PENGARUH RANGE OF MOTION TERHADAP KEKUATAN OTOT PADA PASIEN STROKE ISKEMIK DI RUMAH SAKIT UMUM HKBP BALIGE

Ischemic stroke is a disruption of blood supply to the brain which results in stoppage of blood flow and blood clots that cause atherosclerosis. Ischemic stroke patients can be given training or therapy to help maintain or increase muscle strength with range of motion. Range of motion is usually given during the recovery period or when the patient's condition has improved with a frequency of twice a day in 10-15 minutes. This study aims to determine the effect of range of motion on muscle strength in Balige HKBP General Hospital. This type of research uses one group pretest-posttest and the sample used in this study amounted to 30 people, and the total sampling used in sampling techniques in the population. Data collection was carried out by questionnaire, observation and interview as well as data testing which was carried out using the Wilcoxon test. From the test results obtained a significant effect of 0,000. That is, there are differences in muscle strength before and after given the range of Motion. This proves that Range of Motion affects the increase in respondent's limb muscle strength. The hospital is expected to make an SPO in the handling of rehabilitation of ischemic stroke patients to maintain and increase muscle strength. Abstrak Penyakit stroke iskemik merupakan terganggunya pasokan darah ke otak yang mengakibatkan berhentinya aliran darah dan terjadi pembekuan darah sehingga menyebabkan aterosklerosis. Pasien stroke iskemik dapat diberikan latihan atau terapi untuk membantu mempertahankan atau meningkatkan kekuatan otot yaitu dengan range of motion. Range of motion biasanya diberikan pada masa pemulihan atau pada saat kondisi pasien sudah membaik dengan frekuensi dua kali sehari dalam waktu 10-15 menit. Penelitian ini bertujuan untuk mengetahui adanya pengaruh range of motion terhadap kekuatan otot di RSU HKBP Balige. Jenis penelitian ini menggunakan one group pretest-postest dan sampel yang dipakai dalam penelitian ini berjumlah 30 orang, serta total sampling dipakai dalam teknik pengambilan sampel pada populasi. Pengumpulan data dilakukan dengan kusioner, observasi dan wawancara serta uji data yag dilakukan dengan uji Wilcoxon. Dari hasil uji didapatkan pengaruh yang signifikan sebesar 0.000. Artinya, terdapat perbedaan kekuatan otot sebelum dan sesudah diberikan range of Motion. Hal ini membuktikan bahwa Range of Motion berpengaruh pada peningkatan kekuatan otot ekstremitas responden. Rumah Sakit diharapkan membuat suatu SPO dalam penanganan rehabilitasi pasien stroke iskemik untuk mempertahankan dan meningkatkan kekuatan otot.

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Pengaruh Latihan Range Of Motion (ROM) Menggenggam Bola Terhadap Kekuatan Otot Ekstremitas Atas Pasien Stroke Iskemik

Jurnal Sehat Mandiri ◽

10.33761/jsm.v14i2.151 ◽

2019 ◽

Vol 14 (2) ◽

pp. 79-86

Author(s):

Hendri Budi ◽

Netti Netti ◽

Yossi Suryarinilsih

Keyword(s):

Ischemic Stroke ◽

Muscle Strength ◽

Range Of Motion ◽

Design Research ◽

Nursing Intervention ◽

Wilcoxon Test ◽

Manual Muscle Testing ◽

P Value ◽

Stroke Patients ◽

Muscle Testing

Stroke causes motor hemiparise disorders or weakness. Nursing intervention to overcome this is by doing range of motion (ROM) exercises grasping the ball. The purpose of the study was to identify the effect of ROM-grasping ball exercises on the strength of limb muscles for ischemic stroke patients. Quasi-experimental research type, one group pre-post test design. Research in the Neuro Ward Dr. M. Djamil Padang Hospital. The time of the research is October to December 2017. The intervention is ROM gripping ball exercises, namely rubber balls for 3 days followed by tennis balls for 2 days. Hold the ball firmly for 5 seconds then relax 10 seconds, practice repeated 10 times, frequency 3 times a day. The study population were all stroke patients in the Neuro Ward Dr. M. Djamil Padang Hospital. A sample of 10 people was obtained by purposive sampling that met the inclusion criteria. Data collection by measurement of muscle strength using Manual Muscle Testing (MMT). Data were computerized, analyzed by descriptive statistics and Wilcoxon test. The results of the study showed differences in upper limb muscle strength before and after the ROM exercise held the ball on the patient's shoulder (p value = 0.004), on the elbow of the patient (p value = 0.000), on the patient's hand (p value = 0.000), and on the patient's finger (p value = 0.000). It is recommended to nurses to implement the practice of grasping the ball to increase muscle strength of ischemic stroke patients and make it as a procedure for nursing intervention to patients to muscle strength.

