Inclusion criteria: hemiplegia in dominant and spastic hand; at least 2 months after stroke; modified ashword scale 2-3; men and women with stroke in the age range 30-65; normal vision in perimetry test; MMSE score above10 and NIHSS score 7-15; range of motion in wrist and elbow
Exclusion criteria: stroke origin heart emboli; heart pace maker and arrhythmia; fracture in upper limb; neurologic diseases such as Parkinson disease, Multiple Sclerosis and epilepsy; implant in skull; problem in occipital, limbic system and complementary area and unable to accompany for 4 weeks
Purpose: Recent studies have shown effects of rTMS 1 Hz and joy stick on improve hand function of patients with stroke. The aim of this study is compare of the effect of combination of rTMS and joy stick simultaneously on the wrist and elbow joints movements and compare the results with use of magnetic stimulation, tracking exercise with joy stick and routine physical therapy.
Design: Not blinded.
Methods: Patients will be randomly divided into 4 groups and receive 10 sessions 70 minutes treatment, 4 sessions per week.
Participants: Men and women with stroke in the age range 30-65, at least 2 months after stroke, with no cardiac source of embolism, heart pace maker and arrhythmia, Epilepsy and implant in skull.
Interventions: 4 treatment groups consist of minutes routine rehabilitation(upper limb exercise therapy), treatment with rTMS 1 Hz, treatment with joy stick and treatment with combination of rTMS and joy stick, will treated for 10 sessions 70 minutes treatment, 4 sessions per week.
Variables: Improvement of involved hand function, grip force, range of motion, spasticity, accuracy, time and distance of test will measured.