Improving Stroke Motor Control With Non-invasive Brain Stimulation and Functional Electrical Stimulation

Eligibility Criteria

• 1. Age ≥ 21
• 2. ≥ 6 months since first clinical hemorrhagic or nonhemorrhagic stroke
• 3. Able to follow 3-stage commands and remember 2 of 3 items after 30 minutes
• 4. Full volitional elbow extension/flexion and hand opening/closing of unaffected limb
• 5. Adequate active movement of shoulder and elbow to position the paretic hand in the workspace for table-top task practice
• 6. Patient must be able to sit unassisted in an armless straight-back chair for the duration of the screening portion of the eligibility assessment
• 7. Medically stable
• 8. ≥ 10° finger extension
• 9. Unilateral upper limb hemiparesis with finger extensor strength of ≤ grade 4/5 on the manual muscle test AND a score of
• 10. Skin intact on hemiparetic arm, hand and scalp
• 11. While relaxed, surface neuromuscular electrical stimulation of finger extensors and thumb extensors and/or abductors produces a functional degree of hand opening without pain.
• 12. No significant visual or hearing impairment
• 1. Co-existing neurological condition other than prior stroke involving the hemiparetic upper limb (e.g., peripheral nerve injury, Parkinson's disease, spinal cord injury, traumatic brain injury, multiple sclerosis).
• 2. Uncontrolled seizure disorder
• 3. Use of seizure lowering threshold medications at the discretion of the study physician (Dr. Rich Wilson)
• 4. Cardiac pacemaker or other implanted electronic device and/or stent
• 5. Pregnant
• 6. Intramuscular botox injections in any upper extremity muscle in the last 3 months
• 7. Insensate arm, forearm, or hand
• 8. Severely impaired cognition and communication
• 9. Uncompensated hemi-neglect (extinguishing to double simultaneous stimulation)
• 10. Severe shoulder or hand pain (unable to position hand in the workspace without pain)
• 11. Metal implant in the head