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Effects of Passive Range Of Motion (ROM) Exercise On Increases Muscle Strength in Non-Hemorrhagic Stroke Patients in the Inpatient Room at RSUD Kota Tangerang

Jurnal Ilmiah Keperawatan Indonesia [JIKI] ◽

10.31000/jiki.v3i1.2073 ◽

2020 ◽

Vol 3 (2) ◽

pp. 41

Author(s):

Endah Sri Rahayu ◽

Nuraini Nuraini

Keyword(s):

Muscle Strength ◽

Range Of Motion ◽

Hemorrhagic Stroke ◽

Wilcoxon Test ◽

World Health ◽

P Value ◽

Stroke Patients ◽

Before And After ◽

Quasi Experimental ◽

Health Organization

Stroke is one of the serious health problems in modern life today. According to the World Health Organization (WHO) explained that stroke is the leading cause of death globally. An estimated 17.7 million people die of strokes in 2015 representing 31% of all global deaths. This study aims to determine the effect of Passive Range of Motion (ROM) Exercise on Increasing Muscle Strength in Non-Hemorrhagic Stroke Patients in the Inpatient Room at Rsud Kota Tangerang. Quasi-experimental research design with a sample of 14 people. Univariate and bivariate data analysis using the Wilcoxon test. Samples are measured using Observation Sheets before and after Range Of Motion (ROM) Exercises. This Range Of Motion exercise is carried out for 1 week in 7 days, done 2 times in the morning and afternoon for 15 minutes. Based on the Paired Test, it was found that there was an effect of Passive Range Of Motion (ROM) Exercise on increasing muscle strength in non-hemorrhagic stroke patients with p-value = 0,01 <α 0,05. This proves that passive ROM has an effect on increasing the muscle strength of the respondent. Hospitals should set standard operating procedures for special handling using Passive ROM so that the results obtained can be maximal and uniform for all the problems of the word muscle strength.Keywords: Non-hemorrhagic; stroke; Passive ROM; Muscle Strength

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The influence of nicergoline on cerebral, systemic and cardiac hemodynamics in patients who have had an ischemic stroke

Ageing & Longevity ◽

10.47855/jal9020-2021-1-3 ◽

2021 ◽

pp. 17-26

Author(s):

Viktor Kuznetsov

Keyword(s):

Ischemic Stroke ◽

Recovery Period ◽

Peripheral Resistance ◽

Cerebral Hemodynamics ◽

Stroke Patients ◽

Hemispheric Stroke ◽

Cardiac Hemodynamics ◽

Before And After ◽

Blood Flow Velocities ◽

The Right

The Aim of study was analysis of the effect of nicergoline on the cerebral, cardiac, systemic hemodynamics of patients after ischemic stroke, taking into account the hemispheric localization of the ischemic focus. Materials and methods. A comprehensive clinical and neurological examination was carried out in 38 elderly patients (mean age 64.3 ± 2.5 years) who had undergone atherothrombotic ischemic stroke in the carotid system (recovery period). There were 20 patients with left hemispheric stroke and 18 with right hemispheric stroke. All patients had arterial hypertension (AH). These were ACE inhibitors (enalapril 10-20 mg 1 tablet 2 times a day) and hydrochlorothiazide at a dose of 12.5 mg. Patients received nicergoline at a dose of 4 mg IV drip for 10 days. A comprehensive examination was carried out before and after treatment with nicergoline. The Results of the study allowed us to conclude that the course of nicergoline intake in patients after ischemic atherothrombotic stroke improves the subjective state and reduces the severity of neurological disorders, cerebral hemodynamics, increases linear systolic blood flow velocities (LBFVsys) and reduces peripheral resistance in individual extra- and intracranial vessels of the carotid and vertebro-basilar basins. In patients with right and left hemispheric localization of stroke under the influence of nicergoline, LBFVsys increases in the right and left ICA, PCA, and VA. In addition, LBFVsys increases in patients with right hemispheric stroke in the right MBA; in patients with left hemisphere - in two MBA and BA. In ischemic stroke patients, nicergoline affects systemic and cardiac hemodynamics: it reduces the systemic and cardiac hemodynamics, decreases the systemic vascular resistance and increases the ejection fraction, changes the structure of the relationship between systemic and cerebral hemodynamics, forming a positive relationship between blood pressure and hemodynamics in the vessels of the vertebro-basilar basin. Thus, the complex positive effect of nicergoline on various levels of cerebral, systemic and cardiac hemodynamics in ischemic stroke patients gives grounds to recommend the inclusion of this drug in the rehabilitation system of this category of patients.

