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1. The modulation of the short-latency stretch reflex during walking at different walking speeds was investigated and compared with the stretch reflex during standing in healthy human subjects. 2. Ankle joint stretches were applied by a system able to rotate the human ankle joint during treadmill walking in any phase of the step cycle. The system consisted of a mechanical joint attached to the subject's ankle joint and connected to a motor placed beside the treadmill by means of bowden wires. The weight of the total system attached to the leg of the subject was 900 g. 3. The short-latency soleus stretch reflex was modulated during a step. In the stance phase, the amplitude equaled that found during standing at matched soleus background electromyogram (EMG). In the transition from stance to swing, the amplitude was 0 in all subjects. In late swing, the stretch reflex amplitude increased to 45 +/- 27% (mean +/- SD) of the maximal amplitude in the stance phase (stretch amplitude 8 degrees, stretch velocity 250 degrees/s). 4. The onset (42 +/- 3.2 ms) and peak latencies (59 +/- 2.5 ms) of the stretch reflex did not depend on the phase in the step cycle at which the reflex was elicited. 5. When the ankle joint is rotated, a change in torque can be measured. The torque measured over the first 35 ms after stretch onset (nonreflex torque) was at a maximum during late stance, when the leg supported a large part of the body's weight, and at a minimum during the swing phase. At heel contact the nonreflex torque was 50% of its maximal value. 6. During the stance phase the maximal EMG stretch reflex had a phase lead of approximately 120 ms with respect to the maximal background EMG and a phase lead of approximately 250 ms with respect to the maximal nonreflex torque. 7. The constant latency of the stretch reflex during a step implied that the ankle extensor muscle spindles are always taut during walking. 8. The relatively high amplitude of the stretch reflex in late swing and at heel contact made it likely that the stretch reflex contributed to the activation of the ankle extensor muscles in early stance phase.

Objective: To evaluate a selective implantable drop foot stimulator (ActiGait) in terms of effect on walking and safety. Design: A phase II trial in which a consecutive sample of participants acted as their own controls. Subjects: People who had suffered a stroke at least 6 months prior to recruitment and had a drop-foot that affected walking were recruited from 3 rehabilitation centres in Denmark. Methods: Stimulators were implanted into all participants. Outcome measures were range of ankle dorsiflexion with stimulation and maximum walking speed and distance walked in 4 minutes. Measurements were applied before implantation, at 90 days and at a long-term follow-up assessment. Changes over time and with and without stimulation are reported. Safety was evaluated by nerve conduction velocity and adverse events. Results: Fifteen participants were implanted and 13 completed the trial. Long-term improvements were detected in walking speed and distance walked in 4 minutes when stimulated, and the orthotic effect of stimulation showed statistically significant improvement. The device did not compromise nerve conduction velocity and no serious device-related adverse events were reported. Technical problems were resolved by the long-term follow-up assessment at which further improvement in walking was observed. Conclusion: This trial has evaluated the safety and performance of the device, which was well accepted by patients and did not compromise safety.

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Previously the modulation of the quadriceps H-reflex has only been investigated in the initial part of the gait cycle, and it was suggested that the quadriceps H-reflex modulates with relative high reflex gain at heel contact and decreases during the subsequent part of stance (Dietz et al. 1990b). The objectives of the present study was to elaborate on the previous results by increasing the measurement resolution around heel contact and include additional measures in order to relate the H-reflex modulation to the mechanical function of the knee extensors throughout the gait cycle. EMG profiles were measured in quadriceps and the antagonistic hamstring muscles simultaneously with the knee joint kinematics in ten subjects during treadmill walking at preferred speed. H-reflex excitability was measured in vastus lateralis (VL) and rectus femoris (RF) at 11 selected positions during the gait cycle. The resulting excitability curves showed a significant modulation of the quadriceps H-reflex during the gait cycle. The H-reflex amplitude increases shortly after heel contact and reflex inhibition is present in the remaining part of stance and most of the swing phase. The modulation of the quadriceps H-reflex during walking does not follow the classical pattern of reciprocal inhibition between antagonistic muscles. It is suggested that at least during the stance phase the modulation of the quadriceps H-reflex is controlled by presynaptic inhibition. The present results confirm the idea that the excitability of the quadriceps H-reflex is controlled to comply with the different mechanical demands on the muscle during the gait cycle in humans.