Search Results (86)

Background/Objectives: Although kidney transplantation improves survival and quality of life in children with end-stage kidney disease, neurocognitive and motor impairments acquired during chronic kidney disease (CKD) may persist after transplantation. Cognitive–motor evaluations in this population remain limited. This study compared cognitive function, manual dexterity, grip strength, reaction time, and balance between pediatric kidney transplant recipients and healthy peers. Methods: This study included 30 pediatric kidney transplant recipients aged 8–18 years and 30 age- and sex-matched healthy controls. Cognitive function was assessed using the Stroop Color–Word Test. Fine and gross manual dexterity were evaluated using the Nine-Hole Peg Test and Box and Block Test, respectively. Handgrip strength was measured with a JAMAR dynamometer, reaction time with the FitLight Trainer™ system, and balance with the Pediatric Balance Scale. Results: Compared with healthy controls, pediatric kidney transplant recipients showed poorer executive function, demonstrated by longer Stroop completion times and more color–word errors (all p < 0.05). Manual dexterity was reduced, with a significantly lower Box and Block Test score for the dominant hand (p = 0.020) and longer Nine-Hole Peg Test completion times for both hands (both p < 0.001), whereas the between-group difference in the non-dominant Box and Block Test did not reach statistical significance (p = 0.055). Dominant-hand reaction time and reaction time during the cognitive task were significantly prolonged (p = 0.018 and p = 0.046, respectively). Handgrip strength and Pediatric Balance Scale scores did not differ significantly between groups (both p > 0.05). Conclusions: Pediatric kidney transplant recipients exhibit persistent impairments in executive function, manual dexterity, and cognitive–motor performance despite transplantation. Long-term follow-up should incorporate cognitive and motor assessments to support early rehabilitation and optimize functional outcomes. Full article

Background: Stroke is a leading cause of neurological disability worldwide, with upper limb impairment affecting approximately 70% of survivors and only 5–20% achieving complete dexterity recovery at six months. Brain–computer interface (BCI) neurorehabilitation decodes motor intentions from electroencephalographic (EEG) signals to deliver synchronized functional electrical stimulation (FES) and virtual reality feedback, creating a closed-loop neurofeedback system that reinforces motor learning. While existing evidence supports BCI efficacy and safety in chronic stroke, its feasibility, safety, and cost-effectiveness during the acute and subacute phase (2 to 12 weeks post-stroke), when neuroplasticity is heightened, remain underexplored. Furthermore, there is a paucity of data regarding preliminary health economic analyses for BCI rehabilitation in acute stroke rehabilitation settings. Methods: This prospective, open-label, single-arm pragmatic feasibility pilot trial will recruit 12 patients with hemorrhagic or ischemic stroke (2–12 weeks post-stroke) undergoing inpatient rehabilitation from a public healthcare institution. Up to 15 sessions of BCI-rehabilitation of 30 min each using the recoveriX system will be supervised by a trained therapist or clinical research assistant (4–5 sessions/week over 3–4 weeks), followed by standard occupational therapy within 30–60 min of BCI-rehabilitation. Primary outcomes assessing feasibility and adherence include eligibility and recruitment rate (%/screened); tolerability using self-rated System Usability Scale (SUS) score; within-session adherence > 80%/240 trials, summated for completed trials per patient; programme completion number > 80% of scheduled (>12/15) sessions; and training-related adverse events per patient ≤ 17% (≤2/12 sessions). Secondary outcome measures include clinical efficacy by arm impairment scale using hemiplegic Upper Limb Fugl–Meyer Motor Assessment (FMA-UE), hand function using Action Research Arm Test (ARAT), admission and discharge functional status (Functional Independence Measure-FIM (18–126), Modified Barthel Index-MBI (0–100), stroke impact scale (SIS_3.0), arm, participation domains), and economic analysis. All outcomes will be measured by trained therapists/researchers at baseline week 0, week 3–4 (post-BCI-rehabilitation), and week 12 and 24 (follow-up). BCI-rehabilitation EEG-derived electrophysiological correlates of recovery will be extracted to better understand participant progress over time. An incremental cost-utility analysis will compare the BCI-rehabilitation participants against propensity-matched historical controls from the TTSH stroke rehabilitation registry (2017 to 2025), stratified by baseline motor severity. Discussion: This study will provide preliminary evidence on feasibility, tolerability, safety, clinical efficacy, and cost-effectiveness of early BCI-rehabilitation in acute/subacute stroke to better inform clinicians on its implementation. Full article

