{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:19:24Z","timestamp":1777508364188,"version":"3.51.4"},"reference-count":68,"publisher":"American Spinal Injury Association","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Spasticity is common in spinal cord injury (SCI) and multiple sclerosis (MS), and it can manifest as repeated, rhythmic muscle contractions called clonus. The spontaneous nature of clonus can disrupt independent performance of activities of daily living and negatively impact overall health and quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To quantify biomarkers of clonus and explore management of clonus in individuals with SCI or progressive MS using epidural spinal cord stimulation (ES) or dorsal root stimulation (DRS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Four male participants were included in this case series study: 3 with SCI and 1 with MS. All participants underwent temporary percutaneous ES lead placement over the dorsolateral thoracolumbar region of the spinal cord. Participants with SCI were also implanted with DRS leads at the L4 dorsal root. Clonus was elicited mechanically at the ankle while recording electromyography of the soleus muscle synchronized to direct spinal cord field potential recordings from ES and DRS percutaneous leads.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Clonus was evident as a prominent band (5-8 Hz) in recordings from ES leads, DRS leads, soleus muscle, and accelerometry. In 4 participants, percutaneous spinal stimulation reduced median clonus duration and cycle count. Clonus was immediately suppressed upon activation of spinal cord stimulation, and the suppression persisted even when clonus was reinitiated after turning off the stimulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The use of objective biomarkers, including spinal cord potentials, to quantify clonus in real time combined with the immediate and reversible effects of stimulation highlight the potential of neuromodulation as a therapeutic tool for managing clonus. These data demonstrate preliminary efficacy of ES and DRS for clonus monitoring and treatment in 4 participants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.46292\/sci24-00070","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T07:57:57Z","timestamp":1758700677000},"page":"114-124","source":"Crossref","is-referenced-by-count":1,"title":["Percutaneous Spinal Cord Stimulator Enables Novel Clonus Biomarker and Management in Persons With Spinal Cord Injury and Multiple Sclerosis: An Exploratory Study"],"prefix":"10.46292","volume":"31","author":[{"given":"Anders J.","family":"Asp","sequence":"first","affiliation":[{"name":"Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan L.","family":"Gill","sequence":"additional","affiliation":[{"name":"Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel D.","family":"Veith","sequence":"additional","affiliation":[{"name":"Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omid","family":"Jahanian","sequence":"additional","affiliation":[{"name":"Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. A.","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota"},{"name":"Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Candee J.","family":"Mills","sequence":"additional","affiliation":[{"name":"Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew R.","family":"Thoreson","sequence":"additional","affiliation":[{"name":"Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan M.","family":"Hagedorn","sequence":"additional","affiliation":[{"name":"Pain Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus A.","family":"Bendel","sequence":"additional","affiliation":[{"name":"Pain Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan J.","family":"Solinsky","sequence":"additional","affiliation":[{"name":"Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W. Oliver","family":"Tobin","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Rochester, Minnesota"},{"name":"Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin D.","family":"Zhao","sequence":"additional","affiliation":[{"name":"Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota"},{"name":"Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter J.","family":"Grahn","sequence":"additional","affiliation":[{"name":"Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota"},{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"25425","reference":[{"issue":"6","key":"b1","series-title":"Arch Phys Med Rehabil","first-page":"1132","article-title":"Prevalence and effect of problematic spasticity after traumatic spinal cord injury","volume":"98","author":"Holtz KA","year":"2017","unstructured":"Holtz KA, Lipson R, Noonan VK, Kwon BK, Mills PB. Prevalence and effect of problematic spasticity after traumatic spinal cord injury. Arch Phys Med Rehabil. 