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.All stroke patients with parietal lobe and thalamic lesions 2. Stroke duration: within 48 hours 3. Patients willing to participate in the study 4. MRI/ CT scan showing parietal lobe and thalamic lesion 5. Patients with upper limb weakness

Exclusion Criteria:

1. Stroke duration more than 1 yr
2. Glasgow Coma Scale (GCS) of less than 7
3. Uncooperative patients
B: Inclusion Criteria:

* Ischemic or hemorrhagic stroke onset 3 - 9 weeks before the recruiting, confirmed by computed tomography or magnetic resonance imaging.
* Moderate to severe motor impairment of an upper limb, defined as a score between 7 - 42 on the Upper Limb Subscale of Fugl Meyer Assessment of Sensorimotor Recovery after stroke.
* Ability to provide written informed consent (patient ou legal representative)
* Ability to comply with the schedule of interventions and evaluations in the protocol.

Exclusion Criteria:

* Severe spasticity at the paretic elbow, wrist or fingers, defined as a score of \> 3 on the Modified Ashworth Spasticity Scale.
* Upper limb plegia
* Uncontrolled medical problems such as end-stage cancer or renal disease
* Pregnancy
* Seizures, except for a single seizure during the first week post stroke
* Pacemakers
* Other neurological disorders such as Parkinson's disease
* Psychiatric illness including severe depression
* Aphasia ou severe cognitive deficits that compromise comprehension of the experimental protocol or ability to provide consent.
* Hemineglect
* Drugs that interfere on cortical excitability, except for antidepressants
* Cerebellar lesions
C: Inclusion Criteria:

* Clinical diagnosis of acute stroke
* Able to walk 10m independently
* High risk of falling

Exclusion Criteria:

* Severe functional limitations
* Cognitive impairment
D: 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.

Answer: D