Synergistic Effects of 1 Hz Low Frequency rTMS Priming and Familiar Place Based Visual Cues During Robot Assisted Gait Training in Patients after Stroke: Two Case Reports

This study investigated the effects of a multimodal intervention on spatiotemporal gait parameters and mobility outcomes in patients with subacute stroke. Using a three-phase, single-case design, two participants (6–12 months after onset) received robot-assisted gait training with Angel Legs M20 and 1 Hz low frequency repetitive transcranial magnetic stimulation to the contralesional primary motor cortex as a priming procedure, with Participant 2 additionally receiving familiar place-based visual cues. Cadence, gait speed, and step length were assessed alongside the Berg Balance Scale, Timed Up and Go test, and Functional Ambulation Category. Incorporation of familiar place-based visual cues was associated with improved cadence (42.33 ± 0.58 to 65.00 ± 0.00 steps/min; Δ = +53.5%) and gait speed (0.353 ± 0.006 to 0.540 ± 0.000 m/s; Δ = +52.9%), without altering the step length (Δ = −0.6%). These enhancements were accompanied by modest but clinically meaningful improvements in balance and functional mobility. These findings support further research into its applicability for community ambulation.