Essential tremor (ET) is among the most prevalent movement disorders, causing significant impairment in manual dexterity and daily functioning. Although ET affects individuals across the lifespan, exercise intervention research has focused almost exclusively on older adults, leaving young adults, for whom early intervention may prevent long-term neuromuscular deterioration, critically underrepresented. Furthermore, the effects of strength–endurance oriented exercise combined with task-specific motor activities remain insufficiently explored in any ET population. This quasi-experimental pre-test–post-test study investigated the effects of a 6-week progressive strength–endurance and task-specific exercise program on tremor severity, manual dexterity, and upper extremity functional performance in young adult males with ET (n = 18; mean age: 22.6 ± 4.1 years). The 24-session intervention (four sessions/week) combined proximal upper extremity strength–endurance exercises with seven ADL-specific fine motor tasks. Tremor severity was assessed using the Fahn–Tolosa–Marin Tremor Rating Scale (FTMTRS), manual dexterity using the Nine-Hole Peg Test (NHPT), and upper extremity stability using the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). The Wilcoxon signed-rank test was used for within-group comparisons, with rank biserial correlation (r) and Cohen’s d reported as effect size indices. Significant pre-to-post improvements were observed across nearly all outcome measures, with medium-to-large effect sizes. Spiral drawing performance improved significantly in five of six conditions (r = 0.47–0.62), with the exception of the Spiral left–B task (p = 0.083). Postural tremor, NHPT (both hands), and CKCUEST also showed significant improvements (r = 0.47–0.73). A composite tremor score, integrating all tremor sub-scores, demonstrated a 14.1% overall reduction (p = 0.001, r = 0.83), providing strong evidence of program-wide effectiveness. Session adherence was 95.8%. To our knowledge, this is one of the first studies to show that a structured strength–endurance and task-specific exercise program was associated with reductions in tremor severity and improvements in upper extremity function, specifically in young adults with ET. These findings support the clinical utility of exercise as a non-pharmacological intervention in this underserved population and highlight the importance of early, targeted intervention during young adulthood. Full article

Background/Objectives: Wrist cock-up orthoses are standard for work-related musculoskeletal disorders, yet consensus is lacking on whether commercial orthoses (COs) or custom-made thermoplastic orthoses (THs) better preserve function. While COs offer availability, THs provide a superior anatomical fit. This study evaluated dexterity and satisfaction in healthy female employees to establish a functional baseline for preventive strategies. Methods: Healthy female office workers with no prior musculoskeletal or neurological conditions participated in this randomized cross-over study. Manual dexterity was assessed at baseline and after each of two consecutive workdays, during which participants wore, in a randomized order, either a CO or a TH made by an expert physiotherapist. Outcome measures included the Functional Dexterity Test (FDT), recording time and errors, and the Client Satisfaction with Device (CSD-It) scale. Results: Twenty right-handed women (mean age 45.6 ± 11 years) participated. A significant difference in FDT completion times across conditions (χ² = 12.6, p = 0.002) was found. While both orthoses slowed performance compared to baseline (p < 0.01), the CO allowed for faster dexterity than the TH (p < 0.01). No differences were found in error rates. Regarding satisfaction, the CO achieved significantly better CSD-It scores than the TH (p = 0.0047), despite 60% of users reporting increased skin temperature with the CO. Final preferences were nearly evenly split (55% CO vs. 45% TH). Conclusions: Both orthoses impact manual dexterity without compromising precision. While the CO offered better execution speed and overall satisfaction, the TH version was preferred for prolonged skin tolerability. Selection should be individualized, balancing mechanical efficiency with the superior fit of custom-fabricated solutions in office environments. Full article

