Intermittent Theta-Burst Stimulation

iTBS is expected to improve motor function more than sham stimulation when both are combined with exercise therapy. The protocol uses 3600 iTBS pulses per day divided into two sessions separated by at least 50 minutes. Each active iTBS session delivers 600 pulses at 80% of active motor threshold over 192 seconds. The active iTBS protocol targets the contralateral primary motor cortex corresponding to the affected limb. Conventional iTBS doses of 600 to 1600 pulses per day have produced only modest efficacy for PSCI in prior studies. Repetitive transcranial magnetic stimulation is a non-invasive neuromodulation technique that modulates cortical neural activity and promotes neuroplasticity. Intermittent theta burst stimulation is a rapid rTMS subtype intended to mimic theta rhythms and induce long-term potentiation more quickly than standard rTMS. iTBS is designed to produce long-term potentiation-like effects over a short stimulation period. The trial evaluates whether iTBS combined with exercise therapy improves rehabilitation outcomes in chronic postoperative ankle injury.