Please select the eligibility criteria that correspond to the clinical trial below.
Title: Randomized Control Trial Comparing Walking Task Specific Training With Stride Management Assist (SMA) Device vs.Functional Task Specific Training on Functional Walking Ability in Outpatient Stroke Rehabilitation
Brief Summary: Hypothesis/Specific Aims:

The purpose of this study is to determine the effect of training with the Stride Management Assist (SMA) device vs. Impairment based physical therapy (IPT) on descending corticospinal drive to the lower limb muscles in patients post stroke. The investigators hypothesize that long-term SMA use would strengthen the connections between the motor areas of the brain and the lower limbs. Specifically, individuals in the SMA group will show higher corticospinal excitability of the lower limb muscles compared to those in the IPT group.


Options:
A: Inclusion Criteria:

* Ischemic or hemorrhagic stroke \>6 months prior in men or women aged between 18-80 years.
* Clear indications of hemiparetic gait by clinical observation.
* Completed all conventional physical therapy.
* Ability to walk on a treadmill with handrail support.

Exclusion Criteria:

* Cardiac history of (a) unstable angina, (b) recent (less than 3 months) myocardial infarction, congestive heart failure (NYHA category II); (c) hemodynamically significant valvular dysfunction.
* Major clinical depression: CESD score \> 16 and judgment of clinical depression
* Medical History: (a) recent hospitalization (less than 3 months) for severe medical disease, (b) symptomatic peripheral arterial occlusive disease, (c) orthopedic or chronic pain conditions that significantly alter gait function, (d) pulmonary or renal failure (e) active cancer
* History of non-stroke neuromuscular disorder restricting gait.
* Aphasia or cognitive functioning that confounds participation, defined as unable to follow 2 step commands. The Mini Mental State Exam will be administered with a cut-off of less than 23 (less than 17 if education level at or below 8th grade), or judgment of the medical officer.
* Hypertension that is a contraindication for a bout of treadmill training (greater than 160/100 on two assessments).
* Self-report of pregnancy
B: Inclusion Criteria:

* Ischemic or hemorrhagic stroke greater than 3 months prior
* Residual hemiparetic gait with observable asymmetry in the gait pattern.
* Women or men aged 21 to 85 years
* Completed all conventional physical therapy.
* Adequate language and neurocognitive function to participate in training, testing, and to give informed consent.
* Minimal ankle flexion in either direction (dorsi- or plantar-)

Exclusion Criteria:

* MMSE score \< 23 (9th grade education or more) or MMSE score \< 17 (8th grade education or less)
* CES-D score \> 16
* Clinical history of orthopedic, chronic pain or severe neuromuscular disorders restricting participation in a short term ankle movement training paradigm.
* Severe or global receptive aphasia which confounds reliable testing and training.
* Women of child-bearing potential, if there is any self-reported chance that they may be pregnant.
C: Inclusion Criteria:

* ≥ 30-days post stroke
* Initial gait speed of \> 0.4 m/s and \< 0.8 m/s
* Adequate cognitive function (MMSE score \>17)
* Subject is willing to be randomized to the control group or the treatment group.
* Ability to sit unsupported for 30 seconds
* Ability to walk at least 10m with maximum 1 person assist,
* Ability to follow a three-step command
* Physician approval for patient participation
* Living in the community post-stroke with ability to travel to the intervention site to participate in the outpatient program and able to perform the home exercise program in the residential facility.
* Willing to carry wireless body sensors through the period of the study and to follow-up time period, post inpatient stroke, cardiac, pulmonary, or any other lower extremity physical rehabilitation
* ≥ 90 days post major orthopedic surgery (i.e. hip, knee, and/or ankle joint replacement)
* ≥ 6 months post coronary artery bypass grafting (CABG) or cardiac valve procedure
* Able and willing to give written consent and comply with study procedures, including follow-up visits
* Cannot not be participating in any other structured outpatient or home health physical therapy program

Exclusion Criteria:

* Serious cardiac conditions (hospitalization for myocardial infarction or heart surgery within 3 months, history of congestive heart failure, documented serious and unstable cardiac arrhythmias, hypertrophic cardiomyopathy, severe aortic stenosis, angina or dyspnea at rest or during activities of daily living)
* Severe arthritis or orthopedic problems that limit passive ranges of motion (ROM) of lower extremity (knee flexion contracture of \> 10°, knee flexion ROM \< 90°, hip flexion contracture \> 25°, and ankle plantar flexion contracture \> 15
* Serious medical conditions including myocardial infarction or heart surgery within 3 months, history of congestive heart failure, documented serious and unstable cardiac arrhythmias, hypertrophic cardiomyopathy, severe aortic stenosis, angina or dyspnea at rest or during activities of daily living, Severe hypertension, severe weight bearing pain, life expectancy less than one year
* Preexisting neurological disorders such as Parkinson's disease, Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS), dementia
* History of major head trauma, Lower extremity amputation, Non-healing ulcers of a lower extremity, Renal dialysis or end stage liver disease, Legal blindness or severe visual impairment, a history of significant psychiatric illness
* History of unexplained, recurring headaches, epilepsy/seizures/skull fractures or skull deficits
* Medications that lower seizure threshold
* History of concussion in last 6 months
* Subject is pregnant, nursing or planning a pregnancy
* Inability to travel 3 times per week for outpatient training programs
* Participating in another clinical trial that, according to the Principal Investigator, is likely to affect study outcome or confound results
D: Inclusion Criteria:

* 1st-ever-stroke
* hemiplegic patient after stroke
* who can stand independently, but cannot walk more than 10 meters independently
* whose muscle powers of hip and knee are more than poor on manual muscle test

Exclusion Criteria:

* previous gait difficulty before stroke onset
* arthralgia on lower extremity
* uncontrolled hypertension or hypotension
* severe medical illness

Answer: C