Cortical Priming to Optimize Gait Rehabilitation in Stroke: a Renewal

Inclusion Criteria:

* 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

Exclusion Criteria:

* 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