{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T23:22:01Z","timestamp":1785540121995,"version":"3.56.0"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T00:00:00Z","timestamp":1715644800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01HD079009"],"award-info":[{"award-number":["R01HD079009"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Jack and Dana McCallum Neurorehabilitation Training Fellowship"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Considering the growing interest in clinical applications of neuromodulation, assessing effects of various modulatory approaches is increasingly important. Monosynaptic spinal reflexes undergo depression following repeated activation, offering a means to quantify neuromodulatory influences. Following spinal cord injury (SCI), changes in reflex modulation are associated with spasticity and impaired motor control. To assess disrupted reflex modulation, low-frequency depression (LFD) of Hoffman (H)-reflex excitability is examined, wherein the amplitudes of conditioned reflexes are compared to an unconditioned control reflex. Alternatively, some studies utilize paired-pulse depression (PPD) in place of the extended LFD train. While both protocols induce similar amounts of H-reflex depression in neurologically intact individuals, this may not be the case for persons with neuropathology. We compared the H-reflex depression elicited by PPD and by trains of 3\u201310 pulses to an 11-pulse LFD protocol in persons with incomplete SCI. The amount of depression produced by PPD was less than an 11-pulse train (mean difference = 0.137). When compared to the 11-pulse train, the 5-pulse train had a Pearson\u2019s correlation coefficient (<jats:italic>R<\/jats:italic>) of 0.905 and a coefficient of determination (<jats:italic>R<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>) of 0.818. Therefore, a 5-pulse train for assessing LFD elicits modulation similar to the 11-pulse train and thus we recommend its use in lieu of longer trains.<\/jats:p>","DOI":"10.1371\/journal.pone.0300053","type":"journal-article","created":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T17:30:47Z","timestamp":1715707847000},"page":"e0300053","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Optimizing assessment of low frequency H-reflex depression in persons with spinal cord injury"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5371-6465","authenticated-orcid":true,"given":"Charles J.","family":"Creech","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1342-676X","authenticated-orcid":true,"given":"Jasmine M.","family":"Hope","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Zarkou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7219-4487","authenticated-orcid":true,"given":"Edelle C.","family":"Field-Fote","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,5,14]]},"reference":[{"key":"pone.0300053.ref001","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0079-6123(08)62277-3","article-title":"Modification of reflexes in normal and abnormal movements","volume":"97","author":"RB Stein","year":"1993","journal-title":"Prog Brain Res"},{"issue":"5","key":"pone.0300053.ref002","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1093\/brain\/awu038","article-title":"Altering spinal cord excitability enables voluntary movements after chronic complete paralysis in humans","volume":"137","author":"CA Angeli","year":"2014","journal-title":"Brain"},{"issue":"4","key":"pone.0300053.ref003","doi-asserted-by":"crossref","DOI":"10.3390\/brainsci11040472","article-title":"Transcutaneous Spinal Cord Stimulation Enhances Walking Performance and Reduces Spasticity in Individuals with Multiple Sclerosis","volume":"11","author":"US Hofstoetter","year":"2021","journal-title":"Brain Sciences"},{"issue":"15","key":"pone.0300053.ref004","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10153267","article-title":"Efficacy of Transcutaneous Spinal Stimulation versus Whole Body Vibration for Spasticity Reduction in Persons with Spinal Cord Injury","volume":"10","author":"EB Sandler","year":"2021","journal-title":"Journal of Clinical Medicine"},{"issue":"3","key":"pone.0300053.ref005","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1089\/neu.2019.6588","article-title":"Transcutaneous Spinal Cord Stimulation Induces Temporary Attenuation of Spasticity in Individuals with Spinal Cord Injury","volume":"37","author":"US Hofstoetter","year":"2020","journal-title":"J Neurotrauma"},{"issue":"6","key":"pone.0300053.ref006","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1109\/TNSRE.2018.2834339","article-title":"Transcutaneous Electrical Spinal Stimulation Promotes Long-Term Recovery of Upper Extremity Function in Chronic Tetraplegia","volume":"26","author":"F Inanici","year":"2018","journal-title":"IEEE Transactions on Neural Systems and Rehabilitation Engineering"},{"issue":"6","key":"pone.0300053.ref007","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10061167","article-title":"Combined Transcutaneous Spinal Stimulation and Locomotor Training to Improve Walking Function and Reduce Spasticity in Subacute Spinal Cord Injury: A Randomized Study of Clinical Feasibility and Efficacy","volume":"10","author":"S Estes","year":"2021","journal-title":"J Clin Med"},{"key":"pone.0300053.ref008","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.cnp.2016.02.003","article-title":"Clinical uses of H reflexes of upper and lower limb muscles","volume":"1","author":"D. 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