2017;98(6):1132-1138. doi:10.1016\/j.apmr.2016.09.124."},{"issue":"2","key":"b2","series-title":"Int J MS Care","first-page":"75","article-title":"Recognition, description, and variability of spasticity in individuals with multiple sclerosis and potential barriers to clinician-patient dialogue: Results from SEEN-MSS, a large-scale, self-reported survey","volume":"26","author":"Thrower B","year":"2024","unstructured":"Thrower B, Newsome SD, Hendin B, Danese S, Patterson J, Chinnapongse R. Recognition, description, and variability of spasticity in individuals with multiple sclerosis and potential barriers to clinician-patient dialogue: Results from SEEN-MSS, a large-scale, self-reported survey. Int J MS Care. 2024;26(2):75-80. doi:10.7224\/1537-2073.2022-115."},{"issue":"5","key":"b3","series-title":"Eur J Neurol","first-page":"720","article-title":"Location and severity of spasticity in the first 1-2 weeks and at 3 and 18 months after stroke","volume":"17","author":"Welmer AK","year":"2010","unstructured":"Welmer AK, Wid\u00e9n Holmqvist L, Sommerfeld DK. Location and severity of spasticity in the first 1-2 weeks and at 3 and 18 months after stroke. Eur J Neurol. 2010;17(5):720-725. doi:10.1111\/j.14681331.2009.02915.x."},{"issue":"10","key":"b4","series-title":"Curr Neurol Neurosci Rep","first-page":"79","article-title":"Assessment and measurement of spasticity in MS: State of the evidence","volume":"19","author":"Hugos CL","year":"2019","unstructured":"Hugos CL, Cameron MH. Assessment and measurement of spasticity in MS: State of the evidence. Curr Neurol Neurosci Rep. 2019;19(10):79. doi:10.1007\/s11910019-0991-2."},{"key":"b5","series-title":"Rehabil Res Pract","first-page":"279175","article-title":"Clinical understanding of spasticity: Implications for practice","volume":"2014","author":"Bhimani R","year":"2014","unstructured":"Bhimani R, Anderson L. Clinical understanding of spasticity: Implications for practice. Rehabil Res Pract. 2014;2014:279175. doi:10.1155\/2014\/279175."},{"issue":"1","key":"b6","series-title":"Med Glas (Zenica)","first-page":"19","article-title":"Clonus: Definition, mechanism, treatment","volume":"12","author":"Boyraz I","year":"2015","unstructured":"Boyraz I, Uysal H, Koc B, Sarman H. Clonus: Definition, mechanism, treatment. Med Glas (Zenica). 2015;12(1):19-26."},{"key":"b7","series-title":"Bates\u2019 Guide to Physical Examination and History Taking.","author":"Bickley LS","year":"2023","unstructured":"Bickley LS, Szilagyi PG, Hoffman RM. Bates\u2019 Guide to Physical Examination and History Taking. 13th ed. Lippincott Williams and Wilkins; 2023."},{"issue":"1","key":"b8","series-title":"Arch Phys Med Rehabil","first-page":"52","article-title":"A physiologically based clinical measure for spastic reflexes in spinal cord injury","volume":"86","author":"Benz EN","year":"2005","unstructured":"Benz EN, Hornby TG, Bode RK, Scheidt RA, Schmit BD. A physiologically based clinical measure for spastic reflexes in spinal cord injury. Arch Phys Med Rehabil. 2005;86(1):52-59. doi:10.1016\/j.apmr.2004.01.033."},{"issue":"4","key":"b9","series-title":"Arch Rehabil Res Clin Transl","first-page":"100153","article-title":"Accuracy and reliability of single-camera measurements of ankle clonus and quadriceps hyperreflexia","volume":"3","author":"Macon K","year":"2021","unstructured":"Macon K, Hoang D, Elizondo L, Kallus K, Sulzer J, Manella K. Accuracy and reliability of single-camera measurements of ankle clonus and quadriceps hyperreflexia. Arch Rehabil Res Clin Transl. 2021;3(4):100153. doi:10.1016\/j.arrct.2021.100153."},{"issue":"11","key":"b10","series-title":"J Neurophysiol","first-page":"2666","article-title":"Operant conditioning to increase ankle control or decrease reflex excitability improves reflex modulation and walking function in chronic spinal cord injury","volume":"109","author":"Manella KJ","year":"2013","unstructured":"Manella KJ, Roach KE, Field-Fote EC. Operant conditioning to increase ankle control or decrease reflex excitability improves reflex modulation and walking function in chronic spinal cord injury. J Neurophysiol. 2013;109(11):2666-2679. doi:10.1152\/jn.01039.2011."