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THE EFFECTIVENESS OF THE ACUPUNCTURE REDUCING POINT ON THE IMPROVEMENT OF MUSCULAR STRENGTH OF STROKE PATIENTS

Nurse and Holistic Care ◽

10.33086/nhc.v1i1.2115 ◽

2021 ◽

Vol 1 (1) ◽

pp. 39-47

Author(s):

Dodik Hartono ◽

Deny Prasetyanto ◽

Ainul Yaqin Salam ◽

Erna Handayani ◽

Grido Handoko Sriyono ◽

...

Keyword(s):

Data Analysis ◽

Muscle Strength ◽

Controlled Trial ◽

Statistical Significance ◽

Intervention Group ◽

Wilcoxon Test ◽

Stroke Patients ◽

Significant Difference ◽

Before And After ◽

Acupuncture Meridian

Background: Stroke is a disease caused by disruption of blood flow to areas of the brain that are blocked in the cerebral or cervical arteries which result in decreased or even loss of function controlled by brain tissue. One of the effects caused by stroke is hemiparesis. Rehabilitation therapy plays an important role in a comprehensive restoration of bodily functions due to stroke, this program aims to restore function to reduce disability, one of the treatments is to use acupuncture meridian points. Purpose: The purpose of this study was to determine the effectiveness of acupuncture meridian points in increasing muscle strength in stroke patients. Methods: The research design used in this study was a randomized controlled trial (RCT) design. The number of samples of all stroke patients at the Holistic nursing therapy clinic in Probolinggo and the Healer School Jember Clinic that met the inclusion criteria from October 2020 to March 2021 were 270 respondents. Data collection techniques used observation sheets to assess muscle strength before and after the intervention of acupuncture meridian points in stroke patients. Data analysis used was the Wilcoxon test with a statistical significance value accepted if p <0.05. Results: The results of the data analysis of the intervention group showed a significant value of hand muscle strength (p 0.003; α 0.05) and leg (p 0.005, α 0.05) where (p <0.05) it can be concluded that there is a significant difference in strength. A muscle in the intervention group before and after being given acupuncture. The findings of this study suggest that there is a significant effect of acupuncture on lower and upper muscle strength. Conclusion: In general, the use of acupuncture meridian points can increase muscle strength in stroke patients, so the use of acupuncture meridian points can provide benefits for restoring muscle strength in stroke patients.

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ENGARUH RANGE OF MOTION (ROM) PASIF TERHADAP KEKUATAN OTOT PADA PASIEN STROKE DENGAN PENURUNAN KESADARAN DI RUANG HCU IGD RSUD Dr. MOEWARDI DI SURAKARTA TAHUN 2012

KOSALA : Jurnal Ilmu Kesehatan ◽

10.37831/jik.v3i1.39 ◽

2015 ◽

Vol 3 (1) ◽

Author(s):

Sri Mulyanti

Keyword(s):

