@article {4436,
	title = {The Evoked Potential Operant Conditioning System (EPOCS): A Research Tool and an Emerging Therapy for Chronic Neuromuscular Disorders.},
	journal = {J Vis Exp},
	year = {2022},
	month = {2022 08 25},
	abstract = {<p>The Evoked Potential Operant Conditioning System (EPOCS) is a software tool that implements protocols for operantly conditioning stimulus-triggered muscle responses in people with neuromuscular disorders, which in turn can improve sensorimotor function when applied appropriately. EPOCS monitors the state of specific target muscles-e.g., from surface electromyography (EMG) while standing, or from gait cycle measurements while walking on a treadmill-and automatically triggers calibrated stimulation when pre-defined conditions are met. It provides two forms of feedback that enable a person to learn to modulate the targeted pathway{\textquoteright}s excitability. First, it continuously monitors ongoing EMG activity in the target muscle, guiding the person to produce a consistent level of activity suitable for conditioning. Second, it provides immediate feedback of the response size following each stimulation and indicates whether it has reached the target value. To illustrate its use, this article describes a protocol through which a person can learn to decrease the size of the Hoffmann reflex-the electrically-elicited analog of the spinal stretch reflex-in the soleus muscle. Down-conditioning this pathway{\textquoteright}s excitability can improve walking in people with spastic gait due to incomplete spinal cord injury. The article demonstrates how to set up the equipment; how to place stimulating and recording electrodes; and how to use the free software to optimize electrode placement, measure the recruitment curve of direct motor and reflex responses, measure the response without operant conditioning, condition the reflex, and analyze the resulting data. It illustrates how the reflex changes over multiple sessions and how walking improves. It also discusses how the system can be applied to other kinds of evoked responses and to other kinds of stimulation, e.g., motor evoked potentials to transcranial magnetic stimulation; how it can address various clinical problems; and how it can support research studies of sensorimotor function in health and disease.</p>},
	keywords = {Chronic Disease, Conditioning, Operant, Electromyography, Evoked Potentials, H-Reflex, Humans, Neuromuscular Diseases, Spinal Cord Injuries},
	issn = {1940-087X},
	doi = {10.3791/63736},
	author = {Hill, N Jeremy and Gupta, Disha and Eftekhar, Amir and Brangaccio, Jodi A and Norton, James J S and McLeod, Michelle and Fake, Tim and Wolpaw, Jonathan R and Thompson, Aiko K}
}
@article {3389,
	title = {The simplest motor skill: mechanisms and applications of reflex operant conditioning.},
	journal = {Exerc Sport Sci Rev},
	volume = {42},
	year = {2014},
	month = {04/2014},
	pages = {82-90},
	abstract = {Operant conditioning protocols can change spinal reflexes gradually, which are the simplest behaviors. This article summarizes the evidence supporting two propositions: that these protocols provide excellent models for defining the substrates of learning and that they can induce and guide plasticity to help restore skills, such as locomotion, that have been impaired by spinal cord injury or other disorders.},
	keywords = {Animals, Conditioning, Operant, H-Reflex, Humans, Motor Skills, Muscle, Skeletal, Neuronal Plasticity, Reflex, Spinal Cord, Spinal Cord Injuries},
	issn = {1538-3008},
	doi = {10.1249/JES.0000000000000010},
	url = {http://www.ncbi.nlm.nih.gov/pubmed/24508738},
	author = {Thompson, Aiko K and Jonathan Wolpaw}
}
