Eligibility Criteria- INCLUSION CRITERIA:
We will include patients aged 18-80 years old with subacute thromboembolic non-hemorrhagic subcortical or cortical strokes stratified according to the degree of impairment into mildly impaired (MRC greater than 3) and severely impaired (MRC less than 3). Assessment of the initial functional state will be taken at the admission at NRH. For healthy volunteers, subjects with a normal physical and neurological examination could participate.
1. Patients with more than one stroke in the medial cerebral artery territory.
2. Patients with bilateral motor impairment.
3. Patients with cerebellar or brainstem lesions.
4. Patients with history of severe alcohol or drug abuse, psychiatric illnesses like severe depression, poor motivational capacity, or severe language disturbances, particularly of receptive nature or with serious cognitive deficits (defined as equivalent to a mini-mental state exam score of 23 or less).
5. Patients with severe uncontrolled medical problems (e.g. cardiovascular disease, severe rheumatoid arthritis, active joint deformity of arthritic origin, active cancer or renal disease, any kind of end-stage pulmonary or cardiovascular disease, or a deteriorated condition due to age, uncontrolled epilepsy or others).
6. Patients with increased intracranial pressure as evaluated by clinical means.
7. Patients with unstable cardiac arrhythmia.
8. Patients with thyroid disorders.
9. Patients with more than moderate to severe microangiopathy, polyneuropathy, diabetes mellitus, or ischemic peripheral disease.
11. Patients with metallic implants in the head.
12. Patients with pacemakers.
13. Patients taking antiadrenergic medications.
14. For fMRI: 1) Medical or technical contraindications to MRI procedures (e.g. metal braces, pacemakers, cochlear devices, surgical clips, and other metal/magnetic implants); 2) Claustrophobia; 3) inability to comply with the protocol 4) pregnancy (a urine pregnancy test will be performed for premenopausal females prior to MRI). All other criteria stated above will also apply
15. For TMS: 1) Seizure disorder; 2) Metallic implant in the head; 3) Pacemaker; 4) Unable to perform the task; 5) Pregnant or breast feeding a child; 6) Patients or subjects with increased intracranial pressure as evaluated by clinical means. All other criteria stated above will also apply.
For healthy volunteers, subjects with stroke(s) or movement disorder(s); history of alcohol or drug abuse or a psychiatric illness like depression, other major medical problems that effect heart, lungs or kidneys or epilepsy or diabetes mellitus; thyroid gland problem; other diseases of the brain, like Alzheimer's disease; medical or technical contraindications to MRI procedures (e.g. metal braces, pacemakers, cochlear devices, surgical clips, and other metal/magnetic implants); claustrophobia; pregnant or breast feeding women could not participate.