Background
Methods/Design
Objective
Design
Patient population
Inclusion criteria |
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Experienced a middle cerebral artery stroke with cortical involvement; either a first-ever stroke or at least 1 year after a stroke in non-motor regions |
Medically stable |
Confirmed diagnosis of stroke from CT/MRI imaging |
Have mild/moderate hand weakness (defined in this study as being able to lift and hold a small object, but do not full strength according to Medical Research Council grades) [19] |
Have recordable motor evoked potentials (>200 μV) to transcranial magnetic stimulation (TMS) in affected hand muscles |
Exclusion criteria |
Contraindications to TMS [20] |
For example, history of other neurological disease, including epilepsy, cardiac pacemaker, metal implants in the skull. A complete TMS Safety Screening Questionnaire will be completed in accordance with international guidelines [20] |
Severe receptive aphasia |
Pre-morbid dementia |
Inability to give informed consent |
Study procedures
Primary outcome
Secondary outcomes
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National Institutes of Health Stroke Scale (NIHSS), a measure of stroke severity, recorded on admission to hospital.
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Functional Independence Measure (FIM), a measure of independence with mobility and activities of daily living.
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The Action Research Arm Test (ARAT), to measure arm activity in the domains pinch, grip, grasp and gross arm movement.
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The Grip-lift task, a sensitive indicator of dextrous hand function following stroke [16].