Please select the eligibility criteria that correspond to the clinical trial below.
Title: AMES + Brain Stimulation: Treatment for Profound Plegia in Stroke
Brief Summary: The procedure involves: (1) assisted hand movement by a mechanical device, (2) mechanical vibration applied to the surface of the forearm, and (3) stimulation of the brain with either transcranial magnetic stimulation (TMS) or transcortical direct current stimulation (DCS). These 3 components of the procedure are carried out simultaneously. Each subject will be evaluated pre- and post-treatment with several clinical tests of functional movement. The hypotheses of this project are that the AMES+rTMS and AMES+tDCS procedures are safe and will enable most of the stroke patients to recover finger extension.


Options:
A: Inclusion Criteria:

* stroke onset \>3 months prior to study enrollment
* subject has at least 10 degrees mobility over wrist, thumb and fingers on the affected side
* subject can move, stand up and stand firmly with constrained healthy hand
* subject can perform training 6 hours daily in 2 weeks
* subject is able to understand instructions and be able to cooperate

Exclusion Criteria:

* pregnancy
* contraindications to MRI of brain
* epilepsy, major psychiatric disease
* excessive pain that prevents training
* history of other diseases resulting decreased mobility of affected upper limb
B: Inclusion Criteria:

* Stroke occurring ≥12 months before enrollment
* Hemispheric stroke (ischemic or hemorrhagic), cortical or subcortical
* Residual upper-extremity weakness without the ability to activate volitionally extensor digitorum (no volitional EMG in the long finger extensor muscle)independently
* Age 18-75 years old

Exclusion Criteria:

* Significant upper-extremity proprioceptive deficit (\<70% correct detection of the direction of passive finger movement, with eyes closed)
* Cortical stroke involving the primary motor cortex
* Epilepsy not controlled by medication
* Botox injections 5 months before or during enrollment; use of intrathecal Baclofen
* Residual pain in the tested arm
* Significant neglect involving the affected limb (NIHSS 2 on the extinction and attention items)
* Exercise intolerant
* Uncontrolled hypertension or angina
* Cognitive or behavioral inability to follow instructions
* Current abuse of alcohol or drugs
* Terminal illness with anticipated survival of \<12 months
* Severe apraxia; inability to understand oral directions in English; or inability to communicate adequately with study personnel
* Circumference of arm incompatible with the AMES device (checked by placing the limb in the device)
* Contractures, decreased range of motion, or skin condition preventing tolerance of the AMES muscle vibrators
* Spinal cord injury, arthritis, or fractures of affected limbs resulting in loss of range of motion
* In the tested arm, peripheral nerve injury or neuropathy resulting in significant motor or sensory loss
* Pathological neurological/physical condition other than stroke that impairs the function of the impaired arm or that produces pain in the impaired arm
* Implanted device (e.g., cardiac pacemaker, Baclofen pump) the operation of which might be adversely affected by the brain stimulation
* Previous vascular surgery on the blood vessels of the brain or heart or heart valve surgery
* Female and pregnant
C: Inclusion Criteria:

1. Patients suffering from the consequences of a stroke in the medial cerebral artery, during the sub-acute phase (4-24 weeks after onset)
2. Age between 18-75 years
3. Hospitalised in rehabilitation Hospital Hof Ter Schelde
4. Capable of understanding and giving informed consent

Exclusion Criteria:

1. Cerebellum or brainstem lesions
2. Recently multiple lesions and older lesions which are manifested clinically.
3. History of severe substance abuse (alcohol, drugs, benzodiazepines)
4. Cardiac disease that in the opinion of the clinician precludes participation in the trial (severe dyspnea in rest, severe rhythm disturbances, etc)
5. History of epileptic insults, not caused by the stroke
6. Severe organic co morbidity
7. Psychiatric disorders or history of psychiatric disorders
8. Pace maker / internal defibrillator
9. Pregnancy
D: Inclusion Criteria:

* diagnosis of a stroke
* more than 6 months of stroke onset
* aged 50 years or above
* community-dwelling
* medically stable
* score ≥21 on the Montreal Cognitive Assessment (MoCA)
* score ≤ 25 on the Mini Balance Evaluation Systems Test (Mini-BESTest)
* able to ambulate without physical assistance of another person as determined during the 10-meter walk test
* ability to follow 3-step commands

Exclusion Criteria:

* having neurological conditions other than stroke
* not community-dwelling prior to the stroke event
* significant receptive and expressive aphasia
* severe and uncorrected hearing or visual deficits
* serious musculoskeletal disorders (e.g. amputation)
* serious cardiovascular conditions affecting the ability to participate in exercise training
* pain experienced at rest or movement
* other serious illnesses that preclude participation

Answer: B