To investigate the changes in upper limb spasm and motor function of patients with stroke after low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with occupational therapy (OT.) Methods: Forty-seven patients with upper limb hemiplegia after stroke were recruited to the study. Patients were divided according to the Brunnstrom stages into the stage 3 group (12 patients), stage 4 group (15 patients), and stage 5 group (20 patients) then treated with rTMS combined with OT for 15 days. The affected upper limb spasm and motor function were evaluated prior to and after treatment as well as during the 30-day follow-up. Results: The MAS score and WMFT score for all patients post-treatment and during the 30 day follow-up were significantly decreased (P<0.01), and the FMA score was significantly improved (P<0.01); this was especially apparent in the stage 4 group. At the same time, it was found that patients with improvement to hemiplegia upper limb spasticity improved upper limb motor function significantly more than those without improvement to spasticity. Conclusion: Patients with upper limb hemiplegia after stroke who have been treated with low-frequency rTMS combined with OT for 15 days can significantly improve hemiplegia and motor function in the upper limbs, with patients in Brunnstrom hemiplegia stage 4 experiencing the most benefit. Moreover, improving the spastic symptoms of the damaged upper limb helps to improve its motor function.