Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Randomised Trial of Non-Invasive Brain Stimulation (NIBS) in Stroke Survivors
Brief Summary: After a stroke affecting the right side of the brain, many patients are affected by "spatial neglect": the damage to the brain causes them to ignore the left side of their surroundings. At its most extreme they may be unaware that they have a left side, or believe that it is moving normally when it is in fact paralysed. In milder cases, people may be unable to recognise touch on the left side if their right side is also being touched, or objects in their left visual field if something is visible to their right. Neglect alters peoples' quality of life profoundly, often renders them more dependent on others to undertake basic activities of daily living, and makes effective rehabilitation much more difficult.

The limited success of current treatment approaches indicates gaps in understanding of the underlying mechanisms of neglect and its recovery. Recent data suggest that the problems in responding to the left side are a result of an imbalance of activity in those parts of the brain responsible for deciding which side to pay attention to. It might therefore be possible to help people with neglect by "rebalancing" the brain either by increasing activity in the damaged side, or alternatively by reducing activity in the undamaged side. In this pilot study, the investigators will test whether they can help by doing the second of these things.

The investigators propose to conduct a pilot clinical trial to explore whether using electric currents to temporarily modify the activity of specific areas of the intact side of the brain, influences recovery from neglect, when used either alone, or in combination with a training method that has previously appeared promising as a treatment. Brain activity will be modified using a technique called "transcranial direct current stimulation (tDCS)", in which small electric currents are applied to the scalp with a wire covered in damp cotton pads. This will be done over the specific parts of the brain that are responsible for focusing attention to one side.

The investigators will compare the clinical outcomes of four interventions (1: behavioural, 2: tDCS, 3: a combination of both and 4: control).

The investigators hope that these studies will advance their understanding of what treatments may help people with neglect, and how they might work.


Options:
A: Inclusion Criteria:

* Primary or recurrent, ischemic or hemorrhagic stroke, confirmed by computed tomography or magnetic resonance imaging
* Chronic Stroke (\> 12 months)
* Sensorimotor sequelae in an upper limb due to stroke
* Score ≥ 18 at Folstein Mini Mental State Examination
* Score ≥ 4 at Ashworth Scale
* Minimal active wrist movement (flexion and extension)
* At least one pinch movement

Exclusion Criteria:

* Prior neurological diseases
* Multiple brain lesions
* Metal implant in the skull and face
* Pacemaker
* History of seizures
* Epilepsy
* Pregnancy
* Hemodynamic instability
* Performing physical therapy elsewhere during the period of intervention
* Score \> 59 at the Fugl-Meyer Assessment of Motor Recovery after Stroke
* Traumatic or orthopedic lesion limiting the range of motion of upper limb
B: Inclusion Criteria:

1. Ischemic stroke affecting the right hemisphere, confirmed by CT or MRI.
2. Persistent neglect for one month after ictus (confirmed by BIT).
3. Prestroke functional independence (modified Rankin Scale score 0-2).
4. Between 18-90 years of age

Exclusion Criteria:

1. Patients younger than 18.
2. Patients who do not understand verbal or written English (ie.need of translaters)
3. bilateral infarcts (Confirmed by CT, MRI)
4. Dementia (MOCA, Score \<26).
5. Neurological Disease (eg. Parkinson's Disease, epilepsy, MS)
6. Significant morbidity (eg cancer, severe cardiac failure) likely to affect participation.
7. Alcohol excess (more than 50/40 units a week for men/women respectively).
8. Patients who fall under the exclusion criteria for TDCS which includes patients suffering from a stroke related seizure :

History of epilepsy, medications or psychoactive drugs that can lower seizure threshold \[imipramine, amitriptyline, doxepine, nortriptyline, maprotiline, chlorpromazine, clozapine, foscarnet, ganciclovir, ritonavir, amphetamines, cocaine, (MDMA, ecstasy), phencyclidine (PCP, angel dust), ketamine, gammahydroxybutyrate (GHB), alcohol, theophylline\]. Withdrawal from alcohol, barbiturates, benzodiazepines, meprobamate, chloral hydrate. Patients who are pregnant or have suffered from a stroke-related seizure.
C: Inclusion Criteria:

* stroke with at least slight deficit

Exclusion Criteria:

* epilepsy
* contraindication to tDCS and/or to fMRI
* presence of metal in the head
* inability to understand / complete behavioral tasks
* chronic intake of alcohol or recreational drugs
* major health condition
* presence of pacemaker (for the fMRI part only)
* pregnancy
D: Inclusion Criteria:

* Chronic (\> 6 months) stroke patient
* Aged 18-79 years
* Motor deficit in the upper limb due to the stroke

Exclusion Criteria:

* Absence of recordable MEPs from the ADM after TMS
* Absence of voluntary movement (Fugl-Meyer \< III)
* Head injury or the presence of intracranial metal or intracranial lesions
* History of cranial irradiation
* History of epilepsy
* Presence of a pacemaker
* Taking anticonvulsant or neuroleptic medication
* Substance abuse
* Inability to understand instructions
* History of psychiatric disorders

Answer: B