Clinical Research Directory

Inclusion Criteria: * Diagnosis of stroke (ischemic or hemorrhagic) * Time since stroke onset between 3 and 24 months * Age between 18 and 80 years * Upper extremity motor recovery at Brunnstrom Stages 3-5 * Spasticity in the elbow, wrist, or finger flexor muscle groups of the upper extremity with a Modified Ashworth Scale (MAS) score between +1 and 3 * Receipt of botulinum toxin-A injection to the affected upper extremity within the previous week Exclusion Criteria: * History of epileptic seizures, epileptiform EEG findings, increased seizure risk, or use of antiepileptic medication * Presence of implanted metallic or electronic devices (e.g., cardiac pacemaker, intrathecal baclofen pump) * Pregnancy or lactation * Presence of neurological disorders other than stroke * History of cranial surgery * Orthopedic conditions or previous orthopedic surgery limiting upper extremity movement * Severe upper extremity spasticity (MAS \>3) or presence of contracture * Uncontrolled hypertension, advanced heart failure (NYHA Class III-IV), chronic obstructive pulmonary disease (COPD), active infection, severe hepatic failure, or severe renal failure * History of malignancy * Severe cognitive impairment (Mini-Mental State Examination score \<24) * Severe aphasia or communication disorder that would interfere with participation in the study * Botulinum toxin injection administered to the upper extremity in a separate treatment session within the previous 3 months * Any change in medication type or dosage within the previous month for oral medications used in the management of spasticity