rTMS Treatment of Spasticity in Children With Cerebral Palsy/ Hemiplegia Due to ABI - a RCT

This RCT aims to investigate the effect of repetitive transcranial magnatic stimulation (rTMS) in treating children with hemiplegoc cerebral palsy. The study will measure any improvement in spasticity after using contra-lesional inhibitory rTMS follow by intensive limb training. Participants will attend a 10-day rTMS treatment sessions, follow by intensive training of the impaired limb. They will also undergo MRI scans before and after the treatment to investiagte the underlying neurophysiological mechanisms that lead to changes clinically by using TMS as well as MR-DKI. Researchers will compare the intervention group and the sham group to see if rTMS could result in improvement of participants' spasticity.

Inclusion Criteria: * Patients aged between 4 years and 18 years * Diagnosis of hemiplegia * Upper limb spasticity ≥ 1 * IQ ≥ 50 Exclusion Criteria: * Any contra-indications to rTMS * Severe spasticity (score of 4 or more in Ashworth scale) * Uncontrollable epilepsy * History of Botulinum toxin A injection in previous 6 months * Upper limb casting in previous 6 months