Background: Multiple sclerosis (MS) is a chronic disease of the central nervous system, characterised by high variability in both its progression and symptoms. The disease leads to progressive disability, which manifests itself as slow walking, low muscle mass and impaired manual dexterity, causing difficulties in performing everyday activities and reducing a patient’s social activity and quality of life. The aim of this study is to assess the relationships between muscle mass, physical activity and the food frequency of protein-rich products and the functional fitness of patients with MS. Methods: The study comprised 106 patients with MS (83 women and 23 men) aged 18–65 years. Measurements of their weight and body composition, motor function of the lower limbs using the Timed 25-Foot Walking Test (T25FW), and motor function of the upper limbs using the 9-Hole Peg Test (9-HPT) and the Handgrip Strength (HGS) test were performed. Daily moderate-to-vigorous physical activity (MVPA) and the consumption frequency of protein-rich products were also assessed. Results: Low muscle mass was associated with worse performance in the HGS test (non-dominant hand p = 0.001, dominant hand p = 0.001), while no significant associations were observed for manual dexterity or T25FW performance.. The second tercile of MVPA was significantly associated with reduced HGS in the dominant (p = 0.037) and non-dominant hands (p = 0.015). Conversely, the third tercile of the MVPA compared to the lower tertile was associated with better HGS of the non-dominant hand (p = 0.022) and faster completion of the 9-HPT with the non-dominant (p = 0.010) and dominant hands (p = 0.029). Furthermore, frequent consumption of protein-rich products was correlated with faster completion of the T25FW test (p = 0.033). Conclusions: Regular physical activity is associated with better functional fitness, while more frequent consumption of protein-rich foods may be associated with higher muscle mass of major muscle groups, which is important for effective locomotion. This study has a cross-sectional and exploratory design; therefore, the findings reflect associations only and do not allow casual inferences. Full article

Objective: The aim of this study will be to evaluate the effectiveness of a task-oriented training program in improving functional performance and health outcomes in patients with MS. Methods: A pilot randomized clinical trial will be conducted according to SPIRIT guidelines. Participants will be randomly assigned to the experimental group or the control group. Assessment and treatment will take place at patient association facilities or research center. Participants diagnosed with MS by a neurologist and meeting the inclusion criteria will be invited to participate voluntarily. The experimental group will undergo an 8-week TOT intervention, twice weekly, 45 min. The control group will maintain usual care and be given a fatigue management pamphlet. The main variable in this study will be the Canadian Occupational Performance Measure. The level of fatigue will be assessed with the Modified Impact Fatigue Scale and the Fatigue Severity Scale, upper limb strength using the Arm Curl Test, hand and pinch dynamometer, motor speed with the Finger Tapping Test, manual dexterity with the Nine Hole Peg Test, Purdue Pegboard Test and the Coin Rotation Test. Satisfaction and adherence with the intervention will be recorded with the Sport Injury Rehabilitation Adherence Scale. Results: The results will be published as a peer-reviewed article. Conclusions: The present protocol aims to fill a relevant gap in the literature, offering a structured intervention based on task-oriented training principles, specifically tailored to the functional and occupational needs of people with MS. Full article

Neurological injuries and disorders affecting hand motor control can severely impair the ability to perform activities of daily living and substantially reduce quality of life. Technologies such as virtual reality (VR) are increasingly used to address fundamental challenges in therapy, including motivation and engagement; further, programmable features of digital interfaces offer additional opportunities to personalize and optimize motor training. In this proof-of-concept study, we developed and evaluated a novel VR-based training framework to support improved dexterity and hand function using physiological (sensory-driven) and cognitive (memory) cues designed to promote greater task-relevant neural engagement. The proposed approach leverages the integration of augmented sensory feedback (ASF) with memory-anchored cues for motor learning of target hand gestures. Using a within-subjects design, thirteen neurotypical adults completed four training conditions: (1) control (baseline gesture-matching in VR), (2) visual ASF (enhanced visualization and feedback of gesture accuracy), (3) memory-anchored cues (associating gestures with semantically meaningful entities, loosely analogous to American Sign Language), and (4) hybrid multimodal (visual ASF + memory-anchored cues). Training with the hybrid condition produced the fastest skill acquisition (9.3 trials to reach an 80% accuracy threshold) and the steepest initial learning slope (1.86 ± 0.12%/trial), with all conditions differing significantly in initial slope (all p < 0.002). Post-training assessment showed that the hybrid condition achieved the highest gesture accuracy (95.2%), greatest normalized post-training accuracy gain (14.3% above baseline), fastest execution time to target gesture (1.14 s), and lowest variability in gestural kinematics (SD = 3.9%). Both ASF and memory-anchored cue conditions each also independently outperformed the control condition on gesture accuracy (both p ≤ 0.002), with omnibus ANOVAs indicating significant condition effects across metrics. Together, these findings suggest that pairing ASF cues with memory-based cognitive scaffolding can yield additive benefits for motor skill acquisition and stability. Pending validation in clinical populations, such approaches may inform the design of VR-based motor training frameworks for rehabilitation. Full article

