Gait Rehabilitation Using Nociceptive Withdrawal Reflex-Based Functional Electrical Therapy in Stroke Patients

This chapter describes the modulation of the reflex size depending on the phase of the gait cycle and the stimulation site on the foot. Flexion of the hip and knee was observed irrespective of stimulation site while the largest reflexes were detected when stimulation was delivered at heel-off. Applying repetitive stimulation at 15 Hz (four bursts) increased the mechanical response substantially. This information is needed in order to utilize the reflex response optimally for gait support. In 15 subacute stroke patients, the swing phase was supported by the reflex evoked by four repetitive stimuli applied in the arch of the foot at heel-off during daily gait therapy. When tested one month after therapy, a significantly higher preferred gait velocity (average of 27%) was found compared with a control group receiving the same gait therapy but without reflex support.