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)