{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:29:40Z","timestamp":1786512580435,"version":"build-2736575974"},"reference-count":37,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T00:00:00Z","timestamp":1730073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T00:00:00Z","timestamp":1730073600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>After a stroke many people experience hemiparesis, resulting in walking difficulties which affects independence, mobility, and participation in activities of daily living. Activating the nociceptive withdrawal reflex (NWR) during gait training aims to support the initiation and facilitation of the swing phase of the paretic leg. The aim of this review is to investigate the orthotic and therapeutic effects of a NWR stimulation intervention to improve gait in patients after a stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched the databases CENTRAL, DORIS, MEDLINE, and PEDro, trial registers and reference lists. We selected randomized controlled trials using any type of stimulation of the NWR in people after stroke, comparing it to any control intervention, and reporting a change in gait performance assessed by means of any appropriate measurement method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included three studies in this review, all of which used electrical stimulation to elicit the NWR during walking. The orthotic effect was investigated in one study, and the therapeutic effect in two studies, comparing walking with and without electrical stimulation\u2010triggered NWR. The meta\u2010analysis revealed a borderline statistical significance result for the therapeutic effect. The pooled mean difference between the treatment and control group (random\u2010effects model) for walking speed was 0.13\u2009m\/s (95% CI \u22120.04 to 0.29;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200972%) after treatment and 0.17\u2009m\/s (95% CI \u22120.03 to 0.37;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200962%) at follow\u2010up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Activating the NWR during gait training has not been investigated frequently so far. By using electrical stimulation\u2010elicited NWR, severely affected hemiparetic patients may improve their walking speed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aor.14894","type":"journal-article","created":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T12:38:12Z","timestamp":1730119092000},"page":"1089-1098","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Stimulation of the withdrawal reflex in gait training after stroke: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4153-0791","authenticated-orcid":false,"given":"Carmen","family":"Krewer","sequence":"first","affiliation":[{"name":"TUM School of Medicine and Health, Department of Health and Sport Sciences, Chair of Human Movement Science Technical University of Munich  Munich Germany"},{"name":"Department of Neurology Schoen Clinic Bad Aibling  Bad Aibling Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1898-3967","authenticated-orcid":false,"given":"Elaine","family":"Fischer","sequence":"additional","affiliation":[{"name":"TUM School of Medicine and Health, Department of Health and Sport Sciences, Chair of Human Movement Science Technical University of Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1275-4064","authenticated-orcid":false,"given":"Erika G.","family":"Spaich","sequence":"additional","affiliation":[{"name":"Department of Health Science and Technology Aalborg University  Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1669-3652","authenticated-orcid":false,"given":"Klaus","family":"Jahn","sequence":"additional","affiliation":[{"name":"Department of Neurology Schoen Clinic Bad Aibling  Bad Aibling Germany"},{"name":"German Center for Vertigo and Balance Disorders Ludwig\u2010Maximilians University Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,10,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(19)30034-1"},{"issue":"7","key":"e_1_2_8_3_1","first-page":"355","article-title":"S2e\u2010Leitlinie Rehabilitation der Mobilit\u00e4t nach Schlaganfall (ReMoS)","volume":"21","author":"Dohle C","year":"2015","journal-title":"Neurol Rehabil"},{"key":"e_1_2_8_4_1","volume-title":"Rehabilitation sensomotorischer St\u00f6rungen, S2k\u2010Leitlinie","author":"Nelles G","year":"2023"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/NPT.0000000000000303"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0079-6123(08)00652-3"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1910.sp001362"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-1716.1967.tb03636.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0361-9230(89)90127-5"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-008-0396-x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00221-009-1705-9"},{"key":"e_1_2_8_12_1","volume-title":"Cochrane handbook for systematic reviews of interventions version 6.2 (updated February 2021)","author":"Higgins JPT","year":"2021"},{"key":"e_1_2_8_13_1","unstructured":"The Cochrane Collaboration.Review manager (RevMan). (Version 5.4.1) [Computer program].2020."},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1743-0003-11-81"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-2660296\/v1"},{"key":"e_1_2_8_16_1","volume-title":"Enhancement of gait retraining by electrical stimulation of flexor reflex afferents in acute stroke patients: a randomized, controlled clinical study","author":"Quintern J","year":"2004"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-024-01377-y"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gaitpost.2015.04.009"},{"issue":"4","key":"e_1_2_8_19_1","first-page":"191","article-title":"Comparison of two therapy approaches in the rehabilitation of the pure motor hemiparetic stroke patient","volume":"9","author":"Gelber DA","year":"1995","journal-title":"J Neurol Rehabil"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269215511426803"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/3805628"},{"issue":"5","key":"e_1_2_8_22_1","first-page":"24","article-title":"Application of flexor reflex therapy in rehabilitation of lower extremity of hemiplegic patients after brain injury","volume":"9","author":"Qian KL","year":"2005","journal-title":"Chin J Clin Rehab"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1109\/TBME.2010.2096507"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.26.6.982"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.3233\/NRE-192805"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00115-009-2700-x"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00360.2003"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.35.2.234"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/93.4.743"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2012.07.013"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/94.1.77"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.26.1.39"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00232194"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brainresrev.2004.07.005"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9568.1999.00861.x"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-1716.2007.01706.x"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(199911)22:11<1520::AID-MUS6>3.0.CO;2-V"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s002210000587"}],"container-title":["Artificial Organs"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aor.14894","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/aor.14894","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aor.14894","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:58:40Z","timestamp":1786510720000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aor.14894"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,28]]},"references-count":37,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1111\/aor.14894"],"URL":"https:\/\/doi.org\/10.1111\/aor.14894","archive":["Portico"],"relation":{},"ISSN":["0160-564X","1525-1594"],"issn-type":[{"value":"0160-564X","type":"print"},{"value":"1525-1594","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,28]]},"assertion":[{"value":"2024-02-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}