trns & FESA Novel Multimodal Approach to Promote Motor Recovery and Plasticity After Stroke

Inclusion Criteria:

Female and male subjects are eligible for inclusion only if all of the following criteria are met:

1. Age between 40-85 years
2. Diagnosis of first-ever subcortical stroke (single cerebrovascular accident)
3. Stroke onset of at least six months prior to the time of participation
4. Limited functional wrist and finger flexion and extension, as indicated between 5º-20º active movement
5. Cognitive skills to actively participate, as indicated by scores of ≥ 24 on the Mini-Mental Status Examina-tion
6. English speaking

Exclusion Criteria:

A subject is not eligible for inclusion if any of the following criteria apply:

1. Presence of severe aphasia preventing the ability to follow 1-step directions at least 80% of the time
2. Excessive spasticity of the wrist and finger muscles, defined as a Modified Ashworth Score >2
3. Diagnosis of neurological disorders other than stroke
4. History of recent seizure or epilepsy while taking anticonvulsants
5. Orthopedic/musculoskeletal conditions (e.g., arthritis) affecting the upper extremity
6. Presence of metallic implants in the head or neck
7. Currently or planning to become pregnant
8. Difficulty maintaining alertness or remaining still
9. Ferromagnetic metallic implants, pacemakers, other implanted devices, or ventilators (for MRI)
10. Bodyweight > 300 lbs due to MRI scanner dimensions (for subjects also undergoing MRI)
11. Psychiatric diagnosis according to the criteria of the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-V), or who are on psychotropic medication
12. Participation in concurrent occupational therapy