Please select the eligibility criteria that correspond to the clinical trial below.
Title: Transcranial Direct Current Stimulation in Rehabilitation of Chronic Stroke Patients: Multicenter Clinical Trial
Brief Summary: In this study, the investigators wondered whether bihemispheric transcranial direct current stimulation (tDCS) would be capable to potentialize the effects of physical therapy on upper limb rehabilitation of chronic stroke patients. Moreover, the study aims to investigate the pattern of physiological variables involved in the recovery of these patients. For this purpose, patients included will be submitted to 10 sessions with active or sham bihemispheric tDCS associated with intensive and individual physical therapy session.


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:

* 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
C: Inclusion Criteria:

* single symptomatic stroke more than 3 months ago with hand/arm weakness
* able to perform required tests and provide consent
* Age 18-80
* Modified Ashworth scale \<3
* range of motion functional at shoulder elbow wrist and hand

Exclusion Criteria:

* more than one symptomatic stroke in middle cerebral artery territory or bilateral involvement
* severe medical or psychiatric conditions, drug abuse, seizure disorder
* pregnancy/breast feeding
* subarachnoid hemorrhage, lobar hemorrhage
* patients who can not have tDCS (prior head surgery, pacemakers, metallic implants in the head etc)
* patients taking antiadrenergic medications
D: Inclusion Criteria:

* Stroke survivors \> 3 months from most recent unilateral, stroke based on clinically or experimentally obtained MRI brain scans and behavioral evidence of stroke (e.g., risk factors, hemiplegia, unilateral sensory impairment, or localized higher cortical dysfunction) by report or in the medical record.
* Age: \>21 years of age.
* Complete NIH Stroke Scale.
* Sufficient endurance, motor ability and balance to ambulate at least 10 meters continuously with moderate or less assistance.
* Demonstrate gait impairment during ambulation such that gait instability or inefficient gait patterns \[gait pattern manifesting "dragging" or "catching" of the affected toes during swing phase of gait, or use of compensatory strategies such as circumducting the affected limb, vaulting with the unaffected limb or hiking the affected hip to clear the toes\] are exhibited.
* Pass the Transcranial Magnetic Stimulation (TMS) Adult Safety Screen (TASS) except for items related specifically to stroke and the treatment for stroke.

Exclusion Criteria:

* Edema, skin breakdown, absent sensation of the affected lower limb which interferes with the peroneal nerve stimulator.
* History of potentially fatal cardiac arrhythmias, such as ventricular tachycardia, supraventricular tachycardia, and rapid ventricular response atrial fibrillation with hemodynamic instability.
* Demand pacemakers or any other implanted electronic systems.
* Pregnant women, uncontrolled seizure disorder, Parkinson's Disease, Spinal cord injury, Traumatic brain injury with evidence of motor weakness, Multiple sclerosis.
* Documented episode in the medical record of a seizure occurring 1 month or more post stroke for which the patient received consultation or treatment for said seizures. Seizures occurring within the first month following a stroke are not exclusionary unless followed by another seizure.
* Fixed ankle plantar flexor contracture, peroneal nerve injury at the fibular head as the cause of foot-drop.
* History of dementia, severely impaired cognition, communication or comprehension deficits.
* Presence of severe or frequent headaches
* History of Botulinum toxin (Botox) injection to either of the lower extremities within the 3 month period preceding study entry.
* Have other medical conditions or are taking medications that compromise ambulation or balance.
* Failure to meet established screening criteria for TMS or tDCS (i.e., TASS)
* Principal Investigator's or Medical Monitor's discretion not to include a participant.

Additional Exclusion Criteria for MRI Scan

* Claustrophobia, or the inability to lie still in a confined space
* Major medical disorders (e.g., HIV, cancer)
* Medications which may affect image quality (e.g., water pills)
* Magnetic metallic implants (such as screws, pins, shrapnel remnants, aneurysm clips, artificial heart valves, inner ear (cochlear) implants, artificial joints, and vascular stents), as these may heat, pull, or twist in the strong magnetic field of the MRI scanner
* Non-removable dental implants, such as braces or permanent retainers, as these will distort the MRI images we collect (note: filings, crowns, and silver or gold teeth are OK)
* Permanent makeup or tattoos with metallic dyes
* A positive pregnancy test (for females), since the effect of strong magnetic fields on the developing fetus remains unknown and inconclusive. (We will conduct a pregnancy test for all female participants on the day of the MRI scan.)
* Psychotic disorders (e.g., schizophrenia)
* Any other condition that the investigator believes might put the participant at risk

Answer: A