Motor Recovery Through Plasticity-Inducing Cortical Stimulation

Inclusion Criteria: 22-75 years of age * History of ischemic stroke * Minimum 6 months post-ischemic cortical stroke * Levels of hemiparesis that warrant surgical intervention (upper limb impairment) * Able to participate in a meaningful way in rehabilitation (defined by upper extremity Fugl-Myer (UEFM) score of 25-45 * Disability measured between 3 and 4 on the modified Rankin Scale * Minimum of 30% preservation of the corticospinal pathways in MRI imaging * Observable motor output of the upper limb in response to TMS delivered to the motor cortex * Available for the duration of the study, 54 weeks for multiple visits (38 weeks implanted and 16 weeks post-explant follow-up). * All inclusion and exclusion criteria will be assessed within 90 days before the device implantation procedure (though the PI may determine to override the 90-day limit for MRI imaging results review). Exclusion Criteria: * Unable to discontinue anti-platelet medication for 7 days pre- and 3 days post-op * On therapeutic anticoagulation * A history of unprovoked deep vein thrombosis or any pulmonary embolus * The presence of a bleeding disorder which significantly increases the chances that the patient will have a hemorrhagic complication in relation to study procedures. * Other medical history indicating increased risk of thrombosis per investigator discretion * Any history of seizures * Pregnancy * Geriatric Depression Score greater than 10 * Montreal Cognitive Assessment below 22 unless attributa…