Cortical Priming to Optimize Gait Rehabilitation in Stroke: a Renewal

Who May Qualify: - Age greater than 18 years - First ever monohemispheric stroke \> 3 months since onset - Residual hemiparetic gait deficits (e.g. abnormal gait pattern) - Able to walk for 5 minutes at self-paced speed. Handheld assistive device is acceptable. - Walking speed lesser than 1.2 m/s - Lower limb Fugl-Meyer Motor score between 15-30 - At least 5 deg of ankle dorsiflexion necessary to perform the ankle-tracking task Who Should NOT Join This Trial: - General exclusion criteria - Severe osteoporosis - Contracture-limiting range of motion of lower limb - Score of more than 2 on the Modified Ashworth Scale (indicating increased muscle tone through ankle range of motion) - Uncontrolled anti-spasticity medications during the study period - Score less than 6 on the Fugl-Meyer Sensory Assessment Scale for the Lower Limb - Cardiorespiratory or metabolic diseases (e.g. cardiac arrhythmia, uncontrolled hypertension or diabetes, chronic emphysema) - Unhealed decubiti, persistent infection - Significant cognitive or communication impairment (Mini-Mental State Examination (MMSE)\<21), which could impede the understanding of the purpose of procedures of the study or prevent the patient from performing the ankle-tracking task. - Lesions involving the brainstem and cerebellum - Failure to pass the graded exercise stress test TMS exclusion criteria - Implanted cardiac pacemaker - Metal implants in the head or face - Unexplained, recurring headaches - History of seizures or epilepsy - Currently under medication that could increase motor excitability and lower seizure threshold - Skull abnormalities or fractures - Concussion within the last 6 months - Currently pregnant tDCS exclusion criteria - Skin hypersensitivity - History of contact dermatitits - History of allodynia and/or hyperalgesia - Any other skin or scalp condition that could be aggravated by tDCS Always talk to your doctor about whether this trial is right for you.