Please select the eligibility criteria that correspond to the clinical trial below.
Title: Changes in Cortical Excitability Associated With Upper Limb Motor Recovery - a Study of Neural Strategies Employed in Motor Recovery
Brief Summary: This study is to investigate changes in brain activities in acute stroke patients , and to correlate findings with clinical outcome measures. Another aim of the study is to investigate whether transcranial direct current stimulation (tDCS) could improve motor function in subjects with poor brain activity after stroke. The brain activity will be measured by single and paired pulse TMS (transcranial magnetic stimulation). The study hypothesizes that:

1. The neural mechanisms employed in patients who have different response to TMS stimulation are different. It is hypothesized that patients with no response upon TMS stimulation might have poorer motor function outcome, compared with patients with response upon TMS stimulation.
2. The result of clinical outcome measures is related with TMS measurement.
3. tDCS intervention is beneficial to subjects with poor brain activity. Clinical outcome measures will include a battery of upper limb motor tests such as upper extremity component of the Fugl-Meyer Assessment, Modified Ashworth scale for spasticity, box and block test, and manual muscle testing. Clinical outcome and TMS measurement will be assessed at within 2 weeks, 4-6 weeks and at 6 months post-stroke.


Options:
A: Inclusion Criteria:

1. First-ever stroke with the onset 10-90 days prior to the enrollment
2. Age: 20-80y
3. With a hemiplegic upper extremity with Brunnstrom stage in I\~IV
4. Able to understand simple orders (1-step orders, such as "raise your hand, touch your head....)
5. Totally independent in activity of daily life before the onset of stroke

Exclusion Criteria:

1. Incompliance to the assessments or interventions due to unstable medical condition, abnormal cognition, or other conditions.
2. Stroke of brainstem or cerebellum
3. Had received craniotomy or ventriculoperitoneal shunting
4. Needs of orthoses in walking before the onset of stroke
5. Had had motor dysfunctions (eg, amputation, cerebral palsy, poliomyelitis or other neuromuscular diseases) before the stroke.
6. Intracranial hemorrhage caused by artereovenous malformation, aneurysm, or tumor
7. Able to walk independently for more than 50 meters.
B: Inclusion Criteria:

1. Male or female aged 21-80 years;
2. First ever haemorrhagic or ischaemic hemiplegic stroke less than 1 month prior to study enrollment;
3. Upper extremity impairment of 0-45 out of a maximum score of 66 on the Fugl-Meyer assessment scale.
4. MMSE\>=24.
5. Be able to provide informed consent.

Exclusion Criteria:

pregnancy; cardiac pacemakers; orthodontics (braces); metal implant; history of epilepsy; sensorimotor disturbance due to other causes other than stroke; uncontrolled medical conditions including hypertension, diabetes mellitus and unstable angina; major depression and a history of psychotic disorders.
C: Inclusion Criteria:

* Age \> 18 years
* National health insurance cover
* 1st minor ischaemic stroke (initial NIH score ≤ 4)
* Satisfactory neurological recovery at discharge from hospital (modified Rankin score ≤2)
* Patient living close to the participating centre (\<50 km)
* With early post-stroke fatigue (FFS score ≥ 4 at the definitive inclusion visit (W3))

Exclusion Criteria:

* haemorrhagic stroke
* History of ischaemic or haemorrhagic stroke with clinical manifestations
* History of TIA
* MMS ≤ 24
* Pre-existing dementia (defined according to DSM IV criteria)
* Neurosensory or orthopaedic disorders requiring permanent technical support before the stroke and making reconditioning impossible
* Aggravation of the neurological status after the initial hospitalisation (NIH score ≥ 6)
* Recurrence of the cerebrovascular event or onset of an acute cardio-vascular event between the screening and definitive inclusion
* Pre-stroke Rankin score ≥ 3
* Pregnant patient
* Patient under guardianship
D: Inclusion Criteria:

* Patients with clinical diagnosis of acute ischemic stroke (first or recurrent) confirmed by CCT or MRI admitted to the Acute Vascular Unit of HCPA between the first 48 hours of onset of symptoms.
* Patients older than 18 years.
* Patients clinically and hemodynamically stable (SBP 120-220 mmHg, SatO2 up to 92% with or without supplementation, HR between 60 and 100 bmp, body temperature below 38 and RR below 25 bpm).
* Patients are able to react to verbal commands even without being fully alert (Glasgow Scale above 8).
* Prior Rankin until 3
* Motor deficit and / or coordination measured by the NIHSS

Exclusion Criteria:

* Patients with clinical and / or hemodynamic instability
* Patients with hemorrhagic stroke or TIA (transient ischemic attack).
* Patients with progressive neurological disease and acute coronary disease and / or unstable.

Answer: B