This study will test the ability of myoelectric interface for neurorehabilitation (MINT) training to improve walking function.

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.

Data and metadata will be shared in the Data Archive for the BRAIN Initiative (DABI) database. Clinical functional outcomes, gait kinematics, and analyzed EMG (co-activation), will be uploaded and shared upon publication.

IPD and associated analytic code will be made available upon publication of research results and will remain available for the duration of the funded project.