What this trial measures

• Change in the excitability/strength of the brain-spinal cord-muscle pathway at the brain level as measured by the Motor Evoked PotentialBaseline and final training session (approximately 2.5 months)

  An increased average MEP size (mV) would indicate increased excitability/strength of the brain-spinal cord-muscle pathway

• Change in ability to move the arm as measured by the Action Research Arm Test (ARAT). Maximum score of 57 pointschange from baseline to immediately after completing the training protocol

  An increase in ARAT score indicates an improvement in the ability to move the arm

• Change in ability to move the arm as measured by the Fugl-Meyer Assessment (FMA)change from baseline to immediately after completing the training protocol

  An increase in the FMA score indicates better movement of the arm. Maximum score of 66 points

• Change in gross manual dexterity as measured by the Box and Block Test (BBT)change from baseline to immediately after completing the training protocol

  An increased number of blocks moved in 60s indicates increased gross manual dexterity

• Change in fine motor ability and finger dexterity as measured by the Nine Hole Peg Testchange from baseline to immediately after completing the training protocol

  Decreased amount of time (s) to place and remove pegs in a peg board indicates improved fine motor ability and finger dexterity

• Change in strength as measured by Manual Muscle Testing (MMT)change from baseline to immediately after completing the training protocol

  Increased score on MMT indicates increased strength in the muscle being tested. The examiner grades the patient's strength on a 0 to 5 scale. 0: No muscle activation; 1: Trace muscle activation, such as a twitch, without achieving full range of motion; 2: Muscle activation with gravity eliminated, achieving full range of motion; 3: Muscle activation against gravity, full range of motion; 4: Muscle activation against some resistance, full range of motion; 5: Muscle activation against examiner's full resistance, full range of motion.

• Change in sensation on the back and palm of the hand as measured by the Semmes Weinstein Monofilament Testchange from baseline to immediately after completing the training protocol

  Ability to detect increasingly thinner monofilaments indicates increased sensation

• Change in spasticity as measured by the Modified Ashworth Scale (mAS)change from baseline to immediately after completing the training protocol

  The mAS score ranges from 0: normal muscle tone to 4: rigid in flexion or extension. A decrease in mAS indicates decreased spasticity.