Telerehabilitation and Biomarkers of Recovery After Stroke in Brazil

Prior treatment

• Unable or unwilling to perform study procedures/therapy, or expectation of noncompliance with study procedures/therapy, or expectation that subject cannot participate in all study visits.
• Modified Rankin Scale score \>2 prior to the index stroke.
• A new symptomatic stroke has occurred since the index stroke, or a separate stroke occurred within 30 days prior to the index stroke.
• Botulinum toxin to the paretic arm: received in the prior 3 months or expected by the 1-Month Visit.
• Concurrent enrollment in another therapy-based investigational study where the duration of the investigational therapy's activity is likely to occur during the subject's participation in the study.
• Expectation that participant will not have a single domicile address during the 6 weeks of therapy.

Other illness

• A major, active, coexistent neurological, psychiatric, or medical disease that reduces the likelihood that a subject will be able to comply with all study procedures.
• A diagnosis (apart from the index stroke) that substantially affects paretic arm function.
• Significant cognitive impairment, defined as Montreal Cognitive Assessment \[a lower score can be permitted at the discretion of the PI\].
• On isolation precautions, e.g., due to active COVID-19.

Other

• Severe depression, defined as Geriatric Depression Scale Score \>10/15 at Baseline Visit.
• Deficits in communication that interfere with reasonable study participation.
• Severe UE spasticity, defined as presence of contracture or modified Ashworth Scale score=4 in either biceps or pectoralis.
• Lacking visual acuity, with or without corrective lens, of 20/50 or better in at least one eye.
• Life expectancy \< 9 months
• Pregnancy; women of child-bearing potential must have a negative pregnancy test.
• Subject lacks sufficient Portuguese to comply with study procedures and TR instructions.
• Contraindication to MRI.
• Contraindication to TMS.
• Box and Block Test score of ≥30 blocks with the unaffected arm within 60 seconds at Baseline Visit;
• Spatial neglect interfering with reasonable participation in the study;
• Distance from the participant's home to the study site greater than 120 km \[this can be waived at the discretion of the PI\].
  • 22\. Availability of a 2 m² space for a table and chair setup.

• Age 18-80 years at the time of randomization.
• The index stroke was radiologically verified, due to ischemia, and had time of onset 120±30 days prior to randomization.
• The stroke caused upper extremity deficits as defined by Action Research.
• Arm Test score 18-44 (out of 57) at Baseline Visit.
• Box \& Block Test score with affected arm is ≥1 block in 60 seconds at Baseline Visit.
• Able to successfully perform all 3 rehabilitation exercise test examples (simple commands) at Baseline Visit.
• Informed consent and behavioral contract signed by the subject (i.e., no surrogate consent).