TMSReal-time Personalized Brain State-dependent TMS After Stroke

-Presence of residual upper extremity hemiparesis, defined as any of the following: Fugl Meyer Upper Extremity Score <66, Wolf Motor Function Test Score <70, Affected hand performance on the 9-Hole Peg Test >= 10% worse than unaffected hand, Affected hand pinch, key, or power grip performance >= 10% worse than unaffected hand,

• Occurrence of ischemic or hemorrhagic stroke >= 6 months before participation
• Mini Mental State Exam score > 24
• Willingness and ability to provide informed consent
• No history of neurological disease and/or neurological injury other than stroke
• No TMS contraindications, including but not limited to:

Cardiac pacemaker, Cochlear implant, Cortical stimulator, Deep brain stimulator, Vagus nerve stimulator, Cervical spine epidural stimulation, Ventriculoperitoneal shunt, Ferromagnetic metallic implants above the level of the seventh cervical vertebra, Seizure in the last 12 months while taking anti-epilepsy medication, History of adverse reactions to TMS or peripheral nerve stimulation, Current, suspected, or planned pregnancy, Any recent changes (within the last month) to medication use

\- Presence of residual corticospinal connections innervating an affected upper extremity muscle following stimulation of the lesioned hemisphere (i.e., MEP+), evaluated at rest