, Volume 15, Issue 3, pp 669–683 | Cite as

Retraining Reflexes: Clinical Translation of Spinal Reflex Operant Conditioning

  • Amir EftekharEmail author
  • James J. S. Norton
  • Christine M. McDonough
  • Jonathan R. Wolpaw


Neurological disorders, such as spinal cord injury, stroke, traumatic brain injury, cerebral palsy, and multiple sclerosis cause motor impairments that are a huge burden at the individual, family, and societal levels. Spinal reflex abnormalities contribute to these impairments. Spinal reflex measurements play important roles in characterizing and monitoring neurological disorders and their associated motor impairments, such as spasticity, which affects nearly half of those with neurological disorders. Spinal reflexes can also serve as therapeutic targets themselves. Operant conditioning protocols can target beneficial plasticity to key reflex pathways; they can thereby trigger wider plasticity that improves impaired motor skills, such as locomotion. These protocols may complement standard therapies such as locomotor training and enhance functional recovery. This paper reviews the value of spinal reflexes and the therapeutic promise of spinal reflex operant conditioning protocols; it also considers the complex process of translating this promise into clinical reality.

Key Words

Spinal reflex H-reflex clinical translation operant conditioning plasticity rehabilitation neurological disorders. 



The National Center for Adaptive Neurotechnologies (NCAN) of the Wadsworth Center is supported by the National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health (NIH) (Grant 1P41EB018783 (JRW)). The authors’ work at the Wadsworth Center has also been supported by NIH grants NS22189 (JRW), HD36020 (XYChen), NS061823 (JRW and XYChen), HD32571 (AWEnglish), VA Merit Award 1 I01 BX002550 (JRW), the New York State Spinal Cord Injury Research Board (SCIRB), and the the National Center of Neuromodulation for Rehabilitation (NC NM4R) NIH grant P2CHD086844 (SAKautz). In addition, we would like to acknowledge the invaluable assistance and guidance of the Center for Translation of Rehabilitation Advances and Technology (TREAT), a national rehabilitation research resource funded by the National Center for Medical Rehabilitation Research (NCMRR) of the NIH (Grants P2CHD086841 (RMGreenwald) and R24HD065703 (RMGreenwald)).

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Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2018

Authors and Affiliations

  1. 1.National Center for Adaptive Neurotechnologies, Wadsworth CenterNew York State Department of HealthAlbanyUSA
  2. 2.School of Health and Rehabilitation ServicesUniversity of PittsburghPittsburghUSA
  3. 3.Department of NeurologyStratton VA Medical CenterAlbanyUSA

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