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Hyperreflexia is common after neurological injury such as stroke, yet clinical interventions have had mixed success. Our previous research has shown that hyperreflexia of the rectus femoris (RF) during pre-swing is closely associated with reduced swing phase knee flexion in those with post-stroke Stiff-Knee gait (SKG). Thus, reduction of RF hyperreflexia may improve walking function in those with post-stroke SKG. A non-pharmacological procedure for reducing hyperreflexia has emerged based on operant conditioning of H-reflex, an electrical analog of the spinal stretch reflex. It is currently unknown whether operant conditioning can be applied to the RF. This feasibility study trained 7 participants (5 neurologically intact, 2 post-stroke) to down-condition the RF H-reflex using visual feedback. We found an overall decrease in average RF H-reflex amplitude among all 7 participants (44% drop, p < 0.001, paired t-test), of which the post-stroke individuals contributed (49% drop). We observed a generalized training effect across quadriceps muscles. Post-stroke individuals exhibited improvements in peak knee-flexion velocity, reflex excitability during walking, and clinical measures of spasticity. These outcomes provide promising initial results that operant RF H-reflex conditioning is feasible, encouraging expansion to post-stroke individuals. This procedure could provide a targeted alternative in spasticity management.


Tis work was financially supported in part by the NIH/NICHD (P2CHD086844, Kautz), and JS is the recipient. Tis work was also supported by the NICHD under the National Institutes of Health under the Award Number R01HD100416.Te contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NICHD. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.



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