Crossed spinal soleus muscle communication demonstrated by H-reflex conditioning

Neuromuscular Correlates of the Contralateral Stretch-induced Strength Loss

PURPOSE

The current study investigated the effects of unilateral passive stretching on the neuromuscular mechanisms involved in the force-generating capacity of the contralateral muscle.

METHODS

Twenty-six healthy men underwent unilateral passive stretching of the plantarflexors (5 × 45 s on + 15 s off; total stretching time, 225 s). Before and after the stretching protocol, contralateral ankle range of motion, maximum voluntary contraction (MVC) of the plantarflexors, and surface electromyographic root-mean-square (sEMG RMS) of the soleus and the gastrocnemii muscles were determined. Concurrently, V-wave, maximum and superimposed H-reflex, and M-wave were elicited via nerve stimulation to estimate the supraspinal, spinal, and peripheral mechanisms, respectively. sEMG RMS, V-wave, and H-reflex were normalized to the M-wave.

RESULTS

After passive stretching, contralateral ankle range of motion was increased (+8% [1%/15%], effect size [ES] = 0.43 [0.02/0.84], P < 0.001), MVC of the plantarflexors was decreased (-9% [-21%/-2%], ES = -0.96 [-1.53/-0.38], P < 0.001), and the sEMG RMS/M-wave of the soleus and the gastrocnemii muscles was decreased (≈-9%, ES ≈ -0.33, P < 0.05). Concurrently, the V-wave/M-wave superimposed was decreased in all muscles (≈-13%, ES = -0.81 to -0.52, P < 0.05). No change in H-reflex/M-wave and M-wave was observed under both maximum and superimposed condition. The decrease in the MVC and the sEMG RMS of the contralateral muscle was accompanied by a decrease in the V-wave/M-wave but not the H-reflex/M-wave ratios and the M-wave.

CONCLUSIONS

The present outcomes suggest that only supraspinal mechanisms might be involved in the contralateral decrease in the maximum force-generating capacity.

Phase-Dependent Crossed Inhibition Mediating Coordination of Anti-phase Bilateral Rhythmic Movement: A Mini Review

The activity of the left and right central pattern generators (CPGs) is efficiently coordinated during locomotion. To achieve this coordination, the interplay between the CPG controlling one leg and that controlling another must be present. Previous findings in aquatic vertebrates and mammalians suggest that the alternate activation of the left and right CPGs is mediated by the commissural interneurons crossing the midline of the spinal cord. Especially, V0 commissural interneurons mediate crossed inhibition during the alternative activity of the left and right CPGs. Even in humans, phase-dependent modulation of the crossed afferent inhibition during gait has been reported. Based on those previous findings, crossed inhibition of the CPG in one leg side caused by the activation of the contralateral CPG is a possible mechanism underlying the coordination of the anti-phase rhythmic movement of the legs. It has been hypothesized that the activity of the flexor half center in the CPG inhibits the contralateral flexor half center, but crossed inhibition of the extensor half center is not present because of the existence of the double limb support during gait. Nevertheless, previous findings on the phase-dependent crossed inhibition during anti-phase bilateral movement of the legs are not in line with this hypothesis. For example, extensor activity caused crossed inhibition of the flexor half center during bilateral cycling of the legs. In another study, the ankle extensor was inhibited at the period switching from extension to flexion during anti-phase rhythmic movement of the ankles. In this review article, I provide a critical discussion about crossed inhibition mediating the coordination of the anti-phase bilateral rhythmic movement of the legs.

