Abstract Objective: To investigate the effects of acupuncture combined with repetitive transcranial magnetic stimulation (rTMS) on hand function impairment in patients with middle and late stage recovery from cerebral infarction. 

Methods: A total of 60 patients with hand function impairment in the middle and late stages of recovery from cerebral infarction (4 weeks to 6 months post-onset) are randomly assigned to three groups: the rTMS group, the acupuncture group, and the combined group, with 20 patients in each group.The acupuncture group received acupuncture treatment in addition to conventional drug therapy and routine basic treatment; the rTMS group received magnetic stimulation of the primary motor cortex (M1 area) of the contralateral cerebral hemisphere on the basis of conventional drug therapy and routine basic treatment; the combined group received the same acupuncture treatment as the acupuncture group first, and then the same rTMS treatment as the rTMS group on the basis of conventional drug therapy and routine basic treatment.The treatment effects were evaluated using the Fugl-Meyer hand motor function assessment, Modified Barthel Index, Modified Ashworth Scale for wrist flexor muscles, and surface electromyography before and after treatment. 

Results: After 3 weeks of treatment, both the Modified Barthel Index and the hand motor function subscale scores of the simplified Fugl-Meyer Assessment significantly increased compared to those before treatment (P<0.05), with the combined group showing significantly greater improvement than both the acupuncture and rTMS groups (P<0.05). The Modified Ashworth Scale grades significantly decreased in all three 2groups compared to pre-treatment levels (P<0.05), and the reduction was significantly greater in the combined group than in either the acupuncture or rTMS groups (P<0.05). The root mean square (RMS) value of active thumb abduction was significantly higher after treatment in all three groups (P<0.05), and the combined group demonstrated a significantly greater increase than both the acupuncture and rTMS groups (P<0.05). 

Conclusion: The combination of acupuncture and rTMS therapy can significantly improve hand function impairment in patients with middle and late stage recovery from cerebral infarction, and the therapeutic effect is superior to that of either acupuncture or rTMS alone.