{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:42:48Z","timestamp":1793727768491,"version":"4.6.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Post-stroke spasticity affects 25%\u221240% of survivors, causing pain and functional impairment. Current non-invasive treatments target either central or peripheral pathways alone. This neglects the critical imbalance between spastic agonists and antagonists. We designed this protocol to address this gap through dual-site peripheral theta-burst stimulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center, three-arm, sham-controlled, single-blind randomized controlled trial enrolled 54 stroke survivors (aged 40\u201380, 3\u201312 months post-stroke, Modified Ashworth Scale score \u22651). Participants were randomized in a 1:1:1 ratio to receive a 10-session intervention over 2 weeks (5 days\/week). Each session consisted of stimulation followed by 30 min of conventional physical therapy. The stimulation protocols were: Group 1: active iTBS over extensor carpi radialis longus + sham cTBS over flexor carpi radialis; Group 2: sham iTBS + active cTBS; Group 3: active iTBS + active cTBS. Stimulation was delivered using a MagTD stimulator at 110%\u2212120% of the peripheral motor threshold (mean 38.4% maximum stimulator output), with 600 pulses per session (50 Hz burst frequency, 5 Hz theta rhythm).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Anticipated results<\/jats:title>\n                    <jats:p>We hypothesize that Group 3 (combined stimulation) will yield the greatest reduction in spasticity (MAS decrease \u2265 1) and the most significant improvements in upper-limb function (FMA-UE, ARAT) compared to Groups 1 and 2. These clinical gains are expected to correlate with neurophysiological changes (MEP amplitude, cortical silent period), supporting the central-peripheral synergy model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This protocol tests a novel dual-site pTBS paradigm. Positive findings would provide preliminary evidence for network-based rehabilitation. This could inform larger trials and potentially transform post-stroke spasticity management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2025.1702806","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T05:14:38Z","timestamp":1764652478000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Effects of theta burst peripheral magnetic stimulation on cortical excitability and upper limb function after stroke: protocol for a randomized controlled 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