Withdrawal reflex responses evoked by repetitive painful stimulation delivered on the sole of the foot during late stance: site,phase, and frequency modulation

The modulation of the lower limb nociceptive withdrawal reflex elicited during late stance by a stimulus train with frequencies of 15 and 30 Hz delivered to the mid-forefoot, arch of the foot, and heel was investigated. Stimulation was delivered at four moments of the gait cycle between heel-off and toe-off. Stimulation at 15 Hz induced larger kinematic responses at the knee and hip. Reduced plantarflexion and increased dorsiflexion, compared to control steps, were evoked at the ankle; these kinematic responses were site dependent with minimum responses evoked by stimulation at the heel. The dorsiflexion response was largest when stimulating at toe-off and was larger for stimulation at 15 Hz than at 30 Hz. The muscle reflex responses were site modulated in tibialis anterior with largest responses evoked by stimulation at the arch of the foot and mid-forefoot, and phase and frequency modulated in soleus. This study presents a detailed assessment of the lower limb nociceptive reflex modulation and provides results, which might have application in the rehabilitation of the hemiparetic gait.