Time Window of Perturbation-Induced Response Triggered by Ankle Motion and Body Sway above the Ankle

We determined the precise time windows of the electromyographic (EMG) response components triggered by ankle motion and by body sway above the ankle. A support surface under the feet of healthy young adult participants in the quiet stance was moved in translation. The EMG response component triggered by body displacement above the ankle began at 95–100 ms and ended 145–155 ms after the onset of the support surface translation. The EMG response triggered by ankle dorsiflexion began at 35–50 ms and ended 110–115 ms after the onset of the translation in the soleus muscle, indicating that the response component began at a time similar to the short-latency response. In contrast, the response component in the gastrocnemius muscle began noticeably after that. The EMG response triggered by ankle dorsiflexion began at 75–85 ms and ended 125–135 ms after the onset of the translation in the gastrocnemius muscle. Our findings indicate that the threshold of the early response component to the somatic sensation of the ankle motion in the soleus muscle is lower than that in the gastrocnemius muscle. The response component triggered by the ankle motion continued long after the end of ankle dorsiflexion, indicating that the early component is mediated not only by the monosynaptic stretch reflex pathway but also by the polysynaptic pathway.

Spinal Circuits Mediate a Stretch Reflex Between the Upper Limbs in Humans

Inter-limb reflexes play an important role in coordinating behaviors involving different limbs. Previous studies have demonstrated that human elbow muscles express an inter-limb stretch reflex at long-latency (50-100 ms), a timing consistent with a trans-cortical linkage. Here we probe for inter-limb stretch reflexes in the shoulder muscles of human participants. Unexpected torque pulses displaced one or both shoulders while participants adopted a steady posture against background torques. The results demonstrated inter-limb stretch reflexes occurring at short-latency for both shoulder extensors and flexors; the rapid timing (36-50 ms) must involve a spinal linkage for the two arms. Inter-limb stretch reflexes were also observed at long-latency yet they were opposite to the preceding short-latency; when the short-latency stretch reflex was excitatory then the long-latency stretch reflex was inhibitory and vice versa. Comparing the responses to contralateral arm displacement to those during simultaneous displacement of both arms revealed that inhibitory inter-limb stretch reflexes are independent of within-limb stretch reflexes, but that excitatory inter-limb stretch reflexes are suppressed by within-limb stretch reflexes. Our results provide the first demonstration of short-latency inter-limb stretch reflexes in the upper limb of humans and reveal interacting spinal circuits for within-limb and inter-limb stretch reflexes.

Rapid crossed responses in an intrinsic hand muscle during perturbed bimanual movements

Mechanical perturbations in one upper limb often elicit corrective responses in both the perturbed as well as its contralateral and unperturbed counterpart. These crossed corrective responses have been shown to be sensitive to the bimanual requirements of the perturbation, but crossed responses (CRs) in hand muscles are far less well studied. Here, we investigate corrective CRs in an intrinsic hand muscle, the first dorsal interosseous (1DI), to clockwise and anticlockwise mechanical perturbations to the contralateral index finger while participants performed a bimanual finger abduction task. We found that the CRs in the unperturbed 1DI were sensitive to the direction of the perturbation of the contralateral index finger. However, the size of the CRs was not sensitive to the amplitude of the contralateral perturbation nor its context within the bimanual task. The onset latency of the CRs was too fast to be purely transcortical (<70 ms) in 12/12 participants. This confirms that during isolated bimanual finger movements, sensory feedback from one hand can influence the other, but the pathways mediating the earliest components of this interaction are likely to involve subcortical systems such as the brainstem or spinal cord, which may afford less flexibility to the task demands.NEW & NOTEWORTHY An intrinsic hand muscle shows a crossed response to a perturbation of the contralateral index finger. The crossed response is dependent on the direction of the contralateral perturbation but not on the amplitude or the bimanual requirements of the movement, suggesting a far less flexible control policy than those governing crossed responses in more proximal muscles. The crossed response is too fast to be purely mediated by transcortical pathways, suggesting subcortical contributions.

