Cortical reorganization post stroke has great impact on upper extremity motor recovery. PURPOSE: to investigate the effect of low frequency repetitive transcranial magnetic stimulation (LF-rTMS) on cortical excitability and upper limb motor performance post stroke. Forty ischemic stroke patients aged between 50 to 65 years were randomly assigned into two groups (A and B). Both groups were treated with a selected physical therapy program for the upper limb but only group B received contralesional (LF-rTMS) sessions, daily for two consecutive weeks in addition. Cortical excitability, upper limb motor performance and grip strength were measured and compared for both groups before and after intervention using single pulse TMS to measure contra-and ipsilateral active motor threshold (cAMT, iAMT), Fugl-Myer Assessment Upper Extremity scale (FMA-UE), and hand grip dynamometer for grip strength, respectively. There was significant difference in the post treatment findings of all measured variables between both groups in favour of group B (p =< 0.05). The correlation results revealed significant linear correlation between the tested cortical excitability measures (cAMT, iAMT and iAMT/cAMT difference) and the findings of upper limb motor performance (FMA-UE). The study revealed that 10 contralesional LF-rTMS sessions improved the upper limb functional performance via enhancing cortical reorganization post stroke. Cortical excitability measures as (cAMT, iAMT and iAMT/cAMT difference) could act as an accurate predictor regarding the level of upper limb motor recovery in stroke patients.

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