Objective: To determine which physical clinical test best differentiates minimally impaired people with MS (pwMS) from healthy controls and to compare the discriminatory value of upper limb clinical assessments with sensor-based gait and postural control measures. Methods: Forty-one participants (21 pwMS, 20 matched healthy controls) completed a single testing session including upper limb clinical assessments (Nine-Hole Peg Test [9HPT], grip strength), gait (Timed 25-Foot Walk, Six-Minute Walk Test, and cognitive–walking dual task), and static balance assessments using wearable inertial sensors (APDM Mobility Lab system). Dual-task costs (DTCs) were calculated for gait parameters. Between-group comparisons were performed using independent t-tests. Pearson correlation analyses were conducted to examine interrelationships among gait variables, and a parsimonious binary logistic regression model was constructed, including non-dominant 9HPT and dual-task walking speed. Receiver operating characteristic (ROC) analyses were performed to evaluate discriminative performance and determine the optimal 9HPT cutoff. Results: PwMS performed significantly slower on the 9HPT for both hands (p ≤ 0.006) and demonstrated reduced walking performance and higher gait DTCs (p ≤ 0.041) compared with controls. No significant group differences were observed in grip strength or sensor-based postural control. In multivariable analysis, the overall model was significant (p < 0.001; Nagelkerke R² = 0.49), and the non-dominant 9HPT remained the only independent predictor of group status (OR = 1.75, 95% CI [1.17–2.61]), whereas dual-task walking speed was not significant after adjustment. ROC analysis demonstrated good discriminative ability for the non-dominant 9HPT (AUC = 0.84, 95% CI [0.71–0.97]) and acceptable discrimination for dual-task walking speed (AUC = 0.75, 95% CI [0.60–0.90]). The optimal 9HPT cutoff was ≥21.4 s, yielding 71% sensitivity and 100% specificity in this cohort. Conclusions: Manual dexterity of the non-dominant hand may serve as a sensitive screening marker of early functional impairment in MS, demonstrating greater discriminatory value than sensor-based gait and balance measures. These findings support the inclusion of upper limb dexterity testing in the routine assessment of minimally impaired pwMS. Validation in larger, longitudinal cohorts is warranted. Full article

Background: Early childhood represents a key stage for the development of movement behaviors (MB), motor skills (MS), and executive functions (EF). Body Mass Index (BMI), defined according to World Health Organization (WHO) references, may influence these domains early in life. In this context, this cross-sectional observational study aimed to examine the associations between BMI and 24-h MB, MS, and EF in Tunisian preschool children aged 4 to 5 years. Methods: This cross-sectional observational study included 112 Tunisian children aged 4 to 5 years (50 boys, 62 girls), recruited from kindergartens in urban and rural areas. Anthropometric measurements were used to calculate age-specific BMI z-scores and classify children into three BMI categories: below normal, normal, and above normal. Twenty-four-hour MB physical activity (PA), sedentary behavior (SB), and sleep were objectively assessed using accelerometry over five consecutive days. EF (inhibition and working memory) were assessed using standardized cognitive tests, gross MS were evaluated using the Supine Timed Up and Go test (functional mobility), One-Leg Standing Balance test (postural steadiness), Hand Grip Dynamometer (upper body strength), and Standing Long Jump (lower body strength), and fine MS were assessed using the 9-Hole Pegboard Test (dexterity). All tools are validated and standardized for children. Results: Significant differences between BMI categories were observed for anthropometric variables (p < 0.05). In contrast, no significant differences were found for 24-h MB, adherence to recommendations, EF, and MS (p > 0.05). Only Sleep duration showed a difference significantly between BMI < normal and BMI > normal (p = 0.022). Conclusions: In Tunisian preschool children, weight status is primarily associated with differences in physical growth, with no marked relationship to MB, EF, or MS. These findings highlight the importance of universal preventive interventions, particularly focusing on growth monitoring, starting in early childhood. These results should be interpreted with caution and highlight the need for further studies on larger populations to better understand the relationships between BMI, PA, and development in young children. Full article

Background: Central cord syndrome (CCS) is the most common incomplete spinal cord injury, producing more severe motor deficits in the upper than lower extremities and impairing sensory and autonomic function. Although transcutaneous spinal cord stimulation (tSCS) has shown benefits in motor and sensory recovery after spinal cord injury, studies have not explicitly documented whether CCS subjects were included. The aim of this study was to assess the effects of tSCS over 12 weeks on motor and sensory outcomes in a subject with CCS. Methods: A 20-year-old male with a C7 injury was evaluated at baseline and after 12 weeks with the American Spinal Cord Injury Impairment scale, Modified Ashworth Scale, Penn and Spasm Frequency Scale, 3-Meter Walk Test and 6-Minute Walk Test, 9-Hole Peg Test, Box and Block Test, hand dynamometry, and lower-limb EMG. tSCS was applied between T9 and L1 at 30 Hz. Results: At 12 weeks, upper-limb motor and sensory scores improved, while spasm frequency and hand spasticity were reduced. Manual dexterity improved bilaterally in the 9-Hole Peg and Box and Block Tests, with a 2 kg gain in right-hand grip strength. In the 6-Minute Walk Test, the distance covered increased from 224.4 m to 295.2 m, and a 1.36 s reduction in 3-Meter walking time was achieved. Conclusions: tSCS improved motor and sensory function and reduced spasticity and spasms. These findings suggest that tSCS may serve as an effective complementary intervention for motor and sensory rehabilitation in individuals with mild cervical injuries, including CCS. Full article

