family and friends. He was a retired food and beverage employee, with 12 years of education, and was a hobby farmer. Although brain damage was not visible on the current MRI (Figure 2), the initial medical MRI report indicated the presence of an acute ischemic stroke in the medial temporal lobe. C.S. lived with his wife and did not suffer any paresis or paralysis as he was able to drive and care for himself with minimal assistance.
The assessment battery was administered in a predetermined order in 2 sessions, of approximately 2.5 hours duration in total.
The Albert's Visual Neglect Test to determine unilateral spatial neglect
The Edinburgh Handedness Inventory aimed at evaluating handedness of the preferred hand for carrying out daily activities
The Greek adaptation of the Beck's Depression Inventory-II, to measure characteristic attitudes and symptoms of depression
The background tools were used to fulfil certain inclusion criteria in order to proceed to the pretesting and treatment stage of this study. A detailed case history was taken including personal and medical information. A TMS safety questionnaire was completed prior to entering the first stage of the inclusion process, followed by a screening procedure which included the following: 
The Raven's Coloured Progressive Matrices (RCPM) 
Subtests from the Greek version of Boston Diagnostic Aphasia Evaluation-Short Form (BDAE-SF) 
The RehaCom Working Memory Screening Task
A personal stroke narrative 
The Multilingual Assessment Instrument for Narratives (MAIN) 
A Procedural Discourse task 
The Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) 
A battery of tools was administered at baseline, immediately after treatment (same day), and 3 months posttreatment at the follow-up stage. The tools used were as follows: 
The RCPM, a test used to measure abstract reasoning, is also regarded as a nonverbal estimate of Gf. The RCPM is made up of a series of diagrams or designs with a part missing, and the participant is asked to choose the shape to complete the pattern or shape from six alternatives. The Greek version of RCPM was administered as adapted by. Every correctly solved pattern was given 1 point, with a total score range between 0 and 36.
Conversational and expository speech such as simple social responses, free conversation, and picture description
Auditory comprehension including word comprehension, commands, and complex ideational material
Oral expression, such as automatized sequences, single word repetitions, repetitions of sentences, responsive naming, the Boston Naming Test-Short Form (BNT-SF), and screening of special categories
Reading, including letter and number recognition, picture-word matching, basic oral word reading, oral reading of sentences with comprehension, and reading comprehension of sentences and paragraphs
Writing, including mechanics, dictation writing of primer words, regular phonics and common irregular forms, written naming, narrative writing mechanics, written vocabulary access, syntax, and adequacy of content
The BDAE-SF has been standardized in Greek and is culturally appropriate. It includes five subtests: 
For the purposes of this study, only subtests 1-4 were administered and results were analysed in accordance with the test manual.
The RehaCom Working Memory Screening module is a tool used to assess both simple WM span (simple information holding) and the retention and processing of visual-spatial information. When the WM screening task is initiated, ten dots are presented in a circular arrangement. Individual dots sequentially turn red and fade. The first sequence consists of two random dots out of the ten lighting up in a particular order to be repeated correctly. When selected correctly, the number of dots increases in the next sequence. In sum, the task is to memorize the presented sequence of dots lighting up. The WM screening subtest ends after two consecutive incorrect sequence responses or after 7 minutes. The visual-spatial memory span is measured by the maximum length of the memorized dot patterns that can be reproduced immediately without errors. Additionally, the participant's memory span is calculated based on the highest sequence length measured in number of dots, reproduced without mistakes in position and order, and it is confirmed by completing two consecutive sequences with the same number of dots.
A personal stroke narrative was elicited by asking the participant to describe how his stroke occurred. The sample was transcribed and analysed using the Shewan Spontaneous Language Analysis (SSLA) system in accordance with the SSLA protocol. Variables for analysis included number of utterances, time (total speaking time in minutes), rate (syllables per minute), length (percentage of utterances <= 5 words), melody, articulation, complex sentences (percentage of utterances that contained one independent clause and one or more dependent clauses), errors (percentage of grammatical, syntactic, or morphological errors), content units (units that conveyed information), paraphasias (percentage of substitutions), repetitions, and communication efficiency (content units/time).