Robotic investigation on effect of stretch reflex and crossed inhibitory response on bipedal hopping

To maintain balance during dynamic locomotion, the effects of proprioceptive sensory feedback control (e.g. reflexive control) should not be ignored because of its simple sensation and fast reaction time. Scientists have identified the pathways of reflexes; however, it is difficult to investigate their effects during locomotion because locomotion is controlled by a complex neural system and current technology does not allow us to change the control pathways in living humans. To understand these effects, we construct a musculoskeletal bipedal robot, which has similar body structure and dynamics to those of a human. By conducting experiments on this robot, we investigate the effects of reflexes (stretch reflex and crossed inhibitory response) on posture during hopping, a simple and representative bouncing gait with complex dynamics. Through over 300 hopping trials, we confirm that both the stretch reflex and crossed response can contribute to reducing the lateral inclination during hopping. These reflexive pathways do not use any prior knowledge of the dynamic information of the body such as its inclination. Beyond improving the understanding of the human neural system, this study provides roboticists with biomimetic ideas for robot locomotion control.

Spinal Control of Locomotion: Individual Neurons, Their Circuits and Functions

Systematic research on the physiological and anatomical characteristics of spinal cord interneurons along with their functional output has evolved for more than one century. Despite significant progress in our understanding of these networks and their role in generating and modulating movement, it has remained a challenge to elucidate the properties of the locomotor rhythm across species. Neurophysiological experimental evidence indicates similarities in the function of interneurons mediating afferent information regarding muscle stretch and loading, being affected by motor axon collaterals and those mediating presynaptic inhibition in animals and humans when their function is assessed at rest. However, significantly different muscle activation profiles are observed during locomotion across species. This difference may potentially be driven by a modified distribution of muscle afferents at multiple segmental levels in humans, resulting in an altered interaction between different classes of spinal interneurons. Further, different classes of spinal interneurons are likely activated or silent to some extent simultaneously in all species. Regardless of these limitations, continuous efforts on the function of spinal interneuronal circuits during mammalian locomotion will assist in delineating the neural mechanisms underlying locomotor control, and help develop novel targeted rehabilitation strategies in cases of impaired bipedal gait in humans. These rehabilitation strategies will include activity-based therapies and targeted neuromodulation of spinal interneuronal circuits via repetitive stimulation delivered to the brain and/or spinal cord.

Neural effects of muscle stretching on the spinal reflexes in multiple lower-limb muscles

While previous studies have shown that muscle stretching suppresses monosynaptic spinal reflex excitability in stretched muscles, its effects on non-stretched muscles is still largely unknown. The purpose of this study was to examine the effects of muscle stretching on monosynaptic spinal reflex in non-stretched muscles. Ten healthy male subjects participated in this study. Muscle stretching of the right triceps surae muscle was performed using a motor torque device for 1 minute. Three different dorsiflexion torques (at approximately 5, 10, and 15 Nm) were applied during muscle stretching. Spinal reflexes evoked by transcutaneous spinal cord stimulation were recorded in both the lower-limb muscles before, during, and at 0 and 5 min following muscle stretching. The amplitudes of the spinal reflexes in both the stretched and non-stretched muscles in the right (ipsilateral) leg were smaller during stretching compared to before, and at 0 and 5 min after stretching. Furthermore, the degree of reduction in the amplitude of the spinal reflexes in the right (ipsilateral) leg muscles increased significantly as the dorsiflexion torque (i.e., stretching of the right triceps surae muscles) increased. In contrast, reduction in the amplitude of the spinal reflexes with increasing dorsiflexion torque was not seen in the left (contralateral) leg muscles. Our results clearly indicate that muscle stretching has inhibitory effects on monosynaptic spinal reflexes, not only in stretched muscles, but also in non-stretched muscles of the ipsilateral leg.

