tDCS + CCFES-mediated Functional Task Practice for Post-stroke Upper Extremity Hemiplegia

Eligibility Criteria

• 1. Age ≥ 21 and ≤ 90
• 2. ≥ 6 and ≤ 24 months since first clinical hemorrhagic or nonhemorrhagic stroke
• 3. Able to follow 3-stage command
• 4. Able to remember 2 of 3 items after 30 minutes
• 5. Full volitional elbow extension/flexion and hand opening/closing of unaffected limb
• 6. Adequate active movement of shoulder and elbow to position the paretic hand in the workspace for table-top task practice
• 7. Patient must be able to sit unassisted in an armless straight-back chair for the duration of the screening portion of the eligibility assessment
• 8. Medically stable
• 9. ≥ 10° finger and wrist extension
• 10. Skin intact on hemiparetic arm, hand and scalp
• 11. Muscle contraction can be elicited with Transcranial Magnetic Stimulation
• 12. Unilateral upper limb hemiparesis with finger extensor strength of ≤ grade 4/5 on the Medical Research Council (MRC) scale
• 13. Score of ≥1/14 and ≤ 11/14 on the hand section of the upper extremity Fugl-Meyer Assessment
• 14. While relaxed, surface NMES of finger extensors and thumb extensors and/or abductors produces a functional degree of hand opening without pain.
• 1. Co-existing neurological condition other than prior stroke involving the hemiparetic upper limb (e.g., peripheral nerve injury, PD, SCI, TBI, MS).
• 2. Uncontrolled seizure disorder
• 3. Use of seizure lowering threshold medications and the discretion of the study physician
• 4. Cardiac pacemaker or other implanted electronic device
• 5. Pregnant
• 6. IM Botox injections in any UE muscle in the last 3 months
• 7. Insensate arm, forearm, or hand
• 8. Deficits in communication that interfere with reasonable study participation
• 9. Severely impaired cognition and communication
• 10. Uncompensated hemi-neglect (extinguishing to double simultaneous stimulation)
• 11. Severe shoulder or hand pain (unable to position hand in the workspace without pain)