a goal statement for the protagonist
an attempt by the protagonist to reach the goal
an outcome of the attempt in terms of the goal
the internal states (IST) which initiate the goal and also express reactions
The MAIN is a tool designed to evaluate narrative tell and retell skills in children but has also been used with adults with acquired language deficits associated with neurological disease for research purposes. The MAIN stories consist of coloured picture sequences developed according to strict psycholinguistic criteria. While the MAIN examines narrative production at microstructure and macrostructure levels, for this study, only the macrostructure of the generated story was analysed. The primary unit for macrostructure analysis is the episode. The content of each picture sequence was designed to represent three short episodes. Each episode consists of 
Each story is controlled for cognitive and linguistic complexity and has a moral meaning similar to an Aesop fable. In this study, the "Baby Goats" story was used which portrayed a mother goat wanting to save her baby goat who jumped into the water but a fox jumped forward to catch the other baby goat. Then, a bird saw that the baby goat was in great danger and stopped the fox by biting its tail and chasing it away to save the baby goat. Six-coloured pictures in the form of a cartoon strip were presented, and one-episode was unfolded each time (2 pictures) for the participant to narrate a story based on the pictured stimuli. The scoring sheets of the MAIN "Baby Goats" story provided the scoring system used for the story structure components (setting, goals, attempts, outcomes, and IST). A setting statement, which gives time and place and introduces the story's protagonist, is scored with zero points for wrong or no response, 1 point for one correct response, and 2 points for reference to both time and place. This component is followed by three episodes. Each episode consists of (a) the internal states which initiate the goal and also express reactions; (b) a goal which is a statement of an idea of the protagonist to deal with the initiating event; (c) an attempt by the protagonist to reach the goal, which is an indication of action to obtain the goal; (d) an outcome of the attempt in terms of the goal, which is the event(s) following the attempt and causally linked to it; and (e) the internal states as reaction, which is a statement defining how the protagonist(s) feel or think about the outcome or an action resulting from an emotional response. The story output was transcribed verbatim, and it was analysed using a scoring system of 17 points for story structure components in production, following the guidelines for assessment, and guided by the information on the provided scoring sheets.
Get the bread out
Get two slices of bread//halved bread
Get the butter
Get the (rest of the ingredients, i.e., ham and cheese)
Get a knife
Put/place the bread on the plate
Put/spread butter on bread
Put the ingredients (i.e., ham and cheese) on bread
Put the two pieces together
Cut the sandwich in pieces
The Procedural Discourse task is considered a semispontaneous speech production task that assesses discourse ability following the main concept analysis (MCA) procedure. The MCA enumerates the speaker's ability to communicate the overall idea of an occasion, and it provides a way to evaluate the generated precision and completeness of the critical concepts of the shared topic. The participant was instructed to verbally provide all the required steps to be taken in order to prepare a sandwich. The generated language sample was analysed using the MCA procedure referring to the ten main concepts. The total number of main concepts expected to be produced was analysed and measured based on the concept content as listed below: 
The first five steps comprise concepts concerning retrieving the ingredients needed, the following four steps include concepts concerning ingredient assembly, and the final concept describes the final appearance of the target (sandwich) prior to serving it. The procedure output was transcribed verbatim, and it was analysed using a binary scoring system of "1" for correct information and "0" for incorrect/missing information.
The SAQOL-39g has been translated and culturally adapted in Greek for use in Greece with PWA. The Greek SAQOL-39g shows good reliability and validity as a measure of health-related quality of life in people with stroke, including those with aphasia. An interview with the participant and the first author took place prior to the therapy study where the SAQOL-39 was used to collect the relevant information.
The participant completed ten (10) approximately 45-minute-long treatment sessions comprising of iTBS, immediately followed by RehaCom WM training over a span of 10 consecutive days, including weekends. Within each treatment session, approximately 15 minutes were devoted for setting up the participant with the TMS equipment and iTBS application, and 30 minutes were devoted to the RehaCom WM training task. The treatment regimen is depicted in Figure 3 below.
During the pretherapy baseline phase, the purpose was to establish the level of performance prior to treatment so that the effects of treatment on the task could be clearly measured. Seven outcome measures were used, and the information was collected three times, one week apart, prior to the therapy phase. Preceding the therapy phase, a T1-weighted MRI image was obtained of C. S.'s brain in order to accurately locate the target stimulation site using the Visor 2.0 neuronavigation system (ANT NEURO). Neuronavigated positioning of the stimulation coil allowed for repeated accuracy throughout the study.
