Clinical outcomes of rTMS-augmented rehabilitation for post-stroke language and swallowing dysfunction: a sham-controlled prospective study with theory-informed interpretation

Background: Post-stroke language impairment and dysphagia frequently co-occur and can substantially hinder recovery, daily communication, and safe oral intake. Repetitive transcranial magnetic stimulation (rTMS) has been proposed as an adjunct to conventional rehabilitation, yet evidence on coordinated improvement across both domains remains limited, particularly in studies using clinically interpretable outcome measures. Methods: In this sham-controlled prospective study, 113 patients with post-stroke communication and swallowing impairment were enrolled and allocated to either active rTMS combined with conventional rehabilitation or sham stimulation plus the same rehabilitation program. The intervention lasted 2 weeks, with follow-up assessment after treatment completion. Clinical outcomes were evaluated at baseline, immediately after the intervention, and at follow-up using established measures of language performance, swallowing safety, and oral intake. Safety events and selected care-related indicators were also documented. Because no neurophysiological or neuroimaging markers were collected, mechanistic interpretation was limited to theory-informed inference based on observed clinical patterns. Results: Both groups improved over time. Compared with sham stimulation plus rehabilitation, the active rTMS group showed greater improvement in language-related and swallowing-related outcomes and maintained a more favorable recovery profile at follow-up. Directionally similar trends were observed across secondary clinical indicators, and no increase in safety risk was identified during the study period. Conclusions: rTMS administered before task-oriented rehabilitation was associated with improved short-term recovery in post-stroke language and swallowing function, with acceptable tolerability. These findings support further investigation of rTMS as an adjunct to multidisciplinary neurorehabilitation. Future randomized studies with longer follow-up and direct neurophysiological measures are needed to clarify mechanisms, durability of benefit, and patient-level heterogeneity in treatment response.