},{"issue":"5","key":"b11","series-title":"Phys Ther","first-page":"687","article-title":"Tonic stretch reflex threshold as a measure of ankle plantar-flexor spasticity after stroke","volume":"96","author":"Blanchette AK","year":"2016","unstructured":"Blanchette AK, Mullick AA, Mo\u00efn-Darbari K, Levin MF. Tonic stretch reflex threshold as a measure of ankle plantar-flexor spasticity after stroke. Phys Ther. 2016;96(5):687-695. doi:10.2522\/ptj.20140243."},{"issue":"1","key":"b12","series-title":"J Biomechanics","first-page":"148","article-title":"Clonus is explained from increased reflex gain and enlarged tissue viscoelasticity","volume":"45","author":"de Vlugt E","year":"2012","unstructured":"de Vlugt E, de Groot JH, Wisman WHJ, Meskers CGM. Clonus is explained from increased reflex gain and enlarged tissue viscoelasticity. J Biomechanics. 2012;45(1):148-155. doi:10.1016\/j.jbiomech.2011.09.023."},{"issue":"6","key":"b13","series-title":"J Appl Physiol","first-page":"2166","article-title":"Motor unit behavior during clonus","volume":"99","author":"Wallace DM","year":"2005","unstructured":"Wallace DM, Ross BH, Thomas CK. Motor unit behavior during clonus. J Appl Physiol. 2005;99(6):2166-2172. doi:10.1152\/japplphysiol.00649.2005."},{"issue":"3","key":"b14","series-title":"IEEE Trans Rehabil Eng","first-page":"327","article-title":"A simulation study of reflex instability in spasticity: Origins of clonus","volume":"7","author":"Hidler JM","year":"1999","unstructured":"Hidler JM, Rymer WZ. A simulation study of reflex instability in spasticity: Origins of clonus. IEEE Trans Rehabil Eng. 1999;7(3):327-340. doi:10.1109\/86.788469."},{"issue":"3","key":"b15","series-title":"J Electromyograph Kinesiol","first-page":"438","article-title":"Ankle clonus and its relationship with the medium-latency reflex response of the soleus by peroneal nerve stimulation","volume":"21","author":"Uysal H","year":"2011","unstructured":"Uysal H, Boyrazj, Yag\u02c7c\u0131og\u02c7lu S, Oktay F, Kafal\u0131 P, T\u00f6n\u00fck E. Ankle clonus and its relationship with the medium-latency reflex response of the soleus by peroneal nerve stimulation. J Electromyograph Kinesiol. 2011;21(3):438-444. doi:10.1016\/j.jelekin.2010.11.005."},{"issue":"2","key":"b16","series-title":"Exp Neurol","first-page":"165","article-title":"Short-term effects of intrathecal baclofen in spasticity","volume":"103","author":"Latash ML","year":"1989","unstructured":"Latash ML, Penn RD, Corcos DM, Gottlieb GL. Short-term effects of intrathecal baclofen in spasticity. Exp Neurol. 1989;103(2):165-172. doi:10.1016\/00144886(89)90078-2."},{"key":"b17","series-title":"Front Neurol","first-page":"11","article-title":"Use of surface EMG in clinical rehabilitation of individuals with SCI: Barriers and future considerations","author":"Pilkar R","year":"2020","unstructured":"Pilkar R, Momeni K, Ramanujam A, Ravi M, Garbarini E, Forrest GF. Use of surface EMG in clinical rehabilitation of individuals with SCI: Barriers and future considerations. Front Neurol. 2020;11. doi:10.3389\/fneur.2020.578559."},{"issue":"2","key":"b18","series-title":"Arch Phys Med Rehabil","first-page":"381","article-title":"Effect of Botulinum toxin on clonus: A systematic review","volume":"98","author":"Thanikachalam V","year":"2017","unstructured":"Thanikachalam V, Phadke CP, Ismail F, Boulias C. Effect of Botulinum toxin on clonus: A systematic review. Arch Phys Med Rehabil. 2017;98(2):381-390. doi:10.1016\/j.apmr.2016.09.126."},{"issue":"3","key":"b19","series-title":"NeuroRehabilitation.","first-page":"635","article-title":"Botulinum toxin in gait dysfunction due to ankle clonus: A case series","volume":"32","author":"McGuinness S","year":"2013","unstructured":"McGuinness S, Hillan J, Caldwell SB. Botulinum toxin in gait dysfunction due to ankle clonus: A case series. NeuroRehabilitation. 2013;32(3):635-647. doi:10.3233\/NRE-130886."},{"issue":"1","key":"b20","series-title":"J Spinal Cord Med","first-page":"10","article-title":"Changes in spasticity following functional electrical stimulation cycling in patients with spinal cord injury: A systematic review","volume":"45","author":"Alashram AR","unstructured":"Alashram AR, Annino G, Mercuri NB. Changes in spasticity following functional electrical stimulation cycling in patients with spinal cord injury: A systematic review. J Spinal Cord Med. 45(1):10-23. doi:10.1080\/10790268.2020.1763713."