Convergence of ipsi- and contralateral muscle afferents on common interneurons mediating reciprocal inhibition of ankle plantarflexors in humans

Recent studies have shown that afferents arising from muscle receptors located on one side can affect the activity of muscles on the contralateral side. In animal preparations, evidence supports that afferent pathways originating from one limb converge onto interneurons mediating disynaptic reciprocal Ia inhibition of the opposite limb. This study was designed to investigate whether this pathway is similar in humans to that described in animals. Thirteen healthy volunteers participated in one of two experiments. In experiment 1, the effects of ipsilateral posterior tibial nerve (iPTN) stimulation were assessed on the reciprocal Ia inhibition of the contralateral soleus (cSOL) motoneuronal pool (n = 8). Across all participants, iPTN stimulation intensity was 1.69 ± 0.3 × Motor Threshold (MT) and contralateral common peroneal (cCPN) stimulation intensity was 0.86 ± 0.16 × MT. iPTN and cCPN stimulation were delivered separately or in combination and changes in the ongoing electromyography (EMG) quantified. In experiment 2, the amplitude of a test SOL H-reflex elicited by contralateral PTN (cPTN) stimulation was quantified following iPTN, cCPN or iPTN + cCPN nerve stimulation (n = 5). Intensities used during the H-reflex conditioning experiment were 1.79 ± 0.4 × MT for the iPTN stimulation and 0.88 ± 0.16 × MT for cCPN stimulation. Across all participants, the onset of the cSOL EMG suppression was 42 ± 4, 44 ± 3 and 44 ± 3 ms for iPTN, cCPN and iPTN + cCPN conditions, respectively. The inhibition from the combined iPTN and cCPN stimulation was significantly greater compared to the algebraic sum of their separate effects. When conditioning the cSOL H-reflex, the ISI between the test cPTN and the iPTN or cCPN stimulus was 5.4 ± 0.5 and 2.6 ± 0.5, respectively. The combined stimulation induced a significantly greater inhibition compared to their separate effects. These data provide evidence of convergence on common inhibitory interneurons by muscle afferents activated by iPTN and cCPN stimulation during sitting. Since the inhibition elicited by cCPN stimulation is known to be mediated by the disynaptic Ia inhibitory pathway, this suggests that the crossed inhibition of cSOL motoneurones elicited by muscle afferents from the ipsilateral plantarflexor muscles is at least partly mediated by Ia inhibitory interneurons in the contralateral human spinal cord. This is similar to what has been observed in the cat.

Sensory Feedback in Interlimb Coordination: Contralateral Afferent Contribution to the Short-Latency Crossed Response during Human Walking

A constant coordination between the left and right leg is required to maintain stability during human locomotion, especially in a variable environment. The neural mechanisms underlying this interlimb coordination are not yet known. In animals, interneurons located within the spinal cord allow direct communication between the two sides without the need for the involvement of higher centers. These may also exist in humans since sensory feedback elicited by tibial nerve stimulation on one side (ipsilateral) can affect the muscles activation in the opposite side (contralateral), provoking short-latency crossed responses (SLCRs). The current study investigated whether contralateral afferent feedback contributes to the mechanism controlling the SLCR in human gastrocnemius muscle. Surface electromyogram, kinematic and kinetic data were recorded from subjects during normal walking and hybrid walking (with the legs moving in opposite directions). An inverse dynamics model was applied to estimate the gastrocnemius muscle proprioceptors’ firing rate. During normal walking, a significant correlation was observed between the magnitude of SLCRs and the estimated muscle spindle secondary afferent activity (P = 0.04). Moreover, estimated spindle secondary afferent and Golgi tendon organ activity were significantly different (P ≤ 0.01) when opposite responses have been observed, that is during normal (facilitation) and hybrid walking (inhibition) conditions. Contralateral sensory feedback, specifically spindle secondary afferents, likely plays a significant role in generating the SLCR. This observation has important implications for our understanding of what future research should be focusing on to optimize locomotor recovery in patient populations.

