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

Inclusion criteria

• Age ≥ 21
• ≥ 6 months since first clinical hemorrhagic or nonhemorrhagic stroke
• Able to follow 3-stage commands and remember 2 of 3 items after 30 minutes
• Full volitional elbow extension/flexion and hand opening/closing of unaffected limb
• Adequate active movement of shoulder and elbow to position the paretic hand in the workspace for table-top task practice
• Patient must be able to sit unassisted in an armless straight-back chair for the duration of the screening portion of the eligibility assessment
• Medically stable
• ≥ 10° finger extension
• Unilateral upper limb hemiparesis with finger extensor strength of ≤ grade 4/5 on the manual muscle test AND a score of

≥1 and ≤ 11/14 on the hand section of the upper extremity Fugl-Meyer Assessment

• Skin intact on hemiparetic arm, hand and scalp
• While relaxed, surface neuromuscular electrical stimulation of finger extensors and thumb extensors and/or abductors produces a functional degree of hand opening without pain.
• No significant visual or hearing impairment

Exclusion criteria

• 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).
• Uncontrolled seizure disorder
• Use of seizure lowering threshold medications at the discretion of the study physician (Dr. Rich Wilson)
• Cardiac pacemaker or other implanted electronic device and/or stent
• Pregnant
• Intramuscular botox injections in any upper extremity muscle in the last 3 months
• Insensate arm, forearm, or hand
• Severely impaired cognition and communication
• Uncompensated hemi-neglect (extinguishing to double simultaneous stimulation)
• Severe shoulder or hand pain (unable to position hand in the workspace without pain)
• Metal implant in the head