},{"key":"b21","series-title":"Exp Neurol","first-page":"267","article-title":"Nociceptordependent locomotor dysfunction after clinically-modeled hindlimb muscle stretching in adult rats with spinal cord injury","volume":"318","author":"Keller AV","year":"2019","unstructured":"Keller AV, Hainline C, Rees K, et al. Nociceptordependent locomotor dysfunction after clinically-modeled hindlimb muscle stretching in adult rats with spinal cord injury. Exp Neurol. 2019;318:267-276. doi:10.1016\/j.expneurol.2019.03.006."},{"issue":"9","key":"b22","series-title":"Am J Orthop (Belle Mead NJ)","first-page":"613","article-title":"Soleus neurectomy for dynamic ankle equinus in children with cerebral palsy","volume":"26","author":"Dout\u00e9 DA","year":"1997","unstructured":"Dout\u00e9 DA, Sponseller PD, Tolo VT, Atkins E, Silberstein CE. Soleus neurectomy for dynamic ankle equinus in children with cerebral palsy. Am J Orthop (Belle Mead NJ). 1997;26(9):613-616."},{"issue":"2","key":"b23","series-title":"Pain Pract","first-page":"204","article-title":"The applications of cryoneurolysis for acute and chronic pain management","volume":"23","author":"Biel E","year":"2023","unstructured":"Biel E, Aroke EN, Maye J, Zhang SJ. The applications of cryoneurolysis for acute and chronic pain management. Pain Pract. 2023;23(2):204-215. doi:10.1111\/papr.13182."},{"issue":"11","key":"b24","series-title":"Nat Med","first-page":"1677","article-title":"Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia","volume":"24","author":"Gill ML","year":"2018","unstructured":"Gill ML, Grahn PJ, Calvert JS, et al. Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia. Nat Med. 2018;24(11):1677-1682. doi:10.1038\/s41591-0180175-7."},{"issue":"7729","key":"b25","series-title":"Nature","first-page":"65","article-title":"Targeted neurotechnology restores walking in humans with spinal cord injury","volume":"563","author":"Wagner FB","year":"2018","unstructured":"Wagner FB, Mignardot JB, Le Goff-Mignardot CG, et al. Targeted neurotechnology restores walking in humans with spinal cord injury. Nature. 2018;563(7729):65-71. doi:10.1038\/s41586-018-0649-2."},{"issue":"3","key":"b26","series-title":"J Neurotrauma","first-page":"481","article-title":"Transcutaneous spinal cord stimulation induces temporary attenuation of spasticity in individuals with spinal cord injury","volume":"37","author":"Hofstoetter US","year":"2020","unstructured":"Hofstoetter US, Freundl B, Danner SM, et al. Transcutaneous spinal cord stimulation induces temporary attenuation of spasticity in individuals with spinal cord injury. J Neurotrauma. 2020;37(3):481-493. doi:10.1089\/neu.2019.6588."},{"issue":"2","key":"b27","series-title":"J Neural Eng","first-page":"026020","article-title":"ERAASR: An algorithm for removing electrical stimulation artifacts from multielectrode array recordings","volume":"15","author":"Shea DJ","year":"2018","unstructured":"O\u2019Shea DJ, Shenoy KV. ERAASR: An algorithm for removing electrical stimulation artifacts from multielectrode array recordings. J Neural Eng. 2018;15(2):026020. doi:10.1088\/1741-2552\/aaa365."},{"issue":"2","key":"b28","series-title":"J Spinal Cord Med","first-page":"132","article-title":"Effect of cold application and tizanidine on clonus: Clinical and electrophysiological assessment","volume":"32","author":"Boyraz MD I","year":"2009","unstructured":"Boyraz MD I, Oktay MD F, Celik MD C, Akyuz MD M, Uysal MD H. Effect of cold application and tizanidine on clonus: Clinical and electrophysiological assessment. J Spinal Cord Med. 2009;32(2):132-139. doi:10.1080\/10790268.2009.11760764."},{"issue":"1","key":"b29","series-title":"Phys Ther","first-page":"69","article-title":"Central pattern generation of locomotion: A review of the evidence","volume":"82","author":"MacKay-Lyons M","year":"2002","unstructured":"MacKay-Lyons M. Central pattern generation of locomotion: A review of the evidence. Phys Ther. 2002;82(1):69-83. doi:10.1093\/ptj\/82.1.69."},{"issue":"7","key":"b30","series-title":"NeuroReport","first-page":"1137","article-title":"Deep brain stimulation creates an informational lesion of the stimulated nucleus","volume":"15","author":"Grill WM","year":"2004","unstructured":"Grill WM, Snyder AN, Miocinovic S. Deep brain stimulation creates an informational lesion of the stimulated nucleus. NeuroReport. 2004;15(7):1137."},{"issue":"6","key":"b31","series-title":"Movement Disord","first-page":"937","article-title":"Adaptive deep brain stimulation: From experimental evidence toward practical implementation","volume":"38","author":"Neumann WJ","year":"2023","unstructured":"Neumann WJ, Gilron R, Little S, Tinkhauser G. Adaptive deep brain stimulation: From experimental evidence toward practical implementation. Movement Disord. 