Tele-CE in Severe Stroke

Inclusion Criteria:

* Single, monohemispheric stroke
* Chronic stroke (\> 6 months prior)
* Severe stroke (Fugl-Meyer Lower Extremity motor scale score \< 21 or 6 Minute Walk Test distance \< 300m)

Exclusion Criteria:

* Use of anti-spasticity medications
* Existence of other neurological disorders
* Have brainstem or cerebellar lesions.
* Mini-Mental State Examiniation score of \<21, to ensure participants have the cognitive capacity to consent and can understand instructions both in-person and during remote supervision.
* Non-English-speaking individuals
* Bone, joint or soft tissue injury
* Uncontrolled medical conditions (such as uncontrolled hypertension, untreated cardiac disease, or untreated pulmonary disease)
* Unable to see the tablet and zoom screen
* Unable to move non-paretic ankle (\< 5 degrees of ankle ROM)
* Fugl-Meyer Lower Extremity sensory scale score \< 6

TMS exclusion criteria

* Previous adverse reaction to TMS
* Skull abnormalities or fractures
* Concussion within the prior 6 months
* Unexplained, recurring headaches
* Implanted cardiac pacemaker
* Metal implants in the head or face
* History of seizures or epilepsy
* Use of medications that could alter cortical excitability or increase risk of seizure (e.g., antidepressants, antipsychotics, anxiolytics, anticonvulsants)
* Current pregnancy

PNS exclusion criteria

* Skin hypersensitivity at any sites of stimulation, including the scalp, thoracolumbar spine, and peripheral limbs
* History of contact dermatitis at any of the sites of stimulation
* History of allodynia and/or hyperalgesia
* Active skin infection
* Skin lesions
* Deep vein thrombosis
* Any other skin or scalp condition that could be aggravated by stimulation
* Implanted electronic, metallic, or highly conductive devices near site of stimulation that cannot be removed without permission from a health professional