Robotically Augmented Mental Practice

Inclusion Criteria for Healthy able-bodied volunteers:

• 18-39 years old, men and women

Inclusion Criteria for Right-handed Post-stroke adults:

• 21-75 years old
• Right-handed
• Longer than 6 months post-stroke
• Persistent hemiparesis on the right upper extremity (UE)
• Residual UE voluntary movement as indicated by a score of 1-3 on the motor arm item of the NIH Stroke Scale (NIHSS) and a score of 19-55 on the UE portions of the Fugl Meyer Assessment (UE-FMA)
• Preserved cognitive function
• Ability to follow and read simple instructions as indicated by a score of 1 or above on item #9 on the best language items of the NIHSS

Exclusion Criteria for both healthy and post-stroke individuals: To ensure the safety associated with TMS, the following adults will be excluded (*, not applicable to post-stroke subjects):

• Had an adverse reaction to TMS. Had epilepsy or seizure.
• Have any implanted devices such as a neurostimulator or cochlear implant.
• Had a stroke or lesion (including tumor) in your brain*. Had a head injury or brain surgery*.
• Suffer from frequent or severe headaches.
• Had a fainting spell or syncope.
• Have any metal in the head such as shrapnel, surgical clips, or fragments from welding or metalwork.
• Have any implanted device such as cardiac pacemakers, medical pumps, or intra-cardiac lines.
• Had any brain-related conditions*.
• Had any illness that caused brain injury* (i.e. meningitis, aneurysm, brain tumor).
• Had any head trauma that was associated with a loss of consciousness or diagnosed as a concussion.
• Being treated for any psychiatric condition (i.e. depression, anxiety, PTSD, schizophrenia).
• Had more than 2 cups of coffee/caffeinated beverages in the last 12 hours.
• Had more than 2 alcoholic beverages in the last 12 hours.
• Had less than 6 hours of sleep in the last 24 hours.
• Suspected of pregnancy.

Additional Exclusion Criteria for post-stroke adults:

• A first stroke less than 6 months or more than 24 months prior to the participation.
• Hemiparesis on the left side.
• Hemorrhagic stroke.
• Cerebellar stroke.
• Severe sensory impairment as indicated by the score of 2 (Severe to total sensory loss; the patient is not aware of being touched in the face, arm, and leg) in item #8 (Sensory) of the NIH Stroke Scale (NIHSS).
• Serious uncontrolled medical conditions.
• Severe apraxia of speech.
• Excessive pain in any joint of the more affected extremity that could limit the ability to cooperate with the intervention, as judged by the examining clinician.
• Receiving any anti-spasticity drugs orally at the time of expected participation, 3 months prior, or wish to or is scheduled to receive injections prior to study completion.
• Received phenol injections less than 12 months prior to receiving therapy.
• Unable to stand independently for 2 min., transfer independently to and from the toilet, or perform sit-to-stand.
• A score of less than 24 on the Folstein Mini-Mental State Examination.
• Passive range of motion less than 45 degrees for abduction, flexion or external rotation at the shoulder, or pronation of forearm; or greater than 30 degrees flexion contracture at any finger joint.
• Active range of motion less than 10 degrees for finger flexion or extension.
• Inability to volitionally activate right UE proximal muscles used for EMG placement.
• Clinical judgment of a) a major medical disorder that substantially reduces the likelihood that a subject will be able to comply with all study procedures, b) unable to successfully perform all rehabilitation exercise test examples, or c) unable or unwilling to perform study procedures/therapy, or expectation of non-compliance with study procedures/therapy.
• No TMS response in the first dorsal interosseous muscle in the right hand.