Identifications of Reflex Muscle Activities and Joint Moments Triggered by Electrical Stimulation to Sole of the Foot during Lokomat Treadmill Walking

The aim of this study was to investigate the characteristics of the flexion withdrawal reflex modulated during Lokomat treadmill walking in people with spinal cord injury. The influence of the limb position and movement were tested in 5 subjects with chronic spinal cord injury. EMG activities from tibialis anterior and moments of the hip joint elicited by the foot stimulation were examined during Lokomat treadmill walking. To trigger the flexion withdrawal reflex during Lokomat treadmill walking, a train of 10 stimulus pulses was applied at the skin of the medial arch. The TA EMG activity was modulated during gait phase and the largest TA reflex was obtained after heel-off and initial swing phase. During swing phase, TA EMG was 40.9% greater for the extended hip position (phase 6), compared with flexed hip position (phase 8). The measured reflex moment of the hip joint was also modulated during gait phase. In order to characterize the neural contribution of flexion reflex at the hip joint, we compared estimated moments consisted of the static and dynamic components with measured moment of the hip joint. The mean static gains of reflex hip moments for swing and stance phase are -0.1, -0.8, respectively. The mean dynamic gains of reflex hip moments are 0.25 for swing, 0.75 for stance phase. From this study, we postulate that the joint moment and muscle response of flexion withdrawal reflex have the phase-dependent modulation and linear relationship with hip angle and angular velocity for swing phase during Lokomat treadmill walking.