The Effect of tDCS Combined With Functional Task Training on Motor Recovery in Stroke Patients
The Effect of tDCS Combined With Functional Task Training on Motor Recovery in Stroke Patients
We propose to enhance the effects of brain plasticity using a powerful noninvasive technique
 for brain modulation consisting of navigated transcranial magnetic stimulation (TMS) priming
 with transcranial direct current stimulation (tDCS) in combination with motor-training-like
 constraint-induced movement therapy (CIMT).
Inclusion Criteria:

 1. age 18-90

 2. first-time clinical ischemic or hemorrhagic cerebrovascular accident as noted in the
 radiological (or physician's) report;

 3. the ability to extend =20° at the wrist and 10° at the metacarpophalangeal and
 interphalangeal joints of all digits;

 4. participants must demonstrate adequate balance while wearing the restraint;

 5. the ability to stand from a sitting position and the ability to stand for at least 2
 minutes with or without upper extremity support;

 6. weakness, defined as score of 15-55 (out of 66) on arm motor Fugl-Meyer (FM) scale;
 and

 7. stroke onset more then 6 months prior to study enrollment.

 Exclusion Criteria:

 1. significant pre-stroke disability;

 2. where applicable (a history of depression before the stroke);

 3. any substantial decrease in alertness, language reception, or attention that might
 interfere with understanding the instructions for the motor testing;

 4. excessive pain in any joint of the paretic extremity;

 5. contraindications to single-pulse TMS (TMS will be used to measure cortical
 excitability) such as metal head implants;

 6. advanced liver, kidney, cardiac, or pulmonary disease;

 7. a terminal medical diagnosis consistent with survival 1 year;

 8. coexistent major neurological or psychiatric disease (to decrease the number of
 confounders);

 9. a history of significant drug abuse in the prior 6 months;

 10. the use of certain neuropsychotropic drugs such as tricyclics, antidepressants, or 51
 of 66 carbamazepine;

 11. active enrollment in a separate intervention study targeting stroke recovery; (

 12. previously applied constraint-induced motor therapy and/or tDCS treatment for stroke;
 and

 13. a history of epilepsy before stroke (or episodes of seizures within the last six
 months).