Please select the eligibility criteria that correspond to the clinical trial below.
Title: Enhancing the Beneficial Effects of Upper Extremity Visuomotor Training With tDCS
Brief Summary: This study will determine if electrical brain stimulation during movement practice can improve the ability of stroke patients to reach for objects more than movement practice alone.

People between 18 and 85 years old who have had a stroke may be eligible for this study. Participants are randomly assigned to one of two study groups: movement training with active (tDCS) or movement training with sham (tDCS).

Participants will undergo 1-hour movement training and (tDCS) sessions twice a day, 5 days a week, for 3 weeks. For these sessions, subjects will sit in front of a computer screen that shows a target (round dots) and a cursor (a line). Participants will be instructed to move the cursor to various targets on the computer screen as fast and as accurately as possible, controlling the position of the cursor by moving their arm, which will rest on a mechanical device.

Participants will receive real or sham (tDCS) during the movement training sessions. For (tDCS), electrode sponges soaked in tap water are placed on the scalp and forehead. A small electrical current is passed between the electrodes. The stimulation lasts 20 minutes.

Patients will have the following tests four times during the study - 1) before starting movement training 2) (tDCS) during the course of training and (tDCS), 3) after completing training and (tDCS), 4) and 3 months after completing training and (tDCS):

Functional magnetic resonance imaging (fMRI)

Magnetic resonance imaging (MRI) uses a magnetic field and radio waves to take pictures of the brain. Functional MRI (fMRI) shows what parts of the brain are used when a task is performed. For the test, the subject lies on a table that can slide in and out of the scanner. A computer screen can be seen from inside the scanner. During the scan, subjects may be asked to do the study task or to lie still for up to 20 minutes at a time.

Movement and function tests

* Measurement of arm stiffness
* Moving the arms actively and against resistance
* Picking up objects and moving them as quickly as possible
* Performing daily living tasks like buttoning, dressing and walking
* Performing tasks while wearing a glove that monitors the position of the arm
* Completing questionnaires on ability to perform daily activities or other movements and level of tiredness

Transcranial magnetic stimulation (TMS)

TMS uses a magnet to stimulate the brain in way that is different from (tDCS). This study us...


Options:
A: Inclusion Criteria:

* All subjects must be between the ages of 18-90 and must not be pregnant.
* Patients volunteer to participate in the study, with a written informed consent signed
* Affiliation to a national health insurance program
* First-time clinical ischemic or hemorrhagic cerebrovascular accident - evidenced by a radiological (or physician's) report
* Contralesional motor deficit
* Lesion sparing primary motor cortex
* Stroke onset \>1 month and \<6 months prior to study enrollment

Exclusion Criteria:

* Coexistent major neurological or psychiatric disease as to decrease number of confounders
* History of epilepsy before stroke (or episodes of seizures within the last six months)
* Any substantial decrease in alertness, language reception, or attention that might interfere with understanding instructions for motor testing
* Subjects with global aphasia and deficits of comprehension
* Excessive pain in any joint of the paretic extremity (VAS\>4)
* Contraindications to Tdcs : metal in the head, implanted brain medical devices
* Coexistent major neurological or psychiatric disease as to decrease number of confounders
* A history of significant alcohol or drug abuse in the prior 6 months
* Anyone who is currently taking or who has taken anti-malarial treatment in the last 72 hours
* Subjects may not have already received constraint induced motor therapy and/or tDCS treatment for stroke
* Pregnancy
B: * INCLUSION CRITERIA:
* Age between 18 and 85 years.
* Ability to sit and be active for an hour on a chair (or wheelchair) without cardiac, respiratory and/or pain disturbances as assessed during the screening visit.
* Willingness to commit to participate in the long-term follow-up study (up to 3 months)
* Willingness to give written informed consent.
* Diagnosis of a first clinically apparent unilateral cortical or subcortical stroke at least 3 months prior to study entry

EXCLUSION CRITERIA:

* History of severe neurological illness (e.g. brain tumor, epilepsy or acute seizures, polyneuropathy etc.) or severe cognitive impairment (MMSE less than 23)
* MRI contraindications. (Cardiac pacemakers; Intracardiac lines; Implanted medication pumps; Neural stimulators; blood vessel, cochlear, or eye implants; Metal in the cranium except in the mouth; Dental braces; Metal fragments from occupational exposure; Surgical clips in or near the brain).
* History of alcohol or drug abuse
* Active depression of any severity with psychoactive medication changes in the last 2 months, active psychosis, disruptive or violent behavior, poor motivational capacity as assessed by the study physician by patient questioning
* Aphasia or language disturbances that would interfere with performing the study tasks
* Uncontrolled medical problems (e.g., active cancer or renal disease, any type of end-stage pulmonary or cardiovascular disease, diabetes, or other medical conditions, as determined by the study physician, that would interfere with participation in this study).
* Increased intracranial pressure as evaluated by clinical means (fundoscopic exam).
* Severe neglect or ataxia that would interfere in the completion of the study tasks.
* History of more than one stroke or a stroke that affects both sides of the brain, the brainstem, or the cerebellum.
* Inflammation of the tissue, severe rheumatoid arthritis, or abnormal function of the joints due to arthritis in the affected arm used most often.
* Pregnancy
C: Inclusion Criteria:

* Inpatient at Caulfield Hospital Neurological Rehabilitation Unit at the time of recruitment
* Diagnosis of first stroke
* Presence of lower limb weakness determined by \>10% difference in knee extensor strength between sides
* Functional Ambulation Category (FAC) \> 3
* Can walk a minimal distance of 14 metres (to allow measurement on a 10metre walk test (10MWT)

Participants who meet all the inclusion criteria except for their FAC score will have their FAC score re-measured on a weekly basis until they reach a score of greater than or equal to 3, at which point they become eligible and will be approached for recruitment.

Exclusion Criteria:

* Unable to provide informed consent (determined by consultation with rehabilitation consultant and the team neuropsychologist)
* Other diagnosed central nervous system disorder affecting mobility
* Active oncological diagnosis
* Unstable medication condition such as unstable diabetes or unstable cardiac condition that would prevent participation in cardiovascular activity
* Recent orthopaedic trauma and/or osteoarthritis that would limit participation in physical exercise
* Not willing to continue to attend the program if they discharge home before the end of the six week program
D: Inclusion Criteria:

* diagnosed with stroke
* 18 years of age or older
* community dwelling
* able to walk 10m independently, with or without an assistive device
* medically approved by a physician to participate
* able to tolerate 60 minutes of activity with rest intervals
* able to independently follow instructions

Exclusion Criteria:

* involved in an active rehabilitation program

Answer: B