Efficacy of coupling repetitive transcranial magnetic stimulation and physical therapy to reduce upper-limb spasticity in patients with stroke: A randomized controlled trial.

You will need to have your therapist figure out how to incorporate this into a stroke protocol for you.
http://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J68256&phrase=no&rec=124209
NARIC Accession Number: J68256.  What's this?
ISSN: 0003-9993.
Author(s): Galvao, Silvana C.; Costa dos Santos, Rebeka; Borba dos Santos, Priscila; Cabral, Maria E.; Monte-Silva, Katia.
Publication Year: 2014.
Number of Pages: 8.
Abstract: Study assessed the efficacy of inhibitory repetitive transcranial magnetic stimulation (rTMS) combined with physical therapy (PT) for decreasing upper-limb muscle tone after chronic stroke. Twenty patients with post-stroke upper-limb spasticity participated in a randomized sham-controlled trial with a 4-week follow-up. The experimental group received rTMS to the primary motor cortex of the unaffected side 3 days a week, always before PT, for a total of 10 sessions. The control group received sham stimulation and PT. The primary outcome measure was the Modified Ashworth scale (MAS). Secondary outcome measures included the upper-extremity Fugl-Meyer assessment, Functional Independence Measure, range of motion, and stroke-specific quality-of-life scale. All outcomes were measured at baseline, after treatment (postintervention), and at a 4-week follow-up. A clinically important difference was defined as a reduction of ≥1 in the MAS score. Analyses revealed that PT is efficient for significantly reducing the upper-limb spasticity of patients only when it is associated with rTMS. In the experimental group, 90 percent of the patients at postintervention and 55.5 percent at follow-up showed a decrease of ≥1 in the MAS score, representing clinically important differences. In the control group, 30 percent of the patients at postintervention and 22.2 percent at follow-up experienced clinically meaningful changes. There were no differences between the groups at any time for any of the other outcome measures, indicating that both groups demonstrated similar behaviors over time for all variables. Results suggest that rTMS combined with PT can be beneficial in reducing poststroke spasticity.