Eligibility CriteriaINCLUSION CRITERIA:
We will include patients with thromboembolic non-hemorrhagic hemispheric lesions and with hemorrhagic hemispheric lesions (subcortical in the corticospinal tract, or cortical in motor or somatosensory representations, as documented by CT or MRI) at least 12 months after the stroke. In addition, for the TMS measurements we will include 17 age- and gender-matched control subjects.
For the GOT task, we will choose subjects who initially had a severe sensory paresis (sensory NIH-SS below 1), which subsequently recovered to the point that they have a residual somatosensory deficit but can perform the task.
For the motor performance, we will choose subjects who initially had a severe motor paresis (below MRC grade 2), which subsequently recovered to the point that they have a residual motor deficit but can perform the required tasks.
Patients with more than one stroke.
Patients with bilateral motor impairment.
Patients with cerebellar or brainstem lesions.
Patients or subjects unable to perform the task (wrist or elbow flexion at least MRC grade 2, less than 75% of performance in the grating orientation task with a grating of 3.0).
Patients or subjects with history of severe alcohol or drug abuse, psychiatric illness 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).
Patients or subjects 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).
Patients or subjects with increased intracranial pressure as evaluated by clinical means.
Patients or subjects with unstable cardiac arrhythmia.
Patients or subjects with history of hyperthyroidism or individuals receiving drugs acting primarily on the central nervous system.
Patients with more than moderate to severe microangiopathy, polyneuropathy, diabetes mellitus, or ischemic peripheral disease.
Patients with a history of deep vein thrombosis.
Patients receiving anticoagulant treatment at the time of the proposed study.
Excessive callus at the palm of the fingers.
Pregnancy in women.