Short-latency crossed responses in the human biceps femoris muscle

KEY POINTS

The present study is the first to show short-latency crossed-spinal reflexes in the human upper leg muscles following mechanical rotations to the ipsilateral knee (iKnee) joint. The short-latency reflex in the contralateral biceps femoris (cBF) was inhibitory following iKnee extension perturbations, and facilitatory following iKnee flexion perturbations. The onset latency was 44 ms, indicating that purely spinal pathways mediate the cBF reflexes. The short-latency cBF inhibitory and facilitatory reflexes followed the automatic gain control principle, becoming larger as the level of background contraction in the cBF increased. The short-latency cBF reflexes were observed at the motor unit level using i.m. electromyography recordings, and the same population of cBF motor units that was inhibited following iKnee extensions was facilitated following iKnee flexions. Parallel interneuronal pathways from ipsilateral afferents to common motoneurons in the contralateral leg can therefore probably explain the perturbation direction-dependent reversal in the sign of the short-latency cBF reflex.

ABSTRACT

Interlimb reflexes contribute to the central neural co-ordination between different limbs in both humans and animals. Although commissural interneurons have only been directly identified in animals, spinally-mediated interlimb reflexes have been discovered in a number of human lower limb muscles, indicating their existence in humans. The present study aimed to investigate whether short-latency crossed-spinal reflexes are present in the contralateral biceps femoris (cBF) muscle following ipsilateral knee (iKnee) joint rotations during a sitting task, where participants maintained a slight pre-contraction in the cBF. Following iKnee extension joint rotations, an inhibitory reflex was observed in the surface electromyographic (EMG) activity of the cBF, whereas a facilitatory reflex was observed in the cBF following iKnee flexion joint rotations. The onset latency of both cBF reflexes was 44 ms, which is too fast for a transcortical pathway to contribute. The cBF inhibitory and facilitatory reflexes followed the automatic gain control principle, with the size of the response increasing as the level of background pre-contraction in the cBF muscle increased. In addition to the surface EMG, both short-latency inhibitory and facilitatory cBF reflexes were recorded directly at the motor unit level by i.m. EMG, and the same population of cBF motor units that were inhibited following iKnee extension joint rotations were facilitated following iKnee flexion joint rotations. Therefore, parallel interneuronal pathways (probably involving commissural interneurons) from ipsilateral afferents to common motoneurons in the contralateral leg can probably explain the perturbation direction-dependent reversal in the sign of the short-latency cBF reflex.

A Review on Locomotor Training after Spinal Cord Injury: Reorganization of Spinal Neuronal Circuits and Recovery of Motor Function

Locomotor training is a classic rehabilitation approach utilized with the aim of improving sensorimotor function and walking ability in people with spinal cord injury (SCI). Recent studies have provided strong evidence that locomotor training of persons with clinically complete, motor complete, or motor incomplete SCI induces functional reorganization of spinal neuronal networks at multisegmental levels at rest and during assisted stepping. This neuronal reorganization coincides with improvements in motor function and decreased muscle cocontractions. In this review, we will discuss the manner in which spinal neuronal circuits are impaired and the evidence surrounding plasticity of neuronal activity after locomotor training in people with SCI. We conclude that we need to better understand the physiological changes underlying locomotor training, use physiological signals to probe recovery over the course of training, and utilize established and contemporary interventions simultaneously in larger scale research studies. Furthermore, the focus of our research questions needs to change from feasibility and efficacy to the following: what are the physiological mechanisms that make it work and for whom? The aforementioned will enable the scientific and clinical community to develop more effective rehabilitation protocols maximizing sensorimotor function recovery in people with SCI.

