Stroke is the leading cause of disability, as many of those affected demonstrate difficulty with movement and
walking. Rehabilitation post-stroke can be challenging and often ineffective because no two stroke survivors
present with the same mobility impairments, yet the same physical therapy interventions are utilized. Thus, a need exists to personalize rehabilitation techniques to improve function and mobility post-stroke. The proposed innovative research will test a framework created to identify the most effective intervention based on a participant's specific motor control problems. We plan to study how self-selected walking speed is impacted by a four-week walking program that incorporates either walking on an inclined or declined treadmill compared to walking on a flat treadmill. We will determine the best intervention for each problem and identify predictors of response. Selecting the correct intervention for personalized motor control problems, as opposed to applying a one-size-fits-all strategy for rehabilitation, is likely to improve walking function in Veterans after stroke.

The aim of this study is to gather information about veterans at the Ralph H. Johnson Veterans Medical Center (RHJ-VAMC) who've experienced a stroke and are interested in participating in rehabilitation research.

VA principal investigators at the Center for Rehabilitation Research in Neurologic Conditions (CRRNC) conduct stroke rehabilitation research for individuals. CRRNC include laboratories that investigate and assess upper extremity motor function, neuro-stimulation, communication and swallowing, locomotor energetics, locomotor and rehabilitation, and motor performance functions.

Participants will be asked to come to the CRRNC located at the Medical University of South Carolina (77 President Street, Charleston, South Carolina) and fill out a simple screening form with study personnel. Participants may be contacted in the future for qualifying studies.

Transcranial magnetic stimulation (TMS) is often used to assess the excitability of the brain and the connectivity between the brain and peripheral muscles. However, less work has been completed with the portion of the brain controlling leg muscles. In addition, there appears to be more error and less reliability in these measures in those with stroke. This project aims to assess a battery of TMS-derived outcome measures to determine the most effective for those after stroke. This information is of critical importance as we use this technology to assess changes after rehabilitation post stroke and to understand the motor control of walking after neurologic injury.