2023;38(6):937-948. doi:10.1002\/mds.29415."},{"issue":"8","key":"b32","series-title":"IEEE Trans Neural Syst Rehabil Eng","first-page":"1268","article-title":"Application of empirical mode decomposition combined with notch filtering for interpretation of surface electromyograms during functional electrical stimulation","volume":"25","author":"Pilkar R","year":"2017","unstructured":"Pilkar R, Yarossi M, Ramanujam A, et al. Application of empirical mode decomposition combined with notch filtering for interpretation of surface electromyograms during functional electrical stimulation. IEEE Trans Neural Syst Rehabil Eng. 2017;25(8):1268-1277. doi:10.1109\/TNSRE.2016.2624763."},{"key":"b33","series-title":"Contemp Clin Trials Commun","first-page":"101203","article-title":"Sham controls in device trials for chronic pain \u2013 tricky in practice-a review article","volume":"35","author":"Johnson S","year":"2023","unstructured":"Johnson S, Goebel A. Sham controls in device trials for chronic pain \u2013 tricky in practice-a review article. Contemp Clin Trials Commun. 2023;35:101203. doi:10.1016\/j.conctc.2023.101203."},{"issue":"6","key":"b34","series-title":"J Spinal Cord Med","first-page":"535","article-title":"International standards for neurological classification of spinal cord injury (revised 2011)","volume":"34","author":"Kirshblum SC","year":"2011","unstructured":"Kirshblum SC, Burns SP, Biering-Sorensen F, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34(6):535-546. doi:10.1179\/204577211X13207446293695."},{"issue":"6","key":"b1","series-title":"Arch Phys Med Rehabil","first-page":"1132","article-title":"Prevalence and effect of problematic spasticity after traumatic spinal cord injury","volume":"98","author":"Holtz KA","year":"2017","unstructured":"Holtz KA, Lipson R, Noonan VK, Kwon BK, Mills PB. Prevalence and effect of problematic spasticity after traumatic spinal cord injury. Arch Phys Med Rehabil. 2017;98(6):1132-1138. doi:10.1016\/j.apmr.2016.09.124."},{"issue":"2","key":"b2","series-title":"Int J MS Care","first-page":"75","article-title":"Recognition, description, and variability of spasticity in individuals with multiple sclerosis and potential barriers to clinician-patient dialogue: Results from SEEN-MSS, a large-scale, self-reported survey","volume":"26","author":"Thrower B","year":"2024","unstructured":"Thrower B, Newsome SD, Hendin B, Danese S, Patterson J, Chinnapongse R. Recognition, description, and variability of spasticity in individuals with multiple sclerosis and potential barriers to clinician-patient dialogue: Results from SEEN-MSS, a large-scale, self-reported survey. Int J MS Care. 2024;26(2):75-80. doi:10.7224\/1537-2073.2022-115."},{"issue":"5","key":"b3","series-title":"Eur J Neurol","first-page":"720","article-title":"Location and severity of spasticity in the first 1-2 weeks and at 3 and 18 months after stroke","volume":"17","author":"Welmer AK","year":"2010","unstructured":"Welmer AK, Wid\u00e9n Holmqvist L, Sommerfeld DK. Location and severity of spasticity in the first 1-2 weeks and at 3 and 18 months after stroke. Eur J Neurol. 2010;17(5):720-725. doi:10.1111\/j.14681331.2009.02915.x."},{"issue":"10","key":"b4","series-title":"Curr Neurol Neurosci Rep","first-page":"79","article-title":"Assessment and measurement of spasticity in MS: State of the evidence","volume":"19","author":"Hugos CL","year":"2019","unstructured":"Hugos CL, Cameron MH. Assessment and measurement of spasticity in MS: State of the evidence. Curr Neurol Neurosci Rep. 2019;19(10):79. doi:10.1007\/s11910019-0991-2."},{"key":"b5","series-title":"Rehabil Res Pract","first-page":"279175","article-title":"Clinical understanding of spasticity: Implications for practice","volume":"2014","author":"Bhimani R","year":"2014","unstructured":"Bhimani R, Anderson L. Clinical understanding of spasticity: Implications for practice. Rehabil Res Pract. 2014;2014:279175. doi:10.1155\/2014\/279175."},{"issue":"1","key":"b6","series-title":"Med Glas (Zenica)","first-page":"19","article-title":"Clonus: Definition, mechanism, treatment","volume":"12","author":"Boyraz I","year":"2015","unstructured":"Boyraz I, Uysal H, Koc B, Sarman H. Clonus: Definition, mechanism, treatment. Med Glas (Zenica). 2015;12(1):19-26."