Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effect of Combined Anodal TDCS and Peripheral Nerve Stimulation on Motor Recovery in Acute Stroke
Brief Summary: Recent work showed that application of peripheral nerve and cortical stimulation independently can induce 10-15 % improvement in motor performance in patients with chronic stroke.

The purpose of this study was to compare in post-stroke hemiplegic patients the effect on motor recovery of one session of anodal transcranial direct current stimulation to the ipsilesional primary motor cortex (M1) combined with a peripheral radial nerve electrical stimulation (rEPNS) to the paretic hand repeated 5 successive days with the effect of the same peripheral nerve stimulation combined with sham tDCS.

Design: randomized, double-blind, parallel controlled clinical trial. Patients eligible for the study: Acute ischaemic stroke Primary outcome measure: Jebsen Taylor test Secondary outcome measures Nine peg hole test Hand tapping grip and wrist force Cortical excitability of Ipsilesional M1(TMS) Follow-up: 30 days


Options:
A: Inclusion Criteria:

- first -ever ischemic stroke within 5-30 days a paresis of the arm/hand with NIHSS \<15 age 35-85 years

Exclusion Criteria:

Pregnancy psychiatric disease patients with history of alcohol or drug abuse or severe depression patients with a severe language disturbances, particularly of receptive nature patients with increased intracranial pressure or serious cardiac disease patients with contraindication to TMS
B: 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
C: Inclusion Criteria:

* Subacute stroke patients (5-45 days after stroke) with thromboembolic non-hemorrhagic subcortical or cortical, first clinically overt stroke will be included. Moderate to moderately severe upper-extremity hemiparesis, defined as an Upper Extremity Fugl-Meyer score (UEFMA) between 20 and 58 (inclusive).

Exclusion Criteria:

* pre-existing large lesions (\> 1.5 cm maximum diameter) in a brain area that belongs to the anatomically established sensorimotor/premotor system
* progressive stroke
* completely lesioned hand knob area of M1 affected if no motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) are present
* bilateral motor impairment
* florid alcohol and/or drug abuse
* florid severe psychiatric illness (e.g. schizophrenia)
* severe language disturbances that prevents the patient to give informed consent or inhibit adequate scoring because of insufficient understanding of scoring introductions
* tumor diseases with a life expectancy less than one year
* increased intracranial pressure
* polyneuropathy and/or ischemic peripheral disease if the sensorimotor functions of the upper extremities are affected clinically relevant
* severe cognitive deficits (MMSE ≤ 23)
* pregnancy
* contraindication for MRI or TMS
D: 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.

Answer: A