Functional Connectivity & Stimulation-enhanced Therapy Post Stroke

The ability to predict individuals' responses to treatment can enable effective allocation of
a treatment to likely responders. The long-term goal is to determine whether acute changes in
brain functional connectivity immediately after one treatment session can predict ultimate
gains in motor function after completing multiple treatment sessions. The objective of this
study is to determine feasibility and to examine association between change in brain
functional connectivity after one session and motor gains after completion of all treatment
sessions. This study is a prospective single-cohort longitudinal study. The treatment is
task-practice therapy (3d/wk, 18-session) accompanied with concurrent imperceptible wrist
vibration that is intended to prime the cortical sensorimotor network and enhance hand
functional recovery in chronic stroke survivors. Hand function will be assessed before/after
therapy and at 1-month follow-up. Connectivity will be assessed using fMRI and EEG before and
after a treatment session.

Inclusion Criteria:

- Age = 18 or older

- At least 6 months post-stroke

- Moderate upper limb impairment with the ability to participate in hand task practices

- Fingertip touch sensory deficits (e.g., Monofilament>2.83, 2-point discrimination>5mm,
sense of numbness, tingling)

Exclusion Criteria:

- Complete upper limb deafferentation

- Rigidity (Modified Ashworth Scale=5)

- Botulinum toxin injection within 3 months prior to enrollment or during enrollment

- Brainstem stroke

- Comorbidity (peripheral neuropathy, orthopaedic conditions in the hand that limit
ranges of motion, premorbid neurologic conditions, compromised skin integrity of the
hand/wrist due to long-term use of blood thinners)

- Concurrent upper extremity rehabilitation therapy

- Language barrier or cognitive impairment that precludes following instructions or
providing consent

- MRI incompatible.