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 infections; * Claustrophobia precluding MRI; * A fixed contraction deformity in the affected limb that would prevent normal dexterity if patient were neurologically intact; * Excessive spasticity as indicated by the Modified Ashworth Spasticity (MAS) Scale \>2/4 in either elbow flexors, wrist flexors or finger flexors of the affected limb;i * previous stroke with residual deficits (TIAs not a reason for exclusion); * premorbid (retrospective) modified Rankin Scale (mRS) score ≥2 of any aetiology; * a concurrent progressive neurologic disorder, acute coronary syndrome, severe heart disease (NYHA Classification \> 3), or other major medical condition, * confirmed or suspected lower-limb fracture preventing mobilization, * patients requiring palliative care * patients planning to undergo any other occupational therapy during the 6 week active treatment period of the trial (see section 5.2 for study schedule) than what is provided in the study * A recent injection of botulinium toxin to the affected upper limb in the last 3 months, or the need of an injection of botulinum toxin anytime during the study period and follow up. * A recent injection of phenol to the affected upper limb in the last 6 months, or the need of an injection of phenol anytime during the study period and follow up. * Ataxia as measured by a score \> 1 on item 7 (limb ataxia) of the NIH stroke scale. * Severe sensory deficits as measured by a score of 2 on item 8 of the NIH stroke scale. * Severe aphasia as measured by a score of \> 2 on item 9 (best language) of the NIH stroke scale. * Severe neglect as measured by a score of 2 on item 11 (extinction and inattention) of the NIH stroke scale. * Patients unable to comprehend or follow verbal commands * Based on PI's or local physician's assessment patient unable to tolerate the trial procedure due to medical condition * A Mini mental status exam (MMSE) \<25.