Introduction. Restoration of upper extremity (UE) functional use remains a challenge for individuals following stroke. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive modality that modulates cortical excitability and is being explored as a means to potentially ameliorate these deficits. The purpose of this study was to evaluate, in the presence of chronic stroke, the effects of low-frequency rTMS to the contralesional hemisphere as an adjuvant to functional task practice (FTP), to improve UE functional ability. Methods. Twenty-two individuals with chronic stroke and subsequent moderate UE deficits were randomized to receive 16 sessions (4 times/week for 4 weeks) of either real-rTMS or sham-rTMS followed by 1-hour of paretic UE FTP. Results. No differences in UE outcomes were revealed between the real-rTMS and sham-rTMS intervention groups. After adjusting for baseline differences, no differences were revealed in contralesional cortical excitability postintervention. In a secondary analysis, data pooled across both groups revealed small, but statistically significant, improvements in UE behavioral measures. Conclusions. rTMS did not augment changes in UE motor ability in this population of individuals with chronic stroke. The chronicity of our participant cohort and their degree of UE motor impairment may have contributed to inability to produce marked effects using rTMS. 1. Introduction Between 55% and 75% of stroke survivors experience limitations in functional use of the upper extremity at six-months post-stroke [1]. Upper-limb motor recovery post-stroke is of special concern because the impact of UE impairments on disability and health is so marked [2, 3]. The persistence of UE impairments and the resultant inability to use the arm and hand prevents many individuals from returning to work, representing significant socioeconomic impact on the individual, the healthcare systems and society at large. While these problems are well recognized, little progress has been made in demonstrating substantive UE recovery in this population. Repetitive transcranial magnetic stimulation (rTMS) is a form of noninvasive brain stimulation with the capacity to modulate cortical excitability. In health, transcallosal connections create an environment of mutual interhemispheric inhibition [4], critical to normal motor control, and especially relevant to performance of skilled movements. Following stroke, decreased corticospinal excitability in the lesioned hemisphere leads to an asymmetry in this mutual transcallosal inhibition [5, 6]. Decreased
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