IRCT2016011726056N1 IRCT 2016-08-28 Shiraz University of Medical Sciences The effect of cross education and trans-cranial magnetic stimulation in stroke patients Evaluation of contralateral limb cross education and high frequency repetitive trans-cranial magnetic stimulation on functional indices of affected upper limb in subacute stroke patients 2016-01-20 anticipated 40 Complete https://irct.ir/trial/21700 interventional Randomization: Randomized, Blinding: Double blinded, Placebo: Not used, Assignment: Parallel, Purpose: Treatment. N/A hemiplegia. Intervention 1: for first group ( control group), routine physiotherapy for affected upper exterimity of hemiplegia is applied in 10 sessions ,3 times a week. routine physiotherapy sessions include joints range of motions, gentle stretching of hapertonic muscles, strengthening of muscle weakness, learning of activity daily living and functional electrical stimulation. Intervention 2: For the second group,The subject is seated, both arms are relaxed and unaffected elbow is flexed to a right angle, with the unaffected forearm is in nutral position and resting on a table. maximal grip force of unaffected hand is measured by grip dynamometer. Then, subject grasps unaffected hand with 60-70% of maximal voluntary contraction 30 times in each sessions. Each patient receives 10 treatment sessions (3 times a week) of cross education technique.in addition, Routine physiotherapy is performed in each session. Intervention 3: For the third group, HF- rTMS Is applied over the primary motor cortex for the fingers of the lesional hemisphere. Each rTMS session consists of 2000 pulses. Site of stimulation on the skull is defined as the location where the largest motor evoked potentials of the first dorsal interosseous muscle in the unlesioned upper exterimity are elicited on electromyography. the intensity of stimulation is set at 90% of the motor threshold of the first dorsal interosseous muscle. Frequency of stimulation is 20 Hz and .Each patient receives 10 treatment sessions (3 times a week) of rTMS. Routine physiotherapy is performed after the application of rTMS sessions. Intervention 4: For the fourth group cross education ( similar to second group), HF-rTMS (similar to third group) and physiotherapy is applied in each session.Each patient receives 10 treatment sessions (3 times a week).