Interlimb Reflexes Induced by Electrical Stimulation of Cutaneous Nerves after Spinal Cord Injury

Whether interlimb reflexes emerge only after a severe insult to the human spinal cord is controversial. Here the aim was to examine interlimb reflexes at rest in participants with chronic (>1 year) spinal cord injury (SCI, n = 17) and able-bodied control participants (n = 5). Cutaneous reflexes were evoked by delivering up to 30 trains of stimuli to either the superficial peroneal nerve on the dorsum of the foot or the radial nerve at the wrist (5 pulses, 300 Hz, approximately every 30 s). Participants were instructed to relax the test muscles prior to the delivery of the stimuli. Electromyographic activity was recorded bilaterally in proximal and distal arm and leg muscles. Superficial peroneal nerve stimulation evoked interlimb reflexes in ipsilateral and contralateral arm and contralateral leg muscles of SCI and control participants. Radial nerve stimulation evoked interlimb reflexes in the ipsilateral leg and contralateral arm muscles of control and SCI participants but only contralateral leg muscles of control participants. Interlimb reflexes evoked by superficial peroneal nerve stimulation were longer in latency and duration, and larger in magnitude in SCI participants. Interlimb reflex properties were similar for both SCI and control groups for radial nerve stimulation. Ascending interlimb reflexes tended to occur with a higher incidence in participants with SCI, while descending interlimb reflexes occurred with a higher incidence in able-bodied participants. However, the overall incidence of interlimb reflexes in SCI and neurologically intact participants was similar which suggests that the neural circuitry underlying these reflexes does not necessarily develop after central nervous system injury.

The effect of crossed reflex responses on dynamic stability during locomotion

In recent studies, we demonstrated that a neural pathway within the human spinal cord allows direct communication between muscles located in the opposing limb. Short-latency crossed responses (SLCRs) are elicited in the contralateral triceps surae at an onset of 40-69 ms following electrical stimulation of the ipsilateral tibial nerve (iTN). The SLCRs are significantly affected by lesions of the central nervous system where the patients are unable to attain normal walking symmetry. The aim of this study was to elucidate the functionality of SLCRs by investigating their effects on the center of pressure (CoP) and pressure distribution. SLCRs were elicited by iTN stimulation at the end of the ipsilateral swing phase while the participants (n = 8) walked on a treadmill. CoP location and pressure distribution on the sole of the contralateral foot were recorded using instrumented insoles inserted bilaterally in the participant's shoes. The SLCR induced a significant displacement of the CoP toward the medial and anterior direction, associated with a significant increase in pressure at the level of the first metatarsal head. The SLCR contributed to dynamic stability, accelerating the propulsion phase of the contralateral leg and thus preparing for a faster step in the event that the ipsilateral leg is not able to support body weight. The results presented here provide new insight into the functionality of SLCRs, introducing the perspective that training these reflexes, as shown successfully for other reflex pathways, would increase dynamic stability in patients with impaired locomotion.

Tonic suppression of the soleus H-reflex during rhythmic movement of the contralateral ankle

[Purpose] We investigated the effect of rhythmic ankle movement on the contralateral soleus H-reflex. The H-reflex was evoked from the right soleus muscle. [Subjects and Methods] Healthy humans rhythmically moved the left ankle (movement condition) or held the left ankle stationary (stationary condition) at one of three positions corresponding to the ankle positions at which the H-reflex was evoked in the movement condition. The background electromyographic amplitude in the right soleus muscle was maintained at 10% of the maximum voluntary contraction level, and that in the right tibialis anterior muscle was matched between the stationary and movement conditions. [Results] The soleus H-reflex was suppressed throughout all phases of contralateral rhythmic ankle movement. [Conclusion] Rhythmic movement of the contralateral joint suppresses the H-reflex in the muscle that is the prime mover of the joint homologous to the rhythmically moving joint. This inhibitory mechanism may be activated during unilateral rhythmic movement to isolate the motor control of the moving ankle from that of the contralateral stationary ankle.

