NuroSleeve Powered Brace & Stimulation System to Restore Arm Function

Inclusion Criteria:• Must be 4 years or older

• Must have weakness in one or both arms such that flexion or extension of the wrist,elbow or shoulder are 3/5 or less on the Manual Muscle Testing Scale

• The etiology of weakness is due to a neurological disease or injury or orthopediccondition that occurred 6 or more months ago

• Participant is willing to comply with trial instructions

• Adult participant is able to provide informed consent prior to enrollment in thestudy, and for children, child is able to provide assent and designated caregiver (parent or guardian) is able to provide informed consent

• The participant is fluent in English and, if the participant were a child, at leastone parent/guardian were fluent in English

• Medically stable and living at home in the community.

• No joint contracture, spasticity or other limitations to range of motion in theaffected lower limb(s) precluding the operation of a wearable, powered orthoticdevice on the arm

• Sufficient sitting balance to sit in a chair

• No condition (e.g., severe arthritis, central pain) that would interfere withmovement of the legs, ability to understand verbal commands and cooperate with testprocedures.

• No condition that would pose a risk to the application of electrical current to thebody (e.g., skin conditions or skin breakdown)

Exclusion Criteria:• Visual impairment such that following visually-guided instructions would be challenging even with ordinary corrective lenses

• Orthopedic conditions of either arm that would affect performance on study

• Untreated psychiatric or neurologic disturbances that would affect motivation andtrial participation

• Excessive pain in one or both of the arms (> 5 on a 10-point visual analog scale)

• Excessive spasticity at one or both arms, as defined as a score of > 2 on theModified Ashworth Spasticity Scale

• Advice from any of the participant's health providers that upper extremity poweredorthotics or electrical stimulation were contra-indicated

• Presence of an implanted medical device in the body (such as cardiac pacemaker,implanted defibrillator, metallic device)

• Metal implants or exposed metal in the weak or paralyzed arm

• Lack of access to internet or wireless coverage to enable telemedicine-guidedsessions

• Any history of seizure or epilepsy (only an exclusion criterion for those seeking toundergo optional transcranial magnetic stimulation)

• Currently taking the medication bupropion (only an exclusion criterion for thoseseeking to undergo optional transcranial magnetic stimulation)

• Any history of prior neurosurgical procedure (only an exclusion criterion for thoseseeking to undergo optional transcranial magnetic stimulation)

• Known or suspected skull defect (only an exclusion criterion for those seeking toundergo optional transcranial magnetic stimulation)

• Any history of alcohol or other substance use

• Other conditions or circumstances that, in the opinion of the investigators, wouldpreclude safe and/or effective participation, including severe skin conditions,and/or other sequelae that may be contraindicated for using a powered orthotic orusing electrical stimulation, as well as personal circumstances