Niche Trial: Navigated Inhibitory rTMS to Contralesional Hemisphere Trial

Inclusion Criteria : * ≥ 18 years of age * An ischemic or hemorrhagic stroke suffered 3-12 months prior to the study; * no other known brain abnormalities by history; * A one-sided stroke resulting in upper extremity paresis * A Chedoke-McMaster Stroke Assessment arm stage and hand stage of 3-6 for the affected limb Exclusion Criteria * Implanted metallic parts of implanted electronic devices, including pacemakers, defibrillators, or implant medication pump; * Pregnant or trying to become pregnant; Lack of pregnancy established in females of child-bearing potential by a negative urine pregnancy test at screening. * Active alcohol abuse, illicit drug use or drug abuse or significant mental illness * Patients suffering from depression as measured by a score of \>10 on the Patient Health Questionnaire (PHQ9). For clarity, patients diagnosed with depression which is controlled with stable anti-depressive medication and in whom PHQ9 is \<10 are eligible to participate in the trial. * History of epilepsy, defined as at least two unprovoked seizures occurring greater than 24 hours apart or diagnosis of an epilepsy syndrome, OR a seizure within the last 12 months. * Any condition that would prevent the subject from giving voluntary informed consent; * An implanted brain stimulator; * Any metal in head with the exception of dental work or any ferromagnetic metal elsewhere in the body; * Enrolled or plans to enroll in an interventional trial during this study; * Scalp wounds or infe…