Repetitive TMS and Occupational Therapy in Children and Young Adults With Chronic Hemiparesis

Inclusion Criteria: * Age ≥ 10 years; \< 21 years * Hemiparesis * Manual Ability Classification System (MACS) level I through IV * Provision of written informed consent by the patient and/or guardian, including understanding that insurance may be billed for the occupational therapy * Written assent form signed by participants younger than 18 years of age Exclusion Criteria: * Underlying degenerative or metabolic disorder or supervening medical illness * Severe depression or other psychiatric disorder * Any participant who is pregnant * Any contraindication to TMS (i.e., intracranial metal implants, shunts, ports, pacemaker, baclofen pumps) * Any changes or addition of neuropsychiatric medications within 1 month of starting the study or during course of the study (if applicable) * Any botulinum toxin (Botox, Myobloc) or phenol injection within the last 3 months prior to the study or during the course of the study (if applicable) * Any upper extremity surgery within the last 6 months prior to the study or scheduled during the course of the study (if applicable)