Activation of the flexor reflex for gait training in chronic stroke patients

Mobility limitations are a common and quality-of-life-reducing consequence of stroke. A variety of therapeutic approaches exist to restore or improve walking ability, including electrical stimulation methods. One technique that has rarely been applied in this context is the electrical elicitation of the flexor reflex. This pilot study investigated whether gait training combined with supportive flexor reflex activation in patients in the chronic phase after stroke improves walking speed and walking distance. Five individuals with chronic stroke (mean 3.8 years post-stroke) completed two baseline assessments (T0 and T1), followed by a 5-week training phase comprising 15 therapy sessions (treadmill training and overground walking at moderate intensity). Post-intervention assessments were performed immediately after training (T2) and at follow-up visits 3 months (T3) and 12 months (T4) later. Outcomes included the 10-meter walk test and the 2-min walk test, each performed with and without flexor reflex activation. Additional assessments included comfortable and maximal treadmill walking speed, the User Satisfaction Evaluation Questionnaire, and video recordings of gait patterns. Significant differences between walking with and without flexor reflex activation were observed in both the 10-meter walk test and the 2-min walk test at pre- and post-training assessments. Performance in both tests improved significantly after the training phase, and these improvements remained detectable at T3. The User Satisfaction Evaluation Questionnaire indicated a high level of satisfaction with the device. Blinded video analysis by a physiotherapist indicated improved gait quality (greater safety and speed) both after training and during flexor reflex activation. This study shows for the first time in ambulatory chronic stroke outpatients, who were not enrolled in inpatient neurological rehabilitation, that gait training combined with flexor reflex activation improves walking speed and walking distance. The intervention resulted in sustained improvements in gait parameters, which were also reflected in qualitative gait changes. However, the respective contributions of gait training and flexor reflex activation cannot be distinguished and should be examined in a future randomized controlled trial.