Telerehabilitation for Post-Stroke Hand Function

This pilot randomized controlled trial will evaluate the feasibility and preliminary effects of a home-based, technology-enabled hand telerehabilitation program for adults with chronic stroke. Participants will receive either remotely guided hand training or a standard home exercise program matched for duration and intensity. Outcomes will include measures of hand function, adherence, and feasibility to assess the potential of telerehabilitation for improving access to structured post-stroke hand rehabilitation.

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)