Background/Objectives: Neuromuscular fatigue (NMF) can impair manual dexterity and strength in healthcare professionals. Due to their high physical and cognitive workloads, physiotherapists (PTs) are particularly susceptible to NMF. This study investigated whether NMF, expressed as changes in manual dexterity and grip strength, occurs over a workday and across a workweek in PTs, and explored its relationship with stress and sleep quality. Methods: A total of 43 full-time PTs (25 female, mean age 37.72 ± 11.94 years) were recruited. Manual dexterity was assessed using the Functional Dexterity Test (FDT), while maximal grip strength (MGS) was measured by a hand dynamometer. Reliability was evaluated on a subgroup using Intraclass Correlation Coefficients (ICC_3,1) and Standard Error of Measurement (SEM). Evaluations were conducted at the beginning and at the end of the work shift, on Monday and Friday. Subjective fatigue, perceived stress, and sleep quality were also recorded. Results: The FDT showed excellent intra-rater reliability (ICC > 0.93; SEM < 0.94 s). FDT performance was significantly slower on Friday evening compared to all other time points (p < 0.01), exceeding the minimal detectable change thresholds. No significant changes were observed in MGS across the week. Perceived stress was strongly correlated with fatigue levels on Monday (ρ = 0.731) and Friday (ρ = 0.612) evenings. Sleep quality and professional experience did not correlate with performance changes. Conclusions: PTs experience a significant decline in manual dexterity by the end of the workweek, suggesting an accumulation of NMF. While MGS remains stable, fine motor control is more sensitive to fatigue. Psychosocial stress appears to be a major driver of perceived fatigue in this population. Full article

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterised by motor and non-motor symptoms. Several studies have reported varying prevalence of Carpal Tunnel Syndrome (CTS) among individuals with PD. Objective: This study aimed to estimate the pooled prevalence of CTS in people with PD and explore any potential association between the two conditions. Methods: This systematic review and meta-analysis was conducted and reported in accordance with the PRISMA 2020 guidelines. A systematic search was performed across PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (WoS), Scopus, and EMBASE from inception to April 2024. Studies reporting CTS prevalence data in individuals with PD were included. Methodological quality was assessed using the National Institutes of Health (NIH) quality assessment tool. Pooled prevalence estimates were calculated using a random-effects model. Risk difference (RD) and risk ratio (RR) were calculated to assess the association between PD and CTS compared with control groups. Results: A total of 7 studies involving 411 participants (343 with PD and 68 controls) met the inclusion criteria, with 679 wrists assessed. The pooled prevalence of CTS in PD was estimated at 15% (95% CI: 0.07–0.28) with significant heterogeneity (p < 0.001, I² = 91%). The RD was 10% (95% CI: 0.04–0.16, p = 0.002), with low heterogeneity (p = 0.29, I² = 19%). The RR of CTS in PD compared with controls was 3.31 (95% CI: 0.60–18.42, p = 0.17), with moderate heterogeneity (p = 0.13, I² = 52%). Conclusions: This meta-analysis provides preliminary pooled estimates indicating a potentially increased prevalence of carpal tunnel syndrome in individuals with PD. Although the findings suggest a possible association, clinicians should maintain increased vigilance for CTS symptoms in patients with PD presenting with upper-limb sensory or motor complaints. From a biomechanical and functional perspective, these findings highlight the importance of routine upper-limb screening and the implementation of rehabilitation strategies targeting hand use, dexterity, and sensorimotor control within physiotherapy practice. Further high-quality studies with larger, well-characterised samples are required to confirm this relationship and clarify its clinical and functional implications. Full article