},{"key":"b7","series-title":"Bates\u2019 Guide to Physical Examination and History Taking.","author":"Bickley LS","year":"2023","unstructured":"Bickley LS, Szilagyi PG, Hoffman RM. Bates\u2019 Guide to Physical Examination and History Taking. 13th ed. Lippincott Williams and Wilkins; 2023."},{"issue":"1","key":"b8","series-title":"Arch Phys Med Rehabil","first-page":"52","article-title":"A physiologically based clinical measure for spastic reflexes in spinal cord injury","volume":"86","author":"Benz EN","year":"2005","unstructured":"Benz EN, Hornby TG, Bode RK, Scheidt RA, Schmit BD. A physiologically based clinical measure for spastic reflexes in spinal cord injury. Arch Phys Med Rehabil. 2005;86(1):52-59. doi:10.1016\/j.apmr.2004.01.033."},{"issue":"4","key":"b9","series-title":"Arch Rehabil Res Clin Transl","first-page":"100153","article-title":"Accuracy and reliability of single-camera measurements of ankle clonus and quadriceps hyperreflexia","volume":"3","author":"Macon K","year":"2021","unstructured":"Macon K, Hoang D, Elizondo L, Kallus K, Sulzer J, Manella K. Accuracy and reliability of single-camera measurements of ankle clonus and quadriceps hyperreflexia. Arch Rehabil Res Clin Transl. 2021;3(4):100153. doi:10.1016\/j.arrct.2021.100153."},{"issue":"11","key":"b10","series-title":"J Neurophysiol","first-page":"2666","article-title":"Operant conditioning to increase ankle control or decrease reflex excitability improves reflex modulation and walking function in chronic spinal cord injury","volume":"109","author":"Manella KJ","year":"2013","unstructured":"Manella KJ, Roach KE, Field-Fote EC. Operant conditioning to increase ankle control or decrease reflex excitability improves reflex modulation and walking function in chronic spinal cord injury. J Neurophysiol. 2013;109(11):2666-2679. doi:10.1152\/jn.01039.2011."},{"issue":"5","key":"b11","series-title":"Phys Ther","first-page":"687","article-title":"Tonic stretch reflex threshold as a measure of ankle plantar-flexor spasticity after stroke","volume":"96","author":"Blanchette AK","year":"2016","unstructured":"Blanchette AK, Mullick AA, Mo\u00efn-Darbari K, Levin MF. Tonic stretch reflex threshold as a measure of ankle plantar-flexor spasticity after stroke. Phys Ther. 2016;96(5):687-695. doi:10.2522\/ptj.20140243."},{"issue":"1","key":"b12","series-title":"J Biomechanics","first-page":"148","article-title":"Clonus is explained from increased reflex gain and enlarged tissue viscoelasticity","volume":"45","author":"de Vlugt E","year":"2012","unstructured":"de Vlugt E, de Groot JH, Wisman WHJ, Meskers CGM. Clonus is explained from increased reflex gain and enlarged tissue viscoelasticity. J Biomechanics. 2012;45(1):148-155. doi:10.1016\/j.jbiomech.2011.09.023."},{"issue":"6","key":"b13","series-title":"J Appl Physiol","first-page":"2166","article-title":"Motor unit behavior during clonus","volume":"99","author":"Wallace DM","year":"2005","unstructured":"Wallace DM, Ross BH, Thomas CK. Motor unit behavior during clonus. J Appl Physiol. 2005;99(6):2166-2172. doi:10.1152\/japplphysiol.00649.2005."},{"issue":"3","key":"b14","series-title":"IEEE Trans Rehabil Eng","first-page":"327","article-title":"A simulation study of reflex instability in spasticity: Origins of clonus","volume":"7","author":"Hidler JM","year":"1999","unstructured":"Hidler JM, Rymer WZ. A simulation study of reflex instability in spasticity: Origins of clonus. IEEE Trans Rehabil Eng. 1999;7(3):327-340. doi:10.1109\/86.788469."},{"issue":"3","key":"b15","series-title":"J Electromyograph Kinesiol","first-page":"438","article-title":"Ankle clonus and its relationship with the medium-latency reflex response of the soleus by peroneal nerve stimulation","volume":"21","author":"Uysal H","year":"2011","unstructured":"Uysal H, Boyrazj, Yag\u02c7c\u0131og\u02c7lu S, Oktay F, Kafal\u0131 P, T\u00f6n\u00fck E. Ankle clonus and its relationship with the medium-latency reflex response of the soleus by peroneal nerve stimulation. J Electromyograph Kinesiol. 2011;21(3):438-444. doi:10.1016\/j.jelekin.2010.11.005."},{"issue":"2","key":"b16","series-title":"Exp Neurol","first-page":"165","article-title":"Short-term effects of intrathecal baclofen in spasticity","volume":"103","author":"Latash ML","year":"1989","unstructured":"Latash ML, Penn RD, Corcos DM, Gottlieb GL. Short-term effects of intrathecal baclofen in spasticity. Exp Neurol. 1989;103(2):165-172. doi:10.1016\/00144886(89)90078-2."