The Evoked Potential Operant Conditioning System (EPOCS): a research tool and an emerging therapy for chronic neuromuscular disorders

J Vis Exp, null · DOI: 10.3791/63736 · Published: February 23, 2023

Simple Explanation

The Evoked Potential Operant Conditioning System (EPOCS) is a software tool used to condition muscle responses in individuals with neuromuscular disorders. EPOCS monitors target muscles and automatically triggers stimulation when certain conditions are met, providing feedback to help the person learn to control muscle excitability. This system can be used to modify reflexes, such as the Hoffmann reflex, to improve motor function in conditions like spastic gait after spinal-cord injury.

Study Duration

10 weeks for conditioning sessions, follow-up 3-6 months

Participants

Adults with and without neurological impairment, iSCI patients

Evidence Level

Not specified

Key Findings

1
EPOCS can be used to down-condition the Hoffmann reflex in the soleus muscle, which can improve walking in people with spastic gait due to incomplete spinal-cord injury.
2
The system provides continuous monitoring of EMG activity and immediate feedback of response size, enabling individuals to learn to control their muscle responses.
3
EPOCS includes various modes of operation, such as Stimulus Test, Voluntary Contraction, Recruitment Curve, Control Trials, and Training Trials, to support different aspects of the conditioning protocol.

Research Summary

The Evoked Potential Operant Conditioning System (EPOCS) aids scientific investigation of sensorimotor function, and can administer targeted neurobehavioral training that can impact sensorimotor rehabilitation in neuromuscular disorders. This article describes its capabilities, and illustrates its application in modifying a simple spinal reflex to achieve lasting improvement in motor function. Targeted neuroplasticity is still in its infancy. Its as-yet unexplored avenues are expected to provide great benefits both for developing novel therapeutic approaches and for elucidating the natural history of disease, and mechanisms of central nervous system function in both health and disease.

Practical Implications

Therapeutic Development

EPOCS offers a flexible platform for developing novel therapeutic approaches for neuromuscular disorders through targeted neuroplasticity.

Research Tool

EPOCS serves as a valuable research tool for investigating sensorimotor function and mechanisms of central nervous system function in health and disease.

Clinical Application

The system can be applied to various clinical problems, such as improving locomotion in individuals with spinal-cord injury or multiple sclerosis.

Study Limitations

1
The protocol is sensitive to variations in the relationship between stimulator current setting and the amount of current actually delivered to the nerve.
2
Diurnal variation may also affect a person’s electrophysiological responses.
3
The success of operant conditioning may be sensitive to the accuracy of the time interval chosen by the operator to define the H-reflex.

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