MINT Conditioning to Improve Gait

Inclusion criteria

• Age at enrollment is 18 to 85
• Leg impairment from unilateral stroke at least 6 months prior to screening
• Severe to moderate gait impairment (ambulatory with a maximum walking speed of 0.8 m/s, i.e., half of normal speed)
• Able to stand without assistance
• Clinically observable gait asymmetry
• Abnormal co-activation between adductor magnus and rectus femoris (R greater than or equal to 0.5)

Exclusion criteria

• Cognitive impairment with at least moderately impaired attention on digit-span test, or unable to follow instructions of the MINT task
• Visual impairment (such as hemianopia) preventing sufficient perception of the screen to play the games
• Anesthesia or severe neglect in the affected leg, or visual hemineglect (score of 2 on the NIH Stroke Scale Extinction and Inattention subtest) that impairs ability to play the games
• Participation in another study on the affected leg, or any pharmacological study, within 6 weeks of enrollment
• Inability to understand or follow commands in English due to aphasia or other reason that makes it impossible to perform the training
• Diffuse or multifocal infarcts
• Substantial leg or other pain preventing participation for 60 minutes a day
• Spasticity treatment (pharmacological or Botox) on the affected leg within past 3 months
• Severe osteoporosis causing hip or other fractures
• History of multiple falls within the last year, use of walker for balance, or falling during stance while in the lab in the first session.
• Contracture limiting the range of motion of the leg
• Current pregnancy
• From the TMS portion of the study only: History of epilepsy in adulthood requiring antiseizure medications; recent/current alcoholism or benzodiazepine/barbiturate abuse or recent history of alcohol/benzodiazepine/barbiturate withdrawal, recent history of cocaine or amphetamine use, skull fractures or skull deficits, concussion within the last 6 months, unexplained recurring headaches, vagus nerve stimulator, cochlear implant, deep brain stimulator, intracranial/carotid stents, cardiac pacemaker/AICD.