Mechanisms of Arm Recovery in Stroke Patients With Hand Paralysis

This study examines the effect of non-invasive brain stimulation targeting different brain areas on movement of the affected arm post-stroke. Participants will receive stimulation to each of 3 different brain areas combined with a session of arm exercise.

Small improvements in affected arm movement can be made with intensive physical practice. These improvements could potentially be enhanced by combining non-invasive brain stimulation with practice. To develop such an intervention, it is necessary to understand which brain areas should be stimulated in which types of patients. It is probably more beneficial to target one side of the brain vs. the other, for example, depending on the characteristics of the stroke. This study will examine the effect of stimulating one side of the brain vs. the other on the amount of improvement that occurs from physically practicing functional arm movements.

arm, rehabilitation, non-invasive brain stimulation, transcranial magnetic stimulation, upper extremity

Each participant will receive stimulation targeting each brain area. The order in which the stimulation sites are targeted for each participant is randomized and there is a washout period of several weeks between each treatment.

The individual that conducts the tests of arm movement will be unaware of which brain area was stimulated.

Application of "Unaffected Transcranial Magnetic Stimulation" to unaffected hemisphere site prior to physical practice

Application of "Affected Transcranial Magnetic Stimulation" to affected hemisphere site prior to physical practice

Inclusion Criteria: More than 6 months post-stroke Loss of voluntary finger movement in the affected hand Some voluntary movement of affected shoulder and/or elbow Exclusion Criteria: Brainstem or cerebellar stroke Severe cognitive or language deficits Epilepsy or other seizure disorder Central nervous system disease or disorder other than stroke