},{"key":"b17","series-title":"Front Neurol","first-page":"11","article-title":"Use of surface EMG in clinical rehabilitation of individuals with SCI: Barriers and future considerations","author":"Pilkar R","year":"2020","unstructured":"Pilkar R, Momeni K, Ramanujam A, Ravi M, Garbarini E, Forrest GF. Use of surface EMG in clinical rehabilitation of individuals with SCI: Barriers and future considerations. Front Neurol. 2020;11. doi:10.3389\/fneur.2020.578559."},{"issue":"2","key":"b18","series-title":"Arch Phys Med Rehabil","first-page":"381","article-title":"Effect of Botulinum toxin on clonus: A systematic review","volume":"98","author":"Thanikachalam V","year":"2017","unstructured":"Thanikachalam V, Phadke CP, Ismail F, Boulias C. Effect of Botulinum toxin on clonus: A systematic review. Arch Phys Med Rehabil. 2017;98(2):381-390. doi:10.1016\/j.apmr.2016.09.126."},{"issue":"3","key":"b19","series-title":"NeuroRehabilitation.","first-page":"635","article-title":"Botulinum toxin in gait dysfunction due to ankle clonus: A case series","volume":"32","author":"McGuinness S","year":"2013","unstructured":"McGuinness S, Hillan J, Caldwell SB. Botulinum toxin in gait dysfunction due to ankle clonus: A case series. NeuroRehabilitation. 2013;32(3):635-647. doi:10.3233\/NRE-130886."},{"issue":"1","key":"b20","series-title":"J Spinal Cord Med","first-page":"10","article-title":"Changes in spasticity following functional electrical stimulation cycling in patients with spinal cord injury: A systematic review","volume":"45","author":"Alashram AR","unstructured":"Alashram AR, Annino G, Mercuri NB. Changes in spasticity following functional electrical stimulation cycling in patients with spinal cord injury: A systematic review. J Spinal Cord Med. 45(1):10-23. doi:10.1080\/10790268.2020.1763713."},{"key":"b21","series-title":"Exp Neurol","first-page":"267","article-title":"Nociceptordependent locomotor dysfunction after clinically-modeled hindlimb muscle stretching in adult rats with spinal cord injury","volume":"318","author":"Keller AV","year":"2019","unstructured":"Keller AV, Hainline C, Rees K, et al. Nociceptordependent locomotor dysfunction after clinically-modeled hindlimb muscle stretching in adult rats with spinal cord injury. Exp Neurol. 2019;318:267-276. doi:10.1016\/j.expneurol.2019.03.006."},{"issue":"9","key":"b22","series-title":"Am J Orthop (Belle Mead NJ)","first-page":"613","article-title":"Soleus neurectomy for dynamic ankle equinus in children with cerebral palsy","volume":"26","author":"Dout\u00e9 DA","year":"1997","unstructured":"Dout\u00e9 DA, Sponseller PD, Tolo VT, Atkins E, Silberstein CE. Soleus neurectomy for dynamic ankle equinus in children with cerebral palsy. Am J Orthop (Belle Mead NJ). 1997;26(9):613-616."},{"issue":"2","key":"b23","series-title":"Pain Pract","first-page":"204","article-title":"The applications of cryoneurolysis for acute and chronic pain management","volume":"23","author":"Biel E","year":"2023","unstructured":"Biel E, Aroke EN, Maye J, Zhang SJ. The applications of cryoneurolysis for acute and chronic pain management. Pain Pract. 2023;23(2):204-215. doi:10.1111\/papr.13182."},{"issue":"11","key":"b24","series-title":"Nat Med","first-page":"1677","article-title":"Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia","volume":"24","author":"Gill ML","year":"2018","unstructured":"Gill ML, Grahn PJ, Calvert JS, et al. Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia. Nat Med. 2018;24(11):1677-1682. doi:10.1038\/s41591-0180175-7."},{"issue":"7729","key":"b25","series-title":"Nature","first-page":"65","article-title":"Targeted neurotechnology restores walking in humans with spinal cord injury","volume":"563","author":"Wagner FB","year":"2018","unstructured":"Wagner FB, Mignardot JB, Le Goff-Mignardot CG, et al. Targeted neurotechnology restores walking in humans with spinal cord injury. Nature. 2018;563(7729):65-71. doi:10.1038\/s41586-018-0649-2."},{"issue":"3","key":"b26","series-title":"J Neurotrauma","first-page":"481","article-title":"Transcutaneous spinal cord stimulation induces temporary attenuation of spasticity in individuals with spinal cord injury","volume":"37","author":"Hofstoetter US","year":"2020","unstructured":"Hofstoetter US, Freundl B, Danner SM, et al. Transcutaneous spinal cord stimulation induces temporary attenuation of spasticity in individuals with spinal cord injury. J Neurotrauma. 2020;37(3):481-493. doi:10.1089\/neu.2019.6588."