Task-related modulation of crossed spinal inhibition between human lower limbs

Crossed reflex action mediated by muscle spindle afferent inputs has recently been revealed in humans. This raised the question of whether a complex spinal network involving commissural interneurons receiving inputs from proprioceptors and suprasegmental structures, as described in cats, persists in humans and contributes to the interlimb coordination during movement. First, we investigated the neurophysiological mechanisms underlying crossed reflex action between ankle plantar flexors and its corticospinal control from primary motor cortex. Second, we studied its modulation during motor tasks. We observed crossed inhibition in contralateral soleus motoneurons occurring with about 3 ms central latency, which is consistent with spinal transmission through oligosynaptic pathway. The early phase of inhibition was evoked with lower stimulus intensity than the late phase, suggesting mediation by group I and group II afferents, respectively. The postsynaptic origin of crossed inhibition is confirmed by the finding that both H-reflex and motor-evoked potential were reduced upon conditioning stimulation. Transcranial magnetic stimulation over ipsilateral and contralateral primary motor cortex reduced crossed inhibition, especially its late group II part. Last, late group II crossed inhibition was particularly depressed during motor tasks, especially when soleus was activated during the walking stance phase. Our results suggest that both group I and group II commissural interneurons participate in crossed reflex actions between ankle plantar flexors. Neural transmission at this level is depressed by descending inputs activated by transcranial magnetic stimulation over the primary motor cortex or during movement. The specific modulation of group II crossed inhibition suggests control from monoaminergic midbrain structures and its role for interlimb coordination during locomotion.

Crossed reflex reversal during human locomotion

During human walking, precise coordination between the two legs is required in order to react promptly to any sudden hazard that could threaten stability. The networks involved in this coordination are not yet completely known, but a direct spinal connection between soleus (SOL) muscles has recently been revealed. For this response to be functional, as previously suggested, we hypothesize that it will be accompanied by a reaction in synergistic muscles, such as gastrocnemius lateralis (GL), and that a reversal of the response would occur when an opposite reaction is required. In the present study, surface EMGs of contralateral SOL and GL were analyzed after tibial nerve (TN), sural nerve (SuN), and medial plantar nerve (MpN) stimulation during two tasks in which opposite reactions are functionally expected: normal walking (NW), just before ipsilateral heel strike, and hybrid walking (HW) (legs walking in opposite directions), at ipsilateral push off and contralateral touchdown. Early crossed facilitations were observed in the contralateral GL after TN stimulation during NW, and a reversal of such responses occurred during HW. These results underline the functional significance of short-latency crossed responses and represent the first evidence for short-latency reflex reversal in the contralateral limb for humans. Muscle afferents seem to mediate the response during NW, while during HW cutaneous afferents are likely involved. It is thus possible that different afferents mediate the crossed response during different tasks.

Short-latency crossed spinal responses are impaired differently in sub-acute and chronic stroke patients

OBJECTIVE

Investigate if patients with supraspinal lesions have impaired interlimb spinal reflex pathways. The short-latency crossed spinal response will be investigated during sitting from the non-paretic to paretic and paretic to non-paretic extremities at different stimulation intensities in chronic and sub-acute stroke patients.

METHODS

The ipsilateral tibial nerve of the paretic and non-paretic extremities were stimulated at motor threshold, 35% M-max and 85% M-max of the ipsilateral soleus while the contralateral soleus was contracted from 5% to 15% of the maximum voluntary contraction of the paretic soleus.

RESULTS

Chronic patients (from both extremities) had significantly less prominent inhibitory responses than healthy controls (post hoc tests: P<.01-P<.05). The responses were significantly modulated by stimulus intensity in healthy controls and chronic patients (P<.001-P<.05) but not sub-acute patients (P>.05). Some sub-acute patients had significantly more variable responses than chronic patients and healthy controls (P<.001-P⩽.05).

CONCLUSIONS

Short-latency interlimb reflexes are impaired differently in sub-acute vs. chronic patients, are impaired from the non-paretic and paretic extremity, and abnormal when compared to healthy controls.

SIGNIFICANCE

The inappropriate coordination could result in an inability to quickly avoid obstacles following a mechanical disturbance to the ipsilateral extremity. It also indicates that bilateral descending projections affect the response.