Eligibility Criteria- INCLUSION CRITERIA:
Fifteen adult and impaired patients (right or left) with residual arm function who have had a single monohemispheric ischemic or hemorrhagic stroke (documented by CT or MRI) at least 6 months before, without severe proprioceptive deficits, independent of previous physical therapy will be included.
They should be able to perform the pinch task.
Their gender or ethnic origin will not provide bias for inclusion to the study.
All subjects will sign an informed consent prior to participation in the trial.
Exclusion criteria for the trial will include any current actively treated medical or surgical condition or neurological or psychiatric illness other than stroke.
Any individual who is on medication which is known to lower seizure threshold, or who has a pacemaker, an implanted medical pump, a metal plate, a metal plate or metal object in the skull or eye (for example after brain surgery) will be excluded.
Additional exclusion include patients with:
History of more than one stroke;
Large cortical, cerebellar, or brainstem lesions;
An inability to extend metacarpophalangeal (MP) joints at least 10-20 degrees;
Substantially recovered motor function;
Poor motivational capacity, or severe language disturbances (particularly of receptive nature);
Bilateral motor problems;
Serious cognitive deficits (defined as equivalent to a mini-mental state exam score of 20 or less);
Uncontrolled medical problems, such as: cardiopulmonary disease, severe rheumatoid arthritis, active joint deformity of arthritic origin, active cancer, or renal disease;
Uncontrollable issues due to natural aging;
History of seizure(s).
All patients will underfo electroencephalogram (EEG) examination prior to rTMS experiment as a part of the screening procedure.
Patients without any history of seizures, but with any sign of increased cerebral activity in the EEG will be excluded.
Women who are pregnant may not participate and women who are of childbearing years must be post-menopausal, sterile, or practicing adequate birth control.
Children will be excluded.