Noninvasive Spinal Stimulation in Stroke

OBJECTIVES:

- To determine whether transcutaneous spinal cord stimulation combined with ambulation
training modulates corticospinal locomotor networks in individuals with chronic
hemiplegic stroke

- To determine whether transcutaneous spinal stimulation combined with ambulation training
improves locomotor function in individuals with chronic hemiplegic stroke

- To determine whether transcutaneous spinal stimulation combined with ambulation training
improves symmetry of gait in individuals with chronic hemiplegic stroke

- To determine whether transcutaneous spinal stimulation combined with ambulation training
improves standing posture and balance in individuals with chronic hemiplegic stroke

- To determine whether ambulation efficiency (improved cardiovascular conditioning)
improves with transcutaneousnon-invasive spinal stimulation and locomotor training in
individuals with chronic hemiplegic stroke

Inclusion Criteria:

- Participants are 18 years of age or older

- Participants are at least 4 weeks post stroke

- Participants with hemiplegia secondary to a single stroke

- Functional Ambulation Category of 2 or greater - Patient needs continuous or
intermittent support of one person to help with balance and coordination.

- Participants are able to provide informed consent

- Participants are not currently receiving regular physical therapy services

Exclusion Criteria:

- Individuals less than18 years of age

- Individuals less than 4 weeks post stroke

- Individuals with ataxia

- Individuals with multiple stroke history

- Currently taking medication for spasticity management or depression

- Modified Ashworth score of 3 or greater in lower extremity

- Pregnancy or nursing

- Pacemaker or anti-spasticity implantable pumps

- Active pressure sores

- Unhealed bone fractures

- Peripheral neuropathies

- Painful musculoskeletal dysfunction due to active injuries or infections

- Severe contractures in the lower extremities

- Cardiopulmonary disease

- Active urinary tract infection

- Clinically significant depression, psychiatric disorders, or ongoing drug abuse

- Metal implants in their spine

TMS Specific Exclusion Criteria:

- Medicated with agents known to increase (e.g., amphetamines) or decrease motor system
excitability (e.g., lorazepam)

- Implanted cardiac pacemaker

- Metal implants in the head or face

- Suffers unexplained, recurring headaches

- Had a seizure at any time in the past, or has epilepsy

- Skull abnormalities or fractures

- Suffered a concussion within the last 6 month

- Cardiorespiratory or metabolic diseases (e.g. cardiac arrhythmia, uncontrolled
hypertension or diabetes, chronic emphysema)

- Pregnant