Essential tremor (ET) negatively affects neuromuscular control and hand function in older adults. Resistance exercise may enhance musculoskeletal and functional capacity, yet its modality-specific effects in ET remain unclear. This study compared the effects of home-based and aquatic resistance training on tremor severity, manual dexterity, and handgrip strength in older adults with ET. Twenty-seven participants were randomly assigned using block randomization to a home-based resistance exercise group (HBREG; n = 9), an aquatic resistance exercise group (AREG; n = 9), or a control group (CG; n = 9). Both intervention groups completed an 18-session resistance exercise program, with initial sessions supervised and subsequent sessions performed independently under regular monitoring. Tremor severity (FTMTRS), manual dexterity (Nine-Hole Peg Test), and handgrip strength were assessed pre- and post-intervention. Within-group changes were analyzed using the Wilcoxon signed-rank test and between-group differences using the Kruskal–Wallis test with Bonferroni-adjusted Mann–Whitney U tests (p < 0.05). Both HBREG and AREG demonstrated significant improvements in drawing and pouring tremor tasks, manual dexterity, and handgrip strength compared with the control group, with large effect sizes across outcomes. No significant differences were observed between the two exercise modalities, and no improvement occurred in the highest-difficulty spiral-B task. These findings indicate that both home-based and aquatic resistance training are safe and effective non-pharmacological strategies for reducing tremor severity and enhancing upper-extremity function in older adults with ET. Full article

Cervical spinal cord injury causes severe functional impairment with limited spontaneous recovery, and while spinal cord stimulation has emerged as a promising neuromodulatory strategy, evidence for cervical applications remains fragmented. To address this gap, we conducted a systematic review synthesizing preclinical and clinical evidence on cervical spinal cord stimulation for functional rehabilitation following spinal cord injury. The review was registered on PROSPERO (CRD420251088804) and conducted in accordance with PRISMA guidelines, with PubMed, Embase, IEEE Xplore, and Web of Science searched from inception to July 2025 for animal and human studies of cervical spinal cord stimulation, including epidural, intraspinal, and transcutaneous approaches, reporting functional neurological outcomes. Risk of bias was assessed using the Cochrane RoB 2 and ROBINS-I tools, and due to substantial heterogeneity, results were synthesized narratively. Thirty-one studies comprising 119 animals and 156 human participants, met inclusion criteria. Across studies, outcome measures such as GRASSP, ISNCSCI, and dynamometry consistently demonstrated improvements in hand strength, dexterity, and voluntary motor activation. Several studies also reported gains in sensory and autonomic function, whereas respiratory outcomes were infrequently assessed. Adjunctive interventions, including cortical stimulation, brain–computer interface priming, and task-specific training frequently augmented recovery. Adverse events were generally mild, although overall risk of bias was predominantly serious. Overall, cervical spinal cord stimulation demonstrates preliminary assistive and therapeutic effects on motor recovery, with additional sensory, autonomic, and potential respiratory benefits. Full article

Background/Objectives: Chronic psychomotor and cognitive slowing after stroke can persist despite standard rehabilitation, especially in young adults with subcortical injuries. Innovative, integrated interventions are crucial for patients who have reached a plateau in their rehabilitation. We present a case of a 41-year-old male with chronic psychomotor and cognitive slowing following a left lenticulostriate infarction (NIHSS score = 5 at onset), who had plateaued after conventional rehabilitation. Methods: Over 4 weeks the patient underwent 20 sessions of a multimodal approach including high-frequency repetitive transcranial magnetic resonance stimulation over the supplementary motor area and bilateral temporo-parietal junctions and simultaneous computerized cognitive training targeting attention and executive function. Both motor and cognitive assessments, along with quantitative EEG (qEEG) evaluations, were conducted before and after the treatment. Results: At the end of treatment, the patient showed significant clinical improvement: speed and coordination in upper extremities (Finger Tapping Test) increased by 66% (dominant hand) and 74% (non-dominant hand), while finger dexterity (Nine-Hole Peg Test) increased by 25% (dominant hand) and 19% (non-dominant hand). Cognitive scores improved in alertness (58%), visual exploration (25%), and flexibility (24%), while divided attention remained stable. qEEG investigation showed increases in alpha (79%), gamma (33%), and beta (10%) power, with topographic shifts in the stimulated regions. Conclusions: These findings highlight the feasibility of combining targeted rTMS and cognitive training to enhance neuroplasticity in the chronic phase of stroke. Clinical recovery was accompanied by normalized cortical rhythms, suggesting qEEG biomarkers may be useful for tracking treatment response. Multimodal precision neurorehabilitation may offer a path forward for patients with persistent cognitive–motor deficits post-stroke. Full article