Abstract： Objective:To explore the influence of repetitive transcranial magnetic stimulation(rTMS)combined with graded motor imagery training on motor function and neurological function in patients with hemiplegia after cerebral infarction.Methods:This study was a prospective randomized controlled study, a total of 164 patients were admitted to the department of Neurology and transferred to the department of Rehabilitation Medicine of Xuzhou No.1 People′s Hospital from February 2023 to February 2024, including 79 males and 85 females, aged(57.41±7.79)years old, ranging from 48 to 73 years old.The patients were divided into control group, rTMS group, graded motor imagery group and combined group by random envelope method, with 41 cases in each group.The control group received routine medical treatment and rehabilitation, the rTMS group was given rTMS treatment, the graded motor imagery group adopted graded motor imagery training, and combined group underwent rTMS combined with graded motor imagery training.The motor function of upper and lower limbs, walking function, balance function, activities of daily living, neurological function, cerebral blood flow perfusion status and occurrence of adverse reactions were evaluated in the 4 groups.Results:At 4 weeks after treatment, the upper limb Fugl-Meyer motor assessment(FMA), lower limb FMA, performance-oriented assessment of sensorimotor skills score, Barthel index and apparent diffusion coeffcient value were(57.94±4.71)points, (28.02±2.33)points, (28.21±2.39)points, (73.92±7.16)points and(643.45±65.04)×10 -6mm 2/s in combined group; there were(55.23±4.77)points, (26.33±2.61)points, (26.14±2.61)points, (65.01±6.41)points and(614.01±61.33)×10 -6mm 2/s in rTMS group; there were(54.52±4.86)points, (25.45±2.01)points, (25.36±3.35)points, (63.68±6.33)points, (597.91±70.12)×10 -6mm 2/s in graded motor imagery group, and the above indicators in the 3 groups were higher than(52.41±4.03)points, (23.89±3.94)points, (23.15±3.24)points, (60.32±7.21)points and(562.36±55.02)×10 -6mm 2/s in control group, the differences were statistically significant( P<0.05).The time up and go test was(17.68±3.01)s in combined group, that in rTMS group was(20.06±3.61)s and that in graded motor imagery group was(21.24±3.34)s, the above indicators in the 3 groups were shorter than(23.14±3.15)s in control group, the difference were statistically significant( P<0.05).The 6-minute walk test in combined group was(206.54±20.61)m, that in rTMS group was(189.24±16.64)m and that in graded motor imagery group was(182.35±17.99)m, the above indicators in the 3 groups were longer than(174.36±15.33)m in control group, the differences were statistically significant( P<0.05).The National Institutes of Health stoke scale in combined group was(8.27±1.79)points, that in rTMS group was(9.65±2.16)points and that in graded motor imagery group was(10.05±2.25)points, the above indicators in the 3 groups were lower than(11.36±2.88)points in control group, the differences were statistically significant( P<0.05). Conclusions:rTMS combined with graded motor imagery training can not only improve the motor function and daily activity ability of patients, but also improve cerebral blood perfusion and promote the recovery of neurological function of patients.