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Stroke has a major impact in the total cost of healthcare in the Western  world as stroke is the most common cause of long-term disability [1]. In  attempts to enhance motor recovery after stroke effective treatment  strategies have been developed in recent years. Appropriate evaluation of the  intervention programs requires comprehensive and accurate assessment of the  residual abnormal function. In the present study we compare two well-known  clinical functional scoring tests developed for the assessment of hemiparetic  upper limb function due to stroke and navigated transcranial magnetic  stimulation (nTMS), which measures involuntary target muscle response to  cortical stimulation. The aim is to investigate the equivalence of these  methods and thus add objective evidence of the limb function to strengthen  evidence-based practice. In addition to functional tests, four muscles of  both arms were studied in twenty chronic stroke patients. Those patients  without motor evoked potentials (MEP) to nTMS in the affected upper limb had  significantly lower total score in Action Research Arm Test and Wolf Motor  Function Test and longer performance time than those patients with MEP.  Patients, in whom MEP in each of the four target muscles was elicitable, had  better than average scores in clinical functional tests while patients, in  whom no MEP was elicitable in any target muscle, had worse than average  scores. Transcranial magnetic stimulation adds crucial information when  clinical assessment based on voluntary activation by command is challenging,  e.g. in patients suffering from cognitive deficits

Comparison of TMS-induced arm activation and upper limb functional tests in hemiparetic stroke