Upper-Limb Motor Recovery in the Late Subacute Phase After Stroke: A Single-Case Experimental Study of Robot-Assisted Therapy, rTMS, and Intensive Training for Upper-Limb Rehabilitation in the First Year After Stroke Using Modern Treatment Strategies

Objective: This study aimed to determine whether robot-assisted therapy, low-frequency rTMS, or intensive therapist-guided upper-limb training provides additional recovery beyond self-directed training in individuals 4–9 months post-stroke. Design: A five-phase single-case experimental study was conducted with two baseline phases and three randomized 3-week intervention phases. Subjects/Patients: Sixteen adults with moderate-to-severe upper-limb motor impairment in the late subacute phase after stroke (4–9 months post-stroke) were included. Methods: Participants completed intensive task-oriented training, low-frequency rTMS, and robot-assisted therapy in a randomized order. Primary outcomes were Fugl–Meyer Assessment for the Upper Extremity (FMA-UE), active range of motion, and muscle strength. Secondary outcomes included EQ-5D and WHODAS 2.0. Results: FMA-UE motor scores improved significantly over the study period (8–10 points). However, comparable gains occurred during baseline phases. rTMS and intensive training produced within-phase improvements, whereas robotic therapy did not. Participants with higher initial FMA-UE scores improved, while those with severe paresis showed minimal benefit and occasional decline during rTMS. Disability and quality-of-life measures remained stable. Gains were maintained at 1-year follow-up. Conclusions: In the late subacute phase after stroke, modest upper-limb motor improvements occurred, but effects were not clearly attributable to specific interventions beyond ongoing recovery. Treatment response depended strongly on baseline motor severity, with limited benefit in severe paresis.