Table 3.

Key stakeholders in the clinical translation of spinal reflex conditioning. Their roles, goals, and challenges are indicated

Stakeholder	Role in translation	Needs, wants, goals	Challenges
Patients	Participate in operant conditioning treatment; judge effectiveness; pay portion of costs	Improved function (e.g., walking); reduced need for drugs (e.g., baclofen, botulinum toxin); decreased need for assistive devices; improved ability to function in the community	Time commitment; potential cost of device and co-pays
Clinician/therapist	Decide whom will benefit; provide operant conditioning	Clinically important improvement in symptoms and function	Setup and implementation time; deliver outcomes within reimbursement constraints
Clinical administrator	Buy operant conditioning device	High-quality outcomes; marketability and branding/name recognition for state-of-the-art device/therapy	FDA approval; meets clinical need and sustains itself financially; capital investment
Payers	Approve payment for operant conditioning or pay within existing coverage/reimbursement guidelines	Improved outcomes; value; satisfy patient needs	High-quality RCT trials; serve aging population; decrease disability burdens
Researcher	Optimize methods and outcomes of spinal reflex conditioning	Good study outcomes; research papers; knowledge contribution; presentations; patents	Grant funding; tech support; facilities; sufficient time to complete studies