Combining low-frequency magnetic stimulation with motor imagery to improve lower limb recovery and motor pathway integrity in cerebral infarction: a randomized, double-blind, and controlled study.

There was no sham or untreated control group, so some improvement may have come from usual rehabilitation or spontaneous recovery. All groups received conventional physical rehabilitation plus speech, cognitive and swallowing therapy, so the contribution of any single component cannot be separated. The study had no long-term follow-up, so it cannot show whether gains persisted. The sample was small and some comparisons were only trends, including FMA-LE and TUGT versus rTMS. Patients were in the subacute phase, with disease duration about 60 days (range 30 to 89 days), so results may not apply to acute or chronic stroke. The TMS target was positioned without MRI-guided neuronavigation. Upper limb motor function was not measured, so effects on both limbs were not assessed. The authors reported no significant correlations between brain structural changes and clinical effects.

The authors declared no financial conflicts of interest. Funding was from the Science and Technology Program of Jinhua, Zhejiang Province, grant 2021-4-048.

Do not conclude that magnetic stimulation plus motor imagery is necessary. Every group also received conventional physical rehabilitation plus speech, cognitive and swallowing therapy, and there was no sham or untreated control, so the contribution of any single component cannot be separated. The combined group was also not significantly better than magnetic stimulation alone on the primary lower limb motor score.