Telerehabilitation for Post-Stroke Hand Function

Inclusion Criteria:

* Unilateral cortical or subcortical stroke
* Chronic stroke (≥ 6 months since stroke)
* No significant cognitive deficits as determined by the Mini Mental State Examination (MMSE) score (score≥ 22)

Exclusion Criteria:

* Cerebellar stroke
* Unstable heart condition, uncontrolled diabetes or hypertension
* Recent trauma or fracture in the upper extremities
* History of significant orthopedic or neurological conditions that could affect hand function (e.g., multiple sclerosis)
* Recent history of significant spatial neglect
* Joint contractures or significant spasticity in the hand
* History of a recent Botulinum Toxin (Botox) injection to the upper-extremity muscles (≤ 3 months)
* Pregnant or actively planning to become pregnant (self-reported)
* Inability to communicate or unable to consent

Exclusion Criteria for subjects exposed to Transcranial Magnetic Stimulation (TMS):

* Unable to obtain reliable motor evoked potentials
* Recent history of repeated fainting spells or syncope.
* Recent history of seizure while on anti-seizure medication
* Recent history of skull fracture/head injury
* Ferromagnetic metal implants in the skull
* Cochlear implant
* Implanted deep brain stimulator
* Implanted vagus nerve stimulator
* Implanted cervical spine epidural stimulator
* Ventriculoperitoneal shunt
* Skull defect related to the current stroke
* Previous serious adverse reaction to TMS
* Implanted electronic cardiac device (e.g., cardiac pacemaker)