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Introduction
Stroke is the 1st leading cause of death in Indonesia (15,4%). In 2007, prevalence of Stroke was 8.2
per 1000 population on 33 provinces in Indonesia (Indonesia Basic Health Research 2007). Stroke
accounted for 99/100 000 agegenderstandardized death rate and 685/100 000 agegenderstandardized
disabilityadjusted life years lost (Karyana et al. 2014, Kusuma et al. 2009). Thus, further investigation
into treatments to decrease the number of post stroke disability are critical to undertake.
Stroke is defined by the World Health Organization as a clinical syndrome consisting of rapidly
developing clinical signs of focal (or global in case of coma) disturbance of cerebral function lasting more
than 24 hours or leading to death with no apparent cause other than a vascular origin (Hatano, 1976).
Classification based on the TOAST system identifies the mechanism that leads to five categories: (1)
Largeartery atherosclerosis, (2) Cardioembolism (3) Smallartery occlusion (lacune) (4) Acute stroke of
other determined etiology (5) Stroke of undetermined etiology (Harold et al. 1993)
Approximately two thirds of stroke survivors have residual neurological deficits that impair
function and approximately 50% are left with disabilities making them dependent on others for activities
of daily living (Greshan GE et al. 1975). Previous studies have found that among the more common are
physical impairments in upper limb use and in functional walking. Upper limb dysfunction remains an
important hurdle for many stroke survivors. Only 5% of adult stroke survivors regain full function of the
upper limb and 20% regain no functional use. In addition, the other common concern for poststroke
patients is whether they would regain independent walking (Duncan P et al, 1198).
Advances have occurred in the prevention and treatment of stroke during the past decade. One of
the current methods to treat post stroke disability is TMS. Transcranial magnetic stimulation (TMS) is a
noninvasive method by which weak electrical currents are induced in the brain by a rapidly changing
magnetic field. The magnetic field passes through the skull, inducing mild electric currents in the brain,
which excite and depolarize neurons in the brain (Almaraz et al. 2010). TMS has shown promising results
in improving gait, a major cause of disability, and may provide a therapeutic alternative.
As it is a relatively new form of treatment, there are less data on the side effect or longterm
efficacy. Some studies had addressed the efficacy of TMS for the treatment of motoric impairment of
poststroke patients (Table 1).
This study attempts to assess the efficacy of TMS intervention on improving motoric function of
poststroke patients. In particular, we measured the patients’ motoric impairment using the European
Stroke Scale and compare the result before and after receiving TMS intervention.
Table 1: TMS studies as a treatment for stroke patient Table 1: TMS studies as a treatment for
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