Muscle Strength ◽

Range Of Motion ◽

Muscle Power ◽

Clinical Manifestations ◽

Critical Conditions ◽

Power Stroke ◽

Loss Of Consciousness ◽

Treatment Technique ◽

Stroke Patients ◽

Before And After

AbstractIntroduction: Each year, approximately 15 million people worldwide have a stroke. In Indonesia based on the census of population and demography Indonesia (SKDI) in 2010 as many as 3.6 million per year with a prevalence of 8.3 per 1,000 population. Stroke is a neurological disease that appeared suddenly in a short time. One of the clinical manifestations of the most common is hemiparese. Complications hemiparese in muscles and joints is muscle atrophy and joint contractures. One treatment technique to prevent these complications is the Range Of Motion (ROM) passive exercise.Objective: (1) Identify the characteristics of stroke patients with loss of consciousness (2) Identify the muscle power stroke patients with loss of consciousness (3) to analyze the influence Range Of Motion (ROM) of the passive muscle strength in stroke patients with loss of consciousness. Method: This research is quasy experiment with design one-group pretestposttest design. The population in this study were 13 stroke patients with critical conditions in Space High Care Unit Hospital Dr Moewardi in Surakarta. Samples were taken by sampling saturated. Data were analyzed with the Wilcoxon or Z test using SPSS for windows 16 series.Result: (1) The muscle strength before passive ROM was 11 people (68.8%) is trace, 5 people (31.2%) is poor, and of zero muscle strength, fair, good, and normally does not exist. (2) Muscle strength stroke after passive ROM is 7 (43.8%) of respondents with poor muscle strength scale, 9 people (56.2%) fair, and scale of zero muscle strength, trace, good, and normally there is not exist(0%). (3) The results of the statistical Wilcoxon or Z test significance value (p) of 0000 which means that there are differences in muscle strength scale before and after passive Range Of Motion. (ROM) patients with loss of consciousness. Conclusion: Range Of Motion (ROM) is effective for improving muscle strength for stroke patients with loss of consciousness in H ospital Dr Moewardi Surakarta Keywords: Stroke, Hemiparese, Range Of Motion

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PENGARUH ROM (Range of Motion) TERHADAP KEKUATAN OTOT EKSTREMITAS PADA PASIEN STROKE NON HEMORAGIC

Jurnal Riset Hesti Medan Akper Kesdam I/BB Medan ◽

10.34008/jurhesti.v3i2.46 ◽

2018 ◽

Vol 3 (2) ◽

pp. 64

Author(s):

Anggriani Anggriani ◽

Zulkarnain Zulkarnain ◽

Sulaiman Sulaiman ◽

Roni Gunawan

Keyword(s):

Muscle Strength ◽

Range Of Motion ◽

Brain Dysfunction ◽

Clinical Syndrome ◽

Wilcoxon Test ◽

World Health ◽

Limb Muscle ◽

Before And After ◽

Hand Muscle ◽

Leg Muscle

Stroke is one of the serious health problems in modern life today. The prevalence of stroke increases with age. The World Health Organization (WHO) stipulates that stroke is a clinical syndrome with symptoms of global brain dysfunction that can cause death or abnormalities to persist for more than 24 hours, without other causes except vascular disorders which can cause a person's reduced mobility due to muscle strength downhill. This study aims to determine the effect of ROM (range of motion) on limb muscle strength in non-Hemaoragic stroke patients at H. Adam Malik General Hospital, Medan. Quasi-experimental research design with a sample of 90 people. Univariate and bivariate data analysis using the Wilcoxon test. The significance of hand muscle strength before and after administration of ROM is 0,000. This means that there are differences in hand muscle strength before and after administration of ROM. The significance of leg muscle strength before and after administration of ROM is 0,000. This means that there are differences in leg muscle strength before and after administration of ROM. This proves that ROM influences the strength of the respondent's hand and leg muscles. Hospitals should set standard operating procedures for special handling of ROM so that the results obtained can be maximal and uniform for all muscle strength problemsKeywords: ROM, limb muscle strength, hands, feet

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The effectiveness of discharge planning and range of motion (ROM) training in increasing muscle strength of nonhemorrhagic stroke patients

GHMJ (Global Health Management Journal) ◽

10.35898/ghmj-23271 ◽

2018 ◽

Vol 2 (3) ◽

pp. 57

Author(s):

Mohamat Iskandar

Keyword(s):

