PREP3: Evaluating whether predictions for upper limb motor outcome after stroke can be improved using non-invasive brain stimulation

The recovery of upper limb movement will be observed from within 1 week of stroke until 6 months post-stroke. Information about the participant’s index stroke will be collected from their medical records. Participants within 1 week of stroke will compete the Fugl-Meyer Upper Extremity and the Action Research Arm Test to assess upper limb impairment and activity limitation, respectively, as well as the Oxford Cognitive Screen to assess cognition. Within 1 week of stroke participants will receive non-invasive brain stimulation in the form of transcranial magnetic stimulation. Transcranial magnetic stimulation involves non-invasively stimulating the ipsilesional primary motor cortex to assess functional connectivity of the participant’s corticospinal tract. Responses to transcranial magnetic stimulation are recorded as motor evoked potentials from two hand and two forearm muscles using electromyography. There are no treatment effects from the transcranial magnetic stimulation used in this study. The transcranial magnetic stimulation protocol for this study will only be performed with participants in this study. All together the assessments within 1 week of stroke are expected to take approximately 75 minutes. Follow up assessments will be performed at 3 and 6 months post-stroke. The 3 month post-stroke assessment is the primary end-point for the study and is expected to take approximately 30 minutes. The 3 month post-stroke assessment includes the Fugl-Meyer Upper Extremity and the Action Research Arm Test, as well as the modified Rankin Scale to assess the participant’s level of functional independence. The 6 months post-stroke assessment is expected to take approximately 45 minutes and includes the same assessments as the 3 month post-stroke assessment while adding the Stroke Impact Scale to assess the participant's quality of life.