tDCS + CCFES-mediated Functional Task Practice for Post-stroke Upper Extremity Hemiplegia

Inclusion Criteria:

1. Age ≥ 21 and ≤ 90

2. ≥ 6 and ≤ 24 months since first clinical hemorrhagic or nonhemorrhagic stroke

3. Able to follow 3-stage command

4. Able to remember 2 of 3 items after 30 minutes

5. Full volitional elbow extension/flexion and hand opening/closing of unaffected limb

6. Adequate active movement of shoulder and elbow to position the paretic hand in theworkspace for table-top task practice

7. Patient must be able to sit unassisted in an armless straight-back chair for theduration of the screening portion of the eligibility assessment

8. Medically stable

9. ≥ 10° finger and wrist extension

10. Skin intact on hemiparetic arm, hand and scalp

11. Muscle contraction can be elicited with Transcranial Magnetic Stimulation

12. Unilateral upper limb hemiparesis with finger extensor strength of ≤ grade 4/5 onthe Medical Research Council (MRC) scale

13. Score of ≥1/14 and ≤ 11/14 on the hand section of the upper extremity Fugl-MeyerAssessment

14. While relaxed, surface NMES of finger extensors and thumb extensors and/or abductorsproduces a functional degree of hand opening without pain.

Exclusion Criteria:

1. Co-existing neurological condition other than prior stroke involving the hemipareticupper limb (e.g., peripheral nerve injury, PD, SCI, TBI, MS).

2. Uncontrolled seizure disorder

3. Use of seizure lowering threshold medications and the discretion of the studyphysician

4. Cardiac pacemaker or other implanted electronic device

5. Pregnant

6. IM Botox injections in any UE muscle in the last 3 months

7. Insensate arm, forearm, or hand

8. Deficits in communication that interfere with reasonable study participation

9. Severely impaired cognition and communication

10. Uncompensated hemi-neglect (extinguishing to double simultaneous stimulation)

11. Severe shoulder or hand pain (unable to position hand in the workspace without pain)