Muscle Strength ◽

Range Of Motion ◽

Rating Scale ◽

Discharge Planning ◽

Intervention Group ◽

Sampling Technique ◽

Control Group ◽

Planning Program ◽

Stroke Patients ◽

Central Java

Background: Non-hemorrhagic stroke patients experience hemiparesis, an improper handling results in joint contractures. Discharge planning combined with a range of motion (ROM) training given to patients and their families are expected to improve muscle strength in patients after returning from the hospital. Aims: This study is to identify the effectiveness of discharge planning in increasing muscle strength. Methods: This is a quasi-experimental study with a pre-posttest design. A total of 34 respondents were selected by cluster random sampling technique, from RAA Soewondo Pati General Hospital of Pati, Central Java, Indonesia. The respondents were divided equally into two groups; an intervention group (N = 17) was given a discharge planning program together with stroke information and range of motion (ROM) training while the control group (N = 17) received a standard discharge planning available in the hospital. Further, Muscle Rating Scale (MRS) was employed to assess the muscle strength on the 2nd, 7th, and 14th day after discharge planning presented to the nonhemorrhagic stroke patients. Results: This present study clearly acknowledges the standard discharge planning program available in the hospital improve the muscle strength of the upper and lower extremity in the nonhemorrhagic stroke patients just 2nd day after the care (pretest), and the significant improvement was observed until the day 14. Moreover, combining the care with ROM training at the intervention group faster the recovery and the muscle strength improved significantly at the 7th day and continue increase at the day 14. Looking to the muscle strength since the 2nd day to the day 14, respectively the muscle strength of upper and lower limb at the control group improved at the point of 0.588 and 0.882, while at the group received the ROM training reached the value of 1.472 and 1.412. Conclusions: The ROM training combined to the current discharge planning program will faster the muscle strength recovery of the nonhemorrhagic stroke patients. This research provide insight how family plays important role to the success in monitoring the rehabilitation and recovery progress.

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Abstract P850: Four C’s Are Vital in Improving Door to Thrombolytic Administration

Stroke ◽

10.1161/str.52.suppl_1.p850 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Betty A McGee ◽

Melissa Stephenson

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Median Time ◽

Survival Data ◽

Stroke Patients ◽

Eligibility Criteria ◽

Before And After ◽

Administration Time ◽

System Data ◽

The Impact

Background and Purpose: Thrombolytic therapy is a key link in the stroke chain of survival. Data suggests that four components are vital in decreasing door to thrombolytic administration in acute stroke patients eligible for treatment. Analysis of system data, pre and post implementation of a Door to Needle Project, afforded the opportunity to assess. Hypothesis: We assessed the hypothesis that commitment, collaboration, communication, and consistency (referred to as Four C’s) are vital in improving door to thrombolytic administration time in ischemic stroke patients. Methods: In this quantitative study, we utilized case data collected by a quality improvement team serving five emergency departments within a healthcare system. We retrospectively reviewed times of thrombolytic administration from admission to the emergency department in acute ischemic stroke patients. Cases were included based on eligibility criteria from American Heart Association’s Get With the Guidelines. Times from 2019 were compared with times through April 2020, before and after implementation of the project, which had multidisciplinary process interventions that reinforced the Four C’s. Results: The data revealed a 13.5 % reduction in median administration time. Cases assessed from 2019 had a median time of 52 minutes from door to thrombolytic administration, 95% CI [47.0, 59.0], n = 52. Cases assessed through April 2020 had a median time of 45 minutes from door to thrombolytic administration, 95% CI [39.0, 57.5], n = 18. Comparing cases through April 2020 to those of 2019, there were improvements of 38.1% fewer cases for administration in greater than 60 minutes and 27.8% fewer cases for administration in greater than 45 minutes. Conclusion: The hypothesis that Four C’s are vital in improving door to thrombolytic administration was validated by a decrease in median administration time as well as a reduction in cases exceeding targeted administration times. The impact to clinical outcomes is significant as improving administration time directly impacts the amount of tissue saved. Ongoing initiatives encompassing the Four C’s, within a Cerebrovascular System of Care, are essential in optimizing outcomes in acute stroke patients.

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Abstract TP24: Trends in Iv r-tpa and Thrombectomy Treatment Rates Before and After the LVO RCT’s in a Regional Tele-stroke Network

Stroke ◽

10.1161/str.48.suppl_1.tp24 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Naregnia Pierre Louis ◽

Suman Nalluri ◽

Benny Kim ◽

Aashish Anand ◽

Tanzila Shams ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Statistical Test ◽

