The purpose of the first portion of this study is to gather feedback from clinicians on the usability of the current system and procedure, so the researchers can make reflex training more useful and usable for improving recovery after spinal cord injury or other nervous system injuries and diseases. The researchers are recruiting 20 therapists who have been actively practicing physical medicine and 30 adults with no known neurological conditions to test system usability and the reflex operant conditioning protocol. For this portion of the study, there are 5 visits.

The purpose of the second part of the study is to validate the capacity of the system to change the size of the targeted reflex. For this the researchers are recruiting 25 individuals with chronic incomplete SCI who have spasticity in the leg to participate in the reflex training procedure. The study involves approximately 45 visits with a total study duration of about 6 months.

This study is designed to gain a better understanding and natural history of acute flaccid myelitis (AFM).

This study will include reviewing medical records to record information about the medications taken to treat AFM and your social history (smoking, alcohol and drug use). The results of lab tests, imaging studies and tests will also be collected to determine if you have any damage to your nerves that are done by your clinical care team to diagnose your AFM.

Samples from Mouth, nose, stool and blood will be collected as a part of this study. Any remaining spinal fluid that is in the lab from the spinal tap from clinical labs will also be collected. A neurological exam and tests to determine issues with muscles, functionality and strength after being diagnosed with AFM will also be performed as a part of this study.

We are currently recruiting volunteers who are interested in participating in a brain-spinal cord-muscle response training study that aims to better understand the changes that take place in the nervous system as a result of this type of training. After spinal cord injury, brain-to-muscle connections are often interrupted. Because these connections are important in movement control, when they are not working well, movements may be disturbed. Researchers have found that people can learn to strengthen these connections through training. Strengthening these connections may be able to improve movement control and recovery after injuries.

Research participants will be asked to stand, sit, and walk during the study sessions. Electrodes are placed on the skin over leg muscles for monitoring muscle activity. For examining brain-to-muscle connections, we use transcranial magnetic stimulation. The stimulation is applied over the head and will indirectly stimulate brain cells with little or no discomfort.

Participation in this study requires approximately three sessions per week for four months, followed by two to three sessions over another three months. Each session lasts approximately 1 hour. Participants will receive a mileage reimbursement.

Spinal cord stimulation (SCS) therapy is currently used to treat the symptoms of chronic pain. Studying the effect of SCS during muscle testing, proprioception testing and multiple gait analysis, we expect to gain understanding of exactly how SCS influences motor and sensory pathways of the spinal cord. We expect this approach to broaden our understanding in the application of SCS in the chronic pain conditions, and may lead to therapeutic advances in other populations, for example, patients with spinal cord injury.

Our purpose is to conduct a 45-year follow-up, the ninth data collection in the SCI Longitudinal Aging Study.

Reflexes are important parts of our movements. When reflexes are not working well, movements are clumsy or even impossible. Researchers have found that people can learn to increase or decrease a reflex response with training. Recently, we have found that rats with spinal cord injuries can walk better after they are trained to change a spinal cord reflex. Thus, learning to change a reflex response may help people recover after a nervous system injury. We are currently studying effects of spinal cord reflex training (e.g., a knee jerk reflex) in people in early adulthood. We hope that the results of this study will help us develop spinal reflex training as a new treatment to help people in early adulthood recover better after spinal cord injury or other damage to the nervous system.

Reflexes are important parts of our movements. When reflexes are not working well, movements are clumsy or even impossible. After spinal cord injury, reflex responses may change. Researchers have found that people can learn to increase or decrease a reflex response with training. Recently, we have found that rats with spinal cord injuries can walk better after they are trained to change a spinal reflex. Thus, learning to change a reflex response may help people recover after a nervous system injury. In this study, we aim to examine whether learning to change a spinal reflex through operant conditioning training can improve movement function recovery after spinal cord injury.

Over many years, we have learnt that the brain's connections with the spinal cord change in response to injury or training. Because brain-spinal cord (i.e., corticospinal) pathways are very important in movement control, restoring function of these pathways could help to restore useful movement after spinal cord injury (SCI). In this project, we hypothesize that operant conditioning training of the muscle response to non-invasive transcranial magnetic stimulation can strengthen the functional connectivity of corticospinal pathways and thereby alleviate movement problems in people with chronic incomplete SCI. Specifically, through this project, we will investigate the effects of strengthening the corticospinal connection to the ankle dorsiflexor muscles through operant up-conditioning of the muscle evoked response, in hope to enhance the function of corticospinal pathways and alleviate foot drop (i.e., weak ankle dorsiflexion resulting in toe drop and drag) during walking in people with chronic incomplete SCI.

Spinal reflexes take important part in our movement. After spinal cord injury (SCI), reflexes often change. For many years, researchers and doctors have assumed that abnormally acting spinal reflexes lead to movement problems, without clear scientific evidence. For example, in people who suffer spasticity, a common problem after SCI, walking is disturbed, presumably because stretch reflexes (e.g., knee jerk reflex) and some other reflexes are not working well. Yet, which reflex is causing a problem in what way has not been well understood. Such understanding is very important in developing and applying effective therapies for improving gait recovery after SCI. Therefore, in this project, we are studying spinal stretch reflexes and other reflexes during walking, to understand how these reflexes contribute to spastic gait problems in people with chronic incomplete SCI. Successful completion of this project will result in better understanding of spastic gait problems, which in turn, will help us develop more effective therapy application and improve the quality of life in people after SCI.

In this study researchers aim to improve the collaborative research efforts of the Center for Rehabilitation Research in Neurological Conditions at the Medical University of South Carolina. The Center is comprised of several laboratories, including: the Communication and Swallowing Laboratory; the Locomotor Energetics and Assessment Laboratory; the Locomotor Rehabilitation Laboratory; the Neuromuscular Assessment Laboratory; and the Upper Extremity Motor Function Laboratory. The PI and investigators will recruit for their current and future studies in the above laboratories from the Clinical Database established here. Studies utilizing the Clinical Database will not include PHI but will only link to the Clinical Database individual patient code. This study is completed by completing a simple screening form with study personnel. Medical care/treatment future participation in studies is not influenced by inclusion in this study. We are also recruiting Healthy Controls for this study.