Upper limb motor dysfunction is a common sequela of stroke that severely impairs patients' ability for self-care, making it a primary focus and key challenge in the rehabilitation process.

To investigate the efficacy of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with transcutaneous electrical acupoint stimulation (TEAS) in treating upper limb motor impairment after stroke.

Seventy post-stroke patients admitted to Zhejiang Rehabilitation Medical Center from June 2024 to October 2025 were enrolled in this study. They were randomly assigned to three groups using a random number table: control group (n=24), rTMS group (n=23), and a combined group (n=23). The control group received routine rehabilitation training, the rTMS group received low-frequency rTMS alongside with routine training, the combined group received both low-frequency rTMS and TEAS (TEAS administered 10 minutes after rTMS) alongside routine training. All three groups underwent continuous treatment for 8 weeks. The Fugl-Meyer Assessment-upper Extremities (FMA-UE) scores, Modified Barthel Index (MBI) scores, latency and amplitude of transcranial magnetic motor-evoked potentials (TMS-MEP), as well as co-contraction rate (CR) and root mean square (RMS) of the biceps brachii were collected and compared before and after treatment.

After treatment, FMA-UE and MBI scores in all three groups were significantly increased compared with baseline values (P<0.05); Post-hoc pairwise comparisons showed that the rTMS group had higher FMA-UE and MBI scores than the control group, the combined group had higher FMA-UE scores than both the control and rTMS groups and higher MBI scores than the control group (P<0.05). Additionally, TMS-MEP latency and amplitude were improved in all three groups after treatment (P<0.05); Post-hoc pairwise comparisons showed that the combined group had shorter latency than the control group and higher amplitude than both the control and rTMS groups (P<0.05). For all three groups, the CR and RMS of the biceps brachii were significantly improved after treatment (P<0.05); Post-hoc pairwise comparisons showed that, the rTMS group had lower RMS than the control group, while the combined group demonstrated lower CR and RMS than both the control and rTMS groups (P<0.05).

The combination of rTMS and TEAS exerts a favorable therapeutic effect on upper limb motor function recovery in post-stroke patients, as it significantly enhances upper limb motor function, corrects abnormal movement patterns, regulates muscle tone, and improves activities of daily living. Its potential therapeutic mechanism may be related to the improvement of neurological function in the affected area.