Inclusion Criteria:  History of stroke > 6 months ago Presence of residual upper extremity hemiparesis Willingness to participate Ability to provide informed consent Upper extremity Fugl-Meyer score < 66 Mini Mental State Exam score ≥ 24 Discernible and reliable MEP elicited following single-pulse TMS to the lesioned hemisphere  Exclusion Criteria:  History of neurological disease other than stroke Presence of contraindications to transcranial magnetic stimulation (TMS) or peripheral nerve stimulation (PNS), including:  history of adverse reactions to TMS or PNS metal in head, eyes, neck, chest/trunk, or arms, including but not limited to shrapnel, surgical clips, fragments from metalworking, fragments from welding implanted devices history of frequent and severe headaches or migraines immediate family history of seizure or epilepsy personal history of seizure or epilepsy current, suspected, or planned pregnancy current or recent (within the last 3 months) use of medications acting on the central nervous system other than selective serotonin reuptake inhibitors (SSRIs), including but not limited to antipsychotic drugs, benzodiazepines, prescription stimulants  Upper extremity Fugl-Meyer score ≥ 66 (66 is the maximum on this scale) Mini Mental State Exam score < 24 No discernible and reliable MEP elicited following single-pulse TMS to the lesioned hemisphere