Stroke Therapy ◽

Stroke Patients ◽

Chi Square ◽

The Third ◽

Before And After ◽

Acute Stroke Therapy

The presentation of endovascular stroke trials at international stroke conference was a land mark event in acute stroke therapy. This study aims to analyze the rates of utilization of IV r-tPA, with or without mechanical thrombectomy before and after the 2015 International Stroke Conference (ISC) in a large regional tele-stroke network. Methods: A systematic review of prospective telestroke and procedure database was performed for 18 months prior and 18 months post conference. There were three groups included in the analysis. The first group consisted ischemic stroke patients presented within 12 hours of onset including inpatient events, transfers from primary centers and rural clinics. The second group consisted of patients who received IV r-tPA, and the third group consisted of patients who received IV r-tPA and/or underwent mechanical thrombectomy for a demonstrated LVO. Results: A total of 2628 consecutive ischemic stroke events presented within 12 hours of onset were evaluated. In the pre-ISC conference group, there were 1135 ischemic stroke patients. IV r-tPA was given 535 times(47.1%) and mechanical thrombectomy was utilized in addition to IV r-tPA or alone 42 times(3.7%). In the post-ISC conference group, there were 1493 ischemic stroke patients. IV r-tPA was given 642 times(43%) and mechanical thrombectomy was utilized in addition to IV r-tPA or alone 132 times(8.84%). The Chi Square statistical test was performed comparing these groups. When comparing the rate of IV r-tPA usage, there was a significant decrease from the pre-ISC conference group to the post-ISC conference group (P= 0.04). When comparing the rate of mechanical thrombectomy performed, there was a significant increase of greater than double the percentage of thrombectomy procedures performed in the post conference group compared to the preconference group (p< 0.001). Conclusion: There was a significant decrease in IV r-tPA usage but a greater than double the increase in the thrombectomy rate . This may be secondary to increased awareness of benefit of thrombectomy at referral centers. Slightly lower rates of IV r-tPA usage may be secondary to an increase in transfers of patients outside of the 0-4.5 hr window but were deemed candidates for thrombectomy.

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Combining inhibitory and facilitatory repetitive transcranial magnetic stimulation (rTMS) treatment improves motor function by modulating GABA in acute ischemic stroke patients

Restorative Neurology and Neuroscience ◽

10.3233/rnn-211195 ◽

2021 ◽

pp. 1-16

Author(s):

Qing-Mei Chen ◽

Fei-Rong Yao ◽

Hai-Wei Sun ◽

Zhi-Guo Chen ◽

Jun Ke ◽

...

Keyword(s):

Ischemic Stroke ◽

Treatment Group ◽

Motor Function ◽

Magnetic Stimulation ◽

Sham Group ◽

Repetitive Transcranial Magnetic Stimulation ◽

Motor Dysfunction ◽

Gaba Level ◽

Stroke Patients ◽

Before And After

Background: The combination of inhibitory and facilitatory repetitive transcranial magnetic stimulation (rTMS) can improve motor function of stroke patients with undefined mechanism. It has been demonstrated that rTMS exhibits a neuro-modulatory effect by regulating the major inhibitory neurotransmitter γ-aminobutyric acid (GABA) in other diseases. Objectives: To evaluate the effect of combined inhibitory and facilitatory rTMS on GABA in the primary motor cortex (M1) for treating motor dysfunction after acute ischemic stroke. Methods: 44 ischemic stroke patients with motor dysfunction were randomly divided into two groups. The treatment group was stimulated with 10 Hz rTMS at the ipsilesional M1 and 1 Hz rTMS at the contralesional M1. The sham group received bilateral sham stimulation at the motor cortices. The GABA level in the bilateral M1 was measured by proton magnetic resonance spectroscopy (1H-MRS) at 24 hours before and after rTMS stimulation. Motor function was measured using the Fugl-Meyer Assessment (FMA). The clinical assessments were performed before and after rTMS and after 3 months. Results: The treatment group exhibited a greater improvement in motor function 24 hours after rTMS compared to the sham group. The increased improvement in motor function lasted for at least 3 months after treatment. Following 4 weeks of rTMS, the GABA level in the ipsilesional M1 of the treatment group was significantly decreased compared to the sham group. Furthermore, the change of FMA score for motor function was negatively correlated to the change of the GABA:Cr ratio. Finally, the effect of rTMS on motor function outcome was partially mediated by GABA level change in response to the treatment (27.7%). Conclusions: Combining inhibitory and facilitatory rTMS can decrease the GABA level in M1, which is correlated to the improvement of motor function. Thus, the GABA level in M1 may be a potential biomarker for treatment strategy decisions regarding rTMS neuromodulatory interventions.

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