},{"issue":"2","key":"b27","series-title":"J Neural Eng","first-page":"026020","article-title":"ERAASR: An algorithm for removing electrical stimulation artifacts from multielectrode array recordings","volume":"15","author":"Shea DJ","year":"2018","unstructured":"O\u2019Shea DJ, Shenoy KV. ERAASR: An algorithm for removing electrical stimulation artifacts from multielectrode array recordings. J Neural Eng. 2018;15(2):026020. doi:10.1088\/1741-2552\/aaa365."},{"issue":"2","key":"b28","series-title":"J Spinal Cord Med","first-page":"132","article-title":"Effect of cold application and tizanidine on clonus: Clinical and electrophysiological assessment","volume":"32","author":"Boyraz MD I","year":"2009","unstructured":"Boyraz MD I, Oktay MD F, Celik MD C, Akyuz MD M, Uysal MD H. Effect of cold application and tizanidine on clonus: Clinical and electrophysiological assessment. J Spinal Cord Med. 2009;32(2):132-139. doi:10.1080\/10790268.2009.11760764."},{"issue":"1","key":"b29","series-title":"Phys Ther","first-page":"69","article-title":"Central pattern generation of locomotion: A review of the evidence","volume":"82","author":"MacKay-Lyons M","year":"2002","unstructured":"MacKay-Lyons M. Central pattern generation of locomotion: A review of the evidence. Phys Ther. 2002;82(1):69-83. doi:10.1093\/ptj\/82.1.69."},{"issue":"7","key":"b30","series-title":"NeuroReport","first-page":"1137","article-title":"Deep brain stimulation creates an informational lesion of the stimulated nucleus","volume":"15","author":"Grill WM","year":"2004","unstructured":"Grill WM, Snyder AN, Miocinovic S. Deep brain stimulation creates an informational lesion of the stimulated nucleus. NeuroReport. 2004;15(7):1137."},{"issue":"6","key":"b31","series-title":"Movement Disord","first-page":"937","article-title":"Adaptive deep brain stimulation: From experimental evidence toward practical implementation","volume":"38","author":"Neumann WJ","year":"2023","unstructured":"Neumann WJ, Gilron R, Little S, Tinkhauser G. Adaptive deep brain stimulation: From experimental evidence toward practical implementation. Movement Disord. 2023;38(6):937-948. doi:10.1002\/mds.29415."},{"issue":"8","key":"b32","series-title":"IEEE Trans Neural Syst Rehabil Eng","first-page":"1268","article-title":"Application of empirical mode decomposition combined with notch filtering for interpretation of surface electromyograms during functional electrical stimulation","volume":"25","author":"Pilkar R","year":"2017","unstructured":"Pilkar R, Yarossi M, Ramanujam A, et al. Application of empirical mode decomposition combined with notch filtering for interpretation of surface electromyograms during functional electrical stimulation. IEEE Trans Neural Syst Rehabil Eng. 2017;25(8):1268-1277. doi:10.1109\/TNSRE.2016.2624763."},{"key":"b33","series-title":"Contemp Clin Trials Commun","first-page":"101203","article-title":"Sham controls in device trials for chronic pain \u2013 tricky in practice-a review article","volume":"35","author":"Johnson S","year":"2023","unstructured":"Johnson S, Goebel A. Sham controls in device trials for chronic pain \u2013 tricky in practice-a review article. Contemp Clin Trials Commun. 2023;35:101203. doi:10.1016\/j.conctc.2023.101203."},{"issue":"6","key":"b34","series-title":"J Spinal Cord Med","first-page":"535","article-title":"International standards for neurological classification of spinal cord injury (revised 2011)","volume":"34","author":"Kirshblum SC","year":"2011","unstructured":"Kirshblum SC, Burns SP, Biering-Sorensen F, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34(6):535-546. doi:10.1179\/204577211X13207446293695."}],"container-title":["Topics in Spinal Cord Injury Rehabilitation"],"original-title":[],"link":[{"URL":"https:\/\/tscir.kglmeridian.com\/view\/journals\/tscr\/31\/2\/article-p114.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/meridian.allenpress.com\/tscir\/article-pdf\/31\/2\/114\/3541536\/i1945-5763-31-2-114.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/tscir.kglmeridian.com\/downloadpdf\/journals\/tscr\/31\/2\/article-p114.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/tscir.kglmeridian.com\/downloadpdf\/journals\/tscr\/31\/2\/article-p114.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T15:50:49Z","timestamp":1775145049000},"score":1,"resource":{"primary":{"URL":"https:\/\/tscir.kglmeridian.com\/view\/journals\/tscr\/31\/2\/article-p114.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":68,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.46292\/sci24-00070","relation":{},"ISSN":["1082-0744","1945-5763"],"issn-type":[{"value":"1082-0744","type":"print"},{"value":"1945-5763","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}