 (1) Transcranial Magnetic Stimulation (TMS) Equipment. Single-pulse TMS and intermittent theta-burst stimulation (iTBS) were delivered over the motor cortex and the left dorsolateral prefrontal cortex (LDLPFC), respectively, with the Magstim Rapid2  stimulator (Magstim Co., Wales, UK) connected to a 70 mm figure-8 air cooled coil. Biphasic TMS pulses were delivered with a posterior-to-anterior (P-A) current direction in both, single-pulse TMS and iTBS. The treatment intensity of TMS was individually adjusted the participant's resting motor threshold (RMT). RMT is the minimal intensity at which TMS of motor cortex produces a reliable motor evoked potential (MEP) of minimal amplitude in the target muscle. The MEP was determined with a surface electromyography (EMG) response in the 'target' muscle, through the placement of EMG leads over the first dorsal interosseous (FDI) muscle of the left hand. Full muscle relaxation was maintained through visual and online EMG monitoring. The coil was positioned at 45-degree rotation in relation to the parasagittal plane to induce P-A current in the underlying cortex. The motor "hotspot" was determined with a TMS intensity ranging from 45% to 50% of the maximum stimulator output, whereby single-pulse stimuli were delivered at varying positions across the scalp near the primary motor cortex (M1) while guided by a neuronavigation system (ANT NEURO) using each participant's recent anatomical MRI image. The motor "hotspot" was determined as the position on the scalp that yielded two consecutive MEPs with greater amplitude than the surrounding positions. The location within the left motor cortex that consistently elicited MEPs in the relaxed right FDI muscle was then defined as the motor hotspot. The coil was then placed over the defined target to obtain a MEP in the FDI of at least 50 muV in five or more of 10 consecutive stimulations of the left hand. For this study, a computerized adaptive parameter estimation through sequential testing (PEST) with the software TMS Motor Threshold Assessment Tool, MTAT 2.0, developed by Awiszus and Borckardt et al., was used to determine the RMT. The MTAT 2.0 freeware was obtained online (http://www.clinicalresearcher.org/software.html), and the option for assessment without prior information was selected. No other parameters were changed on the software.
 (1) Transcranial Magnetic Stimulation: iTBS Application. The figure-8 coil was positioned tangentially to the skull, with the handle parallel to the sagittal axis pointing occipitally. The iTBS treatment consisted of bursts of three pulses at 50 Hz given every 200 milliseconds in two second trains, repeated every 10 seconds over 200 seconds for a total of 600 pulses. Based on the participant's recent MRI images, the Visor 2.0 neuronavigation suite (ANT-Neuro, Enschede, Netherlands) was used for image preprocessing, tissue segmentation, and registration into standard stereotaxic space. The stimulation target was defined in the left DLPFC by using the Talairach coordinates x = -39, y = 34, and z = 27. This technology enabled the reliable three-dimensionally precise reapplication of rTMS throughout the study. The participant received one session of iTBS each day for 10 consecutive days.
 (2) RehaCom WM Training Equipment. Immediately following the iTBS session, the participant received 30 minutes WM training using the RehaCom Working Memory (WOME) software package (Hasomed GmbH, DE.). RehaCom WOME is a software package developed to train and improve WM performance. The WM training task involved card presentation in the form of a card game, using a complete card deck of 52 cards and consisting of different levels of difficulty. Three hierarchically ordered modules were designed to exercise the main components of WM on the basis of a card game: (a) storage systems, involving the maintenance of information; (b) selective attention, involving memorizing selective parts of information and inhibiting others; and (c) central executive/manipulation processes, involving active operating with the content retained in WM. RehaCom WOME training involves the memorization and manipulation of an increasing number of visually presented playing cards on a computer screen. Throughout the early levels of training, the participant is required to memorize a short series of cards and reproduce it in the same order, while at higher levels additional tasks are introduced to influence the memory process (e.g., memorize only the cards of a certain suit from a presentation of various cards). In total, there are 70 levels of difficulty. Feedback is constantly provided by the software, and the degree of difficulty is adapted based on the participant's performance level. The sessions were implemented in a quiet room, and C.S. responded on a Lenovo touchscreen laptop.
The Greek BDAE-SF 
The RCPM 
The MAIN 
A Procedural Discourse task 
A personal stroke narrative 
The RehaCom Working Memory Screening Task
The Greek SAQOL-39 
The posttherapy/follow-up phase consisted of two time points. The outcome measures were administered immediately after the completion of the last day of treatment (10th day) and at 3 months posttreatment at the follow-up stage. The purpose of immediate posttesting was to determine short-term efficacy and of the follow-up to determine long-term effects. The exact date of the follow-up was dependent on the participant's availability when contacted to set-up the appointment. The same battery of tools was used as with the baseline phase: