Excitability of the pathways mediating the startle reaction before execution of a voluntary movement

Startle-induced rapid release of a gait initiation sequence in Parkinson's disease with freezing of gait

OBJECTIVE

Freezing of gait (FOG) in Parkinson's disease (PD) is characterized by the inability to initiate stepping, despite the intention to do so. This study used a startling acoustic stimulus paradigm to examine if the capacity to select, prepare and initiate gait under simple and choice reaction time conditions are impaired in people with PD and FOG.

METHODS

Thirty individuals (10 PD with FOG, 10 PD without FOG, and 10 controls) performed an instructed-delay gait initiation task under simple and choice reaction time conditions. In a subset of trials, a startle stimulus (124 dB) was presented 500 ms before the time of the imperative go-cue. Anticipatory postural adjustments preceding and accompanying gait initiation were quantified.

RESULTS

The presentation of a startling acoustic stimulus resulted in the rapid initiation of an anticipatory postural adjustment sequence during both the simple and choice reaction time tasks in all groups.

CONCLUSIONS

The neural capacity to prepare the spatial and temporal components of gait initiation remains intact in PD individuals with and without FOG.

SIGNIFICANCE

The retained capacity to prepare anticipatory postural adjustments in advance may explain why external sensory cues are effective in the facilitation of gait initiation in people with PD with FOG.

Quantitative evaluation of trunk function and the StartReact effect during reaching in patients with cervical and thoracic spinal cord injury

Objective.Impaired trunk stability is frequent in spinal cord injury (SCI), but there is a lack of quantitative measures for assessing trunk function. Our objectives were to: (a) evaluate trunk muscle activity and movement patterns during a reaching task in SCI patients, (b) compare the impact of cervical (cSCI) and thoracic (tSCI) injuries in trunk function, and (c) investigate the effects of a startling acoustic stimulus (SAS) in these patients.Approach.Electromyographic (EMG) and smartphone accelerometer data were recorded from 15 cSCI patients, nine tSCI patients, and 24 healthy controls, during a reaching task requiring trunk tilting. We calculated the response time (RespT) until pressing a target button, EMG onset latencies and amplitudes, and trunk tilt, lateral deviation, and other movement features from accelerometry. Statistical analysis was applied to analyze the effects of group (cSCI, tSCI, control) and condition (SAS, non-SAS) in each outcome measure.Main results.SCI patients, especially those with cSCI, presented significantly longer RespT and EMG onset latencies than controls. Moreover, in SCI patients, forward trunk tilt was accompanied by significant lateral deviation. RespT and EMG latencies were remarkably shortened by the SAS (the so-called StartReact effect) in tSCI patients and controls, but not in cSCI patients, who also showed higher variability.Significance. The combination of EMG and smartphone accelerometer data can provide quantitative measures for the assessment of trunk function in SCI. Our results show deficits in postural control and compensatory strategies employed by SCI patients, including delayed responses and higher lateral deviations, possibly to improve sitting balance. This is the first study investigating the StartReact responses in trunk muscles in SCI patients and shows that the SAS significantly accelerates RespT in tSCI, but not in cSCI, suggesting an increased cortical control exerted by these patients.

Premovement inhibition can protect motor actions from interference by response-irrelevant sensory stimulation

KEY POINTS

Suppression of corticospinal excitability is reliably observed during preparation for a range of motor actions, leading to the belief that this preparatory inhibition is a physiologically obligatory component of motor preparation. The neurophysiological function of this suppression is uncertain. We restricted the time available for participants to engage in preparation and found no evidence for preparatory inhibition. The function of preparatory inhibition can be inferred from our findings that sensory stimulation can disrupt motor output in the absence of preparatory inhibition, but enhance motor output when inhibition is present. These findings suggest preparatory inhibition may be a strategic process which acts to protect prepared actions from external interference. Our findings have significant theoretical implications for preparatory processes. Findings may also have a pragmatic benefit in that acoustic stimulation could be used therapeutically to facilitate movement, but only if the action can be prepared well in advance.

ABSTRACT

Shortly before movement initiation, the corticospinal system undergoes a transient suppression. This phenomenon has been observed across a range of motor tasks, suggesting that it may be an obligatory component of movement preparation. We probed whether this was also the case when the urgency to perform a motor action was high, in a situation where little time was available to engage in preparatory processes. We controlled the urgency of an impending motor action by increasing or decreasing the foreperiod duration in an anticipatory timing task. Transcranial magnetic stimulation (TMS; experiment 1) or a loud acoustic stimulus (LAS; experiment 2) were used to examine how corticospinal and subcortical excitability were modulated during motor preparation. Preparatory inhibition of the corticospinal tract was absent when movement urgency was high, though motor actions were initiated on time. In contrast, subcortical circuits were progressively inhibited as the time to prepare increased. Interestingly, movement force and vigour were reduced by both TMS and the LAS when movement urgency was high, and enhanced when movement urgency was low. These findings indicate that preparatory inhibition may not be an obligatory component of motor preparation. The behavioural effects we observed in the absence of preparatory inhibition were induced by both TMS and the LAS, suggesting that accessory sensory stimulation may disrupt motor output when such stimulation is presented in the absence of preparatory inhibition. We conclude that preparatory inhibition may be an adaptive strategy which can serve to protect the prepared motor action from external interference.

Assessment of trunk flexion in arm reaching tasks with electromyography and smartphone accelerometry in healthy human subjects

Trunk stability is essential to maintain upright posture and support functional movements. In this study, we aimed to characterize the muscle activity and movement patterns of trunk flexion during an arm reaching task in sitting healthy subjects and investigate whether trunk stability is affected by a startling acoustic stimulus (SAS). For these purposes, we calculated the electromyographic (EMG) onset latencies and amplitude parameters in 8 trunk, neck, and shoulder muscles, and the tilt angle and movement features from smartphone accelerometer signals recorded during trunk bending in 33 healthy volunteers. Two-way repeated measures ANOVAs were applied to examine the effects of SAS and target distance (15 cm vs 30 cm). We found that SAS markedly reduced the response time and EMG onset latencies of all muscles, without changing neither movement duration nor muscle recruitment pattern. Longer durations, higher tilt angles, and higher EMG amplitudes were observed at 30 cm compared to 15 cm. The accelerometer signals had a higher frequency content in SAS trials, suggesting reduced movement control. The proposed measures have helped to establish the trunk flexion pattern in arm reaching in healthy subjects, which could be useful for future objective assessment of trunk stability in patients with neurological affections.

When reflex reactions oppose voluntary commands: The StartReact effect on eye opening

A startling auditory stimulus (SAS) induces a reflex response involving, among other reactions, a strong contraction of the orbicularis oculi muscle (OOc) and subsequent eye closure. A SAS also induces the StartReact effect, a significant shortening of reaction time in subjects ready for task execution. We examined the obvious conflict appearing when a StartReact paradigm requires participants with eyes closed to open their eyes to look for a visual target. We recorded OOc EMG activity and eyelid movements in healthy volunteers who were instructed to open their eyes at perception of a somatosensory imperative stimulus (IS) and locate the position of a Libet's clock's hand shown on a computer screen at 80 cm distance. In 6 out of 20 trials, we delivered a SAS simultaneously with the IS. The main outcome measures were reaction time at onset of eyelid movement and the time gap (TG) separating subjective assessment of the clock's hand position from real IS issuing. Control experiments included reaction time to eye closing and target location with eyes open to the same IS. Reaction time was significantly faster in SAS than in noSAS trials and slower for eye opening than for eye closing in both conditions. In the eye-opening task, TG was significantly shorter in SAS with respect to noSAS trials, despite the presence of the SAS-related burst in the OOc before EMG cessation. Our results indicate that the StartReact effect speeds up eye opening and location of a target in the visual field despite the startle reaction opposing the task.

Preparatory suppression and facilitation of voluntary and involuntary responses to loud acoustic stimuli in an anticipatory timing task

In this study, we sought to characterize the effects of intense sensory stimulation on voluntary and involuntary behaviors at different stages of preparation for an anticipated action. We presented unexpected loud acoustic stimuli (LAS) at-rest and at three critical times during active movement preparation (-1,192, -392, and 0 ms relative to expected voluntary movement onset) to probe the state of the nervous system, and measured their effect on voluntary and involuntary motor actions (finger-press and eye-blink startle reflex, respectively). Voluntary responses were facilitated by LAS presented during active preparation, leading to earlier and more forceful responses compared to control and LAS at-rest. Notably, voluntary responses were significantly facilitated on trials where the LAS was presented early during preparation (-1,192 ms). Eye-blink reflexes to the LAS at -392 ms were significantly reduced and delayed compared to blinks elicited at other time-points, indicating suppression of sub-cortical excitability. However, voluntary responses on these trials were still facilitated by the LAS. The results provide insight into the mechanisms involved in preparing anticipatory actions. Induced activation can persist in the nervous system and can modulate subsequent actions for a longer time-period than previously thought, highlighting that movement preparation is a continuously evolving process that is susceptible to external influence throughout the preparation period. Suppression of sub-cortical excitability shortly before movement onset is consistent with previous work showing corticospinal suppression which may be a necessary step before the execution of any voluntary response.

Neurophysiological analysis of the clinical pull test

Postural reflexes are impaired in conditions such as Parkinson's disease, leading to difficulty walking and falls. In clinical practice, postural responses are assessed using the "pull test," where an examiner tugs the prewarned standing patient backward at the shoulders and grades the response. However, validity of the pull test is debated, with issues including scaling and variability in administration and interpretation. It is unclear whether to assess the first trial or only subsequent repeated trials. The ecological relevance of a forewarned backward challenge is also debated. We therefore developed an instrumented version of the pull test to characterize responses and clarify how the test should be performed and interpreted. In 33 healthy participants, "pulls" were manually administered and pull force measured. Trunk and step responses were assessed with motion tracking. We probed for the StartReact phenomenon (where preprepared responses are released early by a startling stimulus) by delivering concurrent normal or "startling" auditory stimuli. We found that the first pull triggers a different response, including a larger step size suggesting more destabilization. This is consistent with "first trial effects," reported by platform translation studies, where movement execution appears confounded by startle reflex-like activity. Thus, first pull test trials have clinical relevance and should not be discarded as practice. Supportive of ecological relevance, responses to repeated pulls exhibited StartReact, as previously reported with a variety of other postural challenges, including those delivered with unexpected timing and direction. Examiner pull force significantly affected the postural response, particularly the size of stepping. NEW & NOTEWORTHY We characterized postural responses elicited by the clinical "pull test" using instrumentation. The first pull triggers a different response, including a larger step size suggesting more destabilization. Thus, first trials likely have important clinical and ecological relevance and should not be discarded as practice. Responses to repeated pulls can be accelerated with a startling stimulus, as reported with a variety of other challenges. Examiner pull force was a significant factor influencing the postural response.

Pattern of startle reflex to somatosensory stimuli changes after spinal cord injury

INTRODUCTION

Spinal cord injury (SCI) may cause functional changes at various levels in central and peripheral nervous systems. One of these changes is increased excitability above the lesion such as enhanced auditory startle responses (ASR). Startle response may also be obtained after somatosensory stimulus (startle reflex to somatosensory stimuli, SSS). In this study, we investigated changes of both ASR and SSS in SCI.

METHOD

We examined ASR and SSS in 14 patients with SCI and 18 age-matched healthy volunteers. SSS responses were recorded from orbicularis oculi (O.oc), sternocleidomastoid (SCM) and biceps brachii (BB) muscles by electrical stimulation of median nerve at the wrist. ASR was evoked by binaural auditory stimuli and recorded from O.oc, masseter, SCM and BB muscles. Probability, latency, amplitude and duration of responses were compared between two groups for each muscle.

RESULTS

Presence of response over O.oc after somatosensory stimuli was decreased in patients compared to controls (P = 0.004). There were no differences in SSS responses of other muscles. ASR latency was shorter in masseter, SCM and BB in patients with SCI, but only BB had significantly reduced latency (P = 0.033). The duration of O.oc response was longer and the amplitude of SCM was larger in patients with SCI (P = 0.037 and P = 0.015, respectively).

CONCLUSION

ASR is enhanced after SCI whereas SSS of eye muscles is hypoactive and pattern of SSS after median stimulation changes in SCI.

Disruption of Fixation Reveals Latent Sensorimotor Processes in the Superior Colliculus

Executive control of voluntary movements is a hallmark of the mammalian brain. In the gaze-control network, this function is thought to be mediated by a critical balance between neurons responsible for generating movements and those responsible for fixating or suppressing movements, but the nature of this balance between the relevant elements-saccade-generating and fixation-related neurons-remains unclear. Specifically, it has been debated whether the two functions are necessarily coupled (i.e., push-and-pull) or independently controlled. Here we show that behavioral perturbation of ongoing fixation with the trigeminal blink reflex in monkeys (Macaca mulatta) alters the effective balance between fixation and saccade-generating neurons in the superior colliculus (SC) and can lead to premature gaze shifts reminiscent of compromised inhibitory control. The shift in balance is primarily driven by an increase in the activity of visuomovement neurons in the caudal SC, and the extent to which fixation-related neurons in the rostral SC play a role seems to be linked to the animal's propensity to make microsaccades. The perturbation also reveals a hitherto unknown feature of sensorimotor integration: the presence of a hidden visual response in canonical movement neurons. These findings offer new insights into the latent functional interactions, or lack thereof, between components of the gaze-control network, suggesting that the perturbation technique used here may prove to be a useful tool for probing the neural mechanisms of movement generation in executive function and dysfunction.

SIGNIFICANCE STATEMENT

Eye movements are an integral part of how we explore the environment. Although we know a great deal about where sensorimotor transformations leading to saccadic eye movements are implemented in the brain, less is known about the functional interactions between neurons that maintain gaze fixation and neurons that program saccades. In this study, we used a novel approach to study these interactions. By transient disruption of fixation, we found that activity of saccade-generating neurons can increase independently of modulation in fixation-related neurons, which may occasionally lead to premature movements mimicking lack of impulse control. Our findings support the notion of a common pathway for sensory and movement processing and suggest that impulsive movements arise when sensory processes become "motorized."

Evidence for Startle Effects due to Externally Induced Lower Limb Movements: Implications in Neurorehabilitation

Passive limb displacement is routinely used to assess muscle tone. If we attempt to quantify muscle stiffness using mechanical devices, it is important to know whether kinematic stimuli are able to trigger startle reactions. Whether kinematic stimuli are able to elicit a startle reflex and to accelerate prepared voluntary movements (StartReact effect) has not been studied extensively to date. Eleven healthy subjects were suspended in an exoskeleton and were exposed to passive left knee flexion (KF) at three intensities, occasionally replaced by fast right KF. Upon perceiving the movement subjects were asked to perform right wrist extension (WE), assessed by extensor carpi radialis (ECR) electromyographic activity. ECR latencies were shortest in fast trials. Startle responses were present in most fast trials, yet being significantly accelerated and larger with right versus left KF, since the former occurred less frequently and thus less expectedly. Startle responses were associated with earlier and larger ECR responses (StartReact effect), with the largest effect again upon right KF. The results provide evidence that kinematic stimuli are able to elicit both startle reflexes and a StartReact effect, which depend on stimulus intensity and anticipation, as well as on the subjects' preparedness to respond.

Triggering prepared actions by sudden sounds: reassessing the evidence for a single mechanism

Loud acoustic stimuli can unintentionally elicit volitional acts when a person is in a state of readiness to execute them (the StartReact effect). It has been assumed that the same subcortical pathways and brain regions underlie all instances of the StartReact effect. They are proposed to involve the startle reflex pathways, and the eliciting mechanism is distinct from other ways in which sound can affect the motor system. We present an integrative review which shows that there is no evidence to support these assumptions. We argue that motor command generation for learned, volitional orofacial, laryngeal and distal limb movements is cortical and the StartReact effect for such movements involves transcortical pathways. In contrast, command generation for saccades, locomotor corrections and postural adjustments is subcortical and subcortical pathways are implicated in the StartReact effect for these cases. We conclude that the StartReact effect is not a special phenomenon mediated by startle reflex pathways, but rather is a particular manifestation of the excitatory effects of intense stimulation on the central nervous system.

Startle activation is additive with voluntary cortical activation irrespective of stimulus modality

When a startling acoustic stimulus (SAS) is presented during a simple reaction time (RT) task, it can trigger the prepared response through an involuntary initiation pathway. Previous research modelling the effects of presenting a SAS at various intervals following a non-startling auditory imperative signal (IS) suggested that involuntary initiation-related neural activation is additive with the voluntary initiation processes. The current study tested the predictions of this additive model when the SAS and IS are of different modalities by using a visual rather than auditory go-signal. Because voluntary RT latencies are delayed for visual stimuli compared to acoustic stimuli, it was hypothesised that the time course of additive activation would be similarly delayed. Participants performed 150 RT trials requiring a targeted 20° wrist extension task with a SAS presented 0-125 ms following a visual go-signal. Results were not different to those predicted by an additive model (p=0.979), yet were significantly different to those predicted by a horse-race model (p=0.037), indicating a joint contribution of voluntary and involuntary activation, even when the IS and SAS are of different modalities. Furthermore, the results indicated that voluntary RT differences due to stimulus modality are attributable to processes that occur prior to the increase in initiation-related activation.

What startles tell us about control of posture and gait

Recently, there has been an increase in studies evaluating startle reflexes and StartReact, many in tasks involving postural control and gait. These studies have provided important new insights. First, several experiments indicate a superimposition of startle reflex activity on the postural response during unexpected balance perturbations. Overlap in the expression of startle reflexes and postural responses emphasizes the possibility of, at least partly, a common substrate for these two types of behavior. Second, it is recognized that the range of behaviors, susceptible to StartReact, has expanded considerably. Originally this work was concentrated on simple voluntary ballistic movements, but gait initiation, online step adjustments and postural responses can be initiated earlier by a startling stimulus as well, indicating advanced motor preparation of posture and gait. Third, recent experiments on StartReact using TMS and patients with corticospinal lesions suggest that this motor preparation involves a close interaction between cortical and subcortical structures. In this review, we provide a comprehensive overview on startle reflexes, StartReact, and their interaction with posture and gait.

Neural processes mediating the preparation and release of focal motor output are suppressed or absent during imagined movement

Movements that are executed or imagined activate a similar subset of cortical regions, but the extent to which this activity represents functionally equivalent neural processes is unclear. During preparation for an executed movement, presentation of a startling acoustic stimulus (SAS) evokes a premature release of the planned movement with the spatial and temporal features of the tasks essentially intact. If imagined movement incorporates the same preparatory processes as executed movement, then a SAS should release the planned movement during preparation. This hypothesis was tested using an instructed-delay cueing paradigm during which subjects were required to rapidly release a handheld weight while maintaining the posture of the arm or to perform first-person imagery of the same task while holding the weight. In a subset of trials, a SAS was presented at 1500, 500, or 200 ms prior to the release cue. Task-appropriate preparation during executed and imagined movements was confirmed by electroencephalographic recording of a contingent negative variation waveform. During preparation for executed movement, a SAS often resulted in premature release of the weight with the probability of release progressively increasing from 24 % at -1500 ms to 80 % at -200 ms. In contrast, the SAS rarely (<2 % of trials) triggered a release of the weight during imagined movement. However, the SAS frequently evoked the planned postural response (suppression of bicep brachii muscle activity) irrespective of the task or timing of stimulation (even during periods of postural hold without preparation). These findings provide evidence that neural processes mediating the preparation and release of the focal motor task (release of the weight) are markedly attenuated or absent during imagined movement and that postural and focal components of the task are prepared independently.

Responses to startling acoustic stimuli indicate that movement-related activation is constant prior to action: a replication with an alternate interpretation

A recent study by Marinovic et al. (J. Neurophysiol., 2013, 109: 996-1008) used a loud acoustic stimulus to probe motor preparation in a simple reaction time (RT) task. Based on decreasing RT latency and increases in motor output measures as the probe stimulus approached the "go" stimulus, the authors concluded that response-related activation increased abruptly 65 ms prior to the imperative stimulus, a result in contrast to previous literature. However, this study did not measure reflexive startle activity in the sternocleidomastoid (SCM) muscle, which has been used to delineate between response triggering by a loud acoustic stimuli and effects of stimulus intensity and/or intersensory facilitation. Due to this methodological limitation, it was unclear if the data accurately represented movement-related activation changes. In order to provide a measure as to whether response triggering occurred on each trial, the current experiment replicated the study by Marinovic et al., with the collection of muscle activation in the SCM. While the replication analyses involving all trials confirmed similar results to those reported by Marinovic et al., when data were limited to those in which startle-related SCM activation occurred, the results indicated that movement-related activation is constant in the 65 ms prior to action initiation. The difference between analyses suggests that when SCM activation is not considered, results may be confounded by trials in which the probe stimulus does not trigger the prepared response. Furthermore, these results provide additional confirmation that reflexive startle activation in the SCM is a robust indicator of response triggering by a loud acoustic stimulus.

Startle neural activity is additive with normal cortical initiation-related activation

The current study examined the process of response initiation in a simple reaction time (RT) task using a startling acoustic stimulus (SAS), which has been shown to trigger a prepared movement through an involuntary initiation pathway. The SAS was presented within the RT interval (concurrent with, and 25, 50, 75, 100, and 125 ms following the "go" signal), with the observed response latency used to examine the relative contributions of voluntary and involuntary activation to response initiation. Our results clearly indicate that both voluntary and startle-related initiation activation jointly contribute to the observed RT. The data support a model in which startle-related neural activity is additive with voluntary cortical initiation-related activation. This result also provides indirect support for the hypothesis that both voluntary and SAS-related involuntary activation involve a similar process of response output.

Corticospinal modulation induced by sounds depends on action preparedness

A loud acoustic stimulus (LAS) presented during movement preparation can induce an early release of the prepared action. Because loud sound has been found to have an inhibitory effect on motor cortex excitability, it is possible that the motor cortex plays little role in the early release of prepared responses. We sought to shed new light on this suggestion by probing changes in corticospinal excitability after LAS presentation during preparation for an anticipatory action. Unexpectedly, we show that the changes in corticospinal excitability after LAS presentation are not fixed. Based on the magnitude of motor-evoked potentials elicited by transcranial magnetic and electric stimulation of the motor cortex, we demonstrate that the effects of auditory stimuli on corticospinal excitability depend on the level of readiness for action: inhibition in early preparation and facilitation close to movement onset. We also show that auditory stimuli can regulate intracortical excitability by increasing intracortical facilitation and reducing short-interval intracortical inhibition. Together, these findings indicate that, at least in part, the early release of motor responses by auditory stimuli involves the motor cortex.

Decreased fibularis reflex response during inversion perturbations in FAI subjects

Investigate reflex responses in muscles throughout the lower limb and low back during sudden inversion perturbations in individuals with and without Functional Ankle Instability (FAI) while walking. Forty subjects participated in the study. Surface electromyogram recordings were obtained from the fibularis (FIB), gluteus medius (GM), erector spinae (ES), and sternocleidomastoid (SCM) of the injured/matched side as well as the uninjured/matched contralateral side (FIB_CLS, GM_CLS, or ES_CLS). Latency and amplitude data were collected while subjects were walking on a custom-built perturbation walkway. The onset of the short-latency stretch reflex of the FIB was significantly later in the injured side of the FAI individuals when compared to the control group (P=0.009). Both the short and long latency reflex amplitude was significantly smaller in the FIB muscle in the FAI group than in the control group (P<0.008). No significant differences in latency or amplitude reflex responses were identified between the two groups in the GM, ES, FIB_CLS, GM_CLS, or ES_CLS (P>.05). Interpretation of these results indicate that during a dynamic perturbation task individuals with FAI demonstrate longer fibularis muscle latencies on the injured side while no significant changes in the proximal muscle groups. Additionally, short and long latency reflex amplitude was significantly decreased in FAI individuals.

The StartReact effect on self-initiated movements

Preparation of the motor system for movement execution involves an increase in excitability of motor pathways. In a reaction time task paradigm, a startling auditory stimulus (SAS) delivered together with the imperative signal (IS) shortens reaction time significantly. In self-generated tasks we considered that an appropriately timed SAS would have similar effects. Eight subjects performed a ballistic wrist extension in two blocks: reaction, in which they responded to a visual IS, and action, in which they moved when they wished within a predetermined time window. In 20-25% of the trials, a SAS was applied. We recorded electromyographic activity of wrist extension and wrist movement kinematic variables. No effects of SAS were observed in action trials when movement was performed before or long after SAS application. However, a cluster of action trials was observed within 200 ms after SAS. These trials showed larger EMG bursts, shorter movement time, shorter time to peak velocity, and higher peak velocity than other action trials (P < 0.001 for all), with no difference from Reaction trials containing SAS. The results show that SAS influences the execution of self-generated human actions as it does with preprogrammed reaction time tasks during the assumed building up of preparatory activity before execution of the willed motor action.

Are postural responses to backward and forward perturbations processed by different neural circuits?

Startle pathways may contribute to rapid accomplishment of postural stability. Here we investigate the possible influence of a startling auditory stimulus (SAS) on postural responses. We formulated four specific questions: (1) can a concurrent SAS shorten the onset of automatic postural responses?; and if so (2) is this effect different for forward versus backward perturbations?; (3) does this effect depend on prior knowledge of the perturbation direction?; and (4) is this effect different for low- and high-magnitude perturbations? Balance was perturbed in 11 healthy participants by a movable platform that suddenly translated forward or backward. Each participant received 160 perturbations, 25% of which were combined with a SAS. We varied the direction and magnitude of the perturbations, as well as the prior knowledge of perturbation direction. Perturbation trials were interspersed with SAS-only trials. The SAS accelerated and strengthened postural responses with clear functional benefits (better balance control), but this was only true for responses that protected against falling backwards (i.e. in tibialis anterior and rectus femoris). These muscles also demonstrated the most common SAS-triggered responses without perturbation. Increasing the perturbation magnitude accelerated postural responses, but again with a larger acceleration for backward perturbations. We conclude that postural responses to backward and forward perturbations may be processed by different neural circuits, with influence of startle pathways on postural responses to backward perturbations. These findings give directions for future studies investigating whether deficits in startle pathways may explain the prominent backward instability seen in patients with Parkinson's disease and progressive supranuclear palsy.

Responses to loud auditory stimuli indicate that movement-related activation builds up in anticipation of action

Previous research using a loud acoustic stimulus (LAS) to investigate motor preparation in reaction time (RT) tasks indicates that responses can be triggered well in advance of the presentation of an imperative stimulus (IS). This is intriguing given that high levels of response preparation cannot be maintained for long periods (≈ 200 ms). In the experiments reported here we sought to assess whether response-related activation increases gradually over time in simple RT tasks. In experiment 1, a LAS was presented at different times just prior to the presentation of the IS to probe the level of activation for the motor response. In experiment 2, the same LAS was presented at different times after the presentation of the IS. The results provide evidence that response-related activation does increase gradually in anticipation of the IS, but it remains stable for a short time after this event. The data display a pattern consistent with the response being triggering by the LAS, rather than a reaction to the IS.

Acoustic startle response in patients with orthostatic tremor

BACKGROUND AND AIM

Orthostatic tremor is a high frequency tremor predominantly on calf muscles during standing. Brainstem is the most probable generator in the pathogenesis since it comprises bilaterally projecting centers regulating stance or tone. We aimed to investigate the functional role of brainstem through the evaluation of acoustic startle response in primary orthostatic tremor patients.

PATIENTS AND METHOD

We included 7 (2 males) consecutive patients and 13 (5 males) healthy volunteers. Diagnosis was confirmed by polymyographic surface electromyography. All subjects underwent acoustic startle response and blink reflex investigations.

RESULTS

Presence rate (71.4% vs. 100%, p=0.042) and response rate (27.5% vs. 40.5%, p=0.047) of total acoustic startle response were lower in patient group. Similarly, probability over orbicularis oculi was lower among patients (p=0.003). However, blink reflex was observed in all patients and healthy volunteers and latencies of startle and blink reflexes were similar between groups.

CONCLUSIONS

In our patient group, normal response rate and latencies of R1 and R2 show structural integrity of at least blink reflex circuit at brainstem. On the other hand, suppressed response rates probably reflect decreased excitability of auditory startle reflex pathway.

Planning of ballistic movement following stroke: insights from the startle reflex

Following stroke, reaching movements are slow, segmented, and variable. It is unclear if these deficits result from a poorly constructed movement plan or an inability to voluntarily execute an appropriate plan. The acoustic startle reflex provides a means to initiate a motor plan involuntarily. In the presence of a movement plan, startling acoustic stimulus triggers non-voluntary early execution of planned movement, a phenomenon known as the startReact response. In unimpaired individuals, the startReact response is identical to a voluntarily initiated movement, except that it is elicited 30–40 ms. As the startReact response is thought to be mediated by brainstem pathways, we hypothesized that the startReact response is intact in stroke subjects. If startReact is intact, it may be possible to elicit more task-appropriate patterns of muscle activation than can be elicited voluntarily. We found that startReact responses were intact following stroke. Responses were initiated as rapidly as those in unimpaired subjects, and with muscle coordination patterns resembling those seen during unimpaired volitional movements. Results were striking for elbow flexion movements, which demonstrated no significant differences between the startReact responses elicited in our stroke and unimpaired subject groups. The results during planned extension movements were less straightforward for stroke subjects, since the startReact response exhibited task inappropriate activity in the flexors. This inappropriate activity diminished over time. This adaptation suggests that the inappropriate activity was transient in nature and not related to the underlying movement plan. We hypothesize that the task-inappropriate flexor activity during extension results from an inability to suppress the classic startle reflex, which primarily influences flexor muscles and adapts rapidly with successive stimuli. These results indicate that stroke subjects are capable of planning ballistic elbow movements, and that when these planned movements are involuntarily executed they can be as rapid and appropriate as those in unimpaired individuals.

The early release of planned movement by acoustic startle can be delayed by transcranial magnetic stimulation over the motor cortex

Previous studies have shown that preplanned movements can be rapidly released when a startling acoustic stimulus (SAS) is presented immediately prior to, or coincident with, the imperative signal to initiate movement. Based on the short latency of the onset of muscle activity (typically in less than 90 ms) and the frequent co-expression of startle responses in the neck and eye muscles, it has been proposed that the release of planned movements by a SAS is mediated by subcortical, possibly brainstem, pathways. However, a role for cortical structures in mediating these responses cannot be ruled out based on timing arguments alone. We examined the role of the cortex in the mediation of these responses by testing if a suprathreshold transcranial magnetic stimulation applied over the primary motor cortex, which suppresses voluntary drive and is known to delay movement initiation, could delay the release of movement by a SAS. Eight subjects performed an instructed-delay task requiring them to make a ballistic wrist movement to a target in response to an acoustic tone (control task condition). In a subset of trials subjects received one of the following: (1) suprathreshold TMS over the contralateral primary motor cortex 70 ms prior to their mean response time on control trials (TMS(CT)), (2) SAS 200 ms prior to the go cue (SAS), (3) suprathreshold TMS 70 ms prior to the mean SAS-evoked response time (TMS(SAS)), or (4) TMS(SAS) and SAS presented concurrently (TMS+SAS). Movement kinematics and EMG from the wrist extensors and flexors and sternocleidomastoid muscles were recorded. The application of TMS(CT) prior to control voluntary movements produced a significant delay in movement onset times (P < 0.001) (average delay = 37.7 ± 12.8 ms). The presentation of a SAS alone at -200 ms resulted in the release of the planned movement an average of 71.7 ± 2.7 ms after the startling stimulus. The early release of movement by a SAS was significantly delayed (P < 0.001, average delay = 35.0 ± 12.9 ms) when TMS(SAS) and SAS were presented concurrently. This delay could not be explained by a prolonged suppression of motor unit activity at the spinal level. These findings provide evidence that the release of targeted ballistic wrist movements by SAS is mediated, in part, by a fast conducting transcortical pathway via the primary motor cortex.

Assessment of excitability in brainstem circuits mediating the blink reflex and the startle reaction

Excitability is probably the concept that fits better with the definition of the role of neurophysiology in the study of brainstem functions and circuits. Neurophysiological techniques are likely the best suited of all paraclinical tests for documenting the eventual excitability changes that may occur in certain physiological states and in many neurological disorders. The best known test of brainstem excitability is the blink reflex. While a single stimulus can already indicate the readiness of the interneuronal path and the facial motoneurons to fire, pairs of stimuli (conditioning and test) are suited to analyze the degree of excitability recovery after a single discharge. Another brainstem reflex circuit, which excitability testing can be of interest for physiological and clinical exams is the one involved in the startle reaction. The size of the responses and their habituation are the typical measures of excitability of the startle reflex circuit. Prepulse inhibition is a method to modulate both, the blink reflex and the startle reaction. It is defined as the inhibitory effect caused by a stimulus of an intensity low enough not to induce a response by itself on the response elicited by a subsequent stimulus. The circuits of the blink reflex, startle reaction and prepulse inhibition share some commonalities but they are different enough for the three techniques to provide unique, clinically relevant, information in certain conditions. The role of neurophysiology is not limited to testing those functions. It is important also for the assessment of many other circuits, such as those implicated in eye movements, vestibular reflexes, arousal, sleep, breathing, or autonomic reactions, which are not considered in this review.

Postural preparation prior to stepping in patients with Parkinson's disease

People with Parkinson's disease (PD) frequently have difficulties with generating anticipatory postural adjustments (APAs) for forward propulsion and lateral weight transfer when initiating gait. This impairment has been attributed to deficits in motor planning and preparation. This study examined the preparation of APAs prior to an imperative cue to initiate forward stepping. A startling acoustic stimulus (SAS) was used to probe the state of preparation of the APA in eight PD (off medication) and seven matched control subjects. Subjects performed visually cued trials involving a pre-cue light instructing them to prepare to step, followed 3.5 s later by a go-cue light to rapidly initiate stepping. In random trials, a SAS (124 dB) was presented at −1,500, −1,000, −500, −250, −100, or 0 ms before the go-cue. Subjects also performed self-initiated steps. Ground reaction forces (GRFs), center of pressure (CoP) changes, and electromyographic (EMG) signals were recorded. The SAS triggered APAs in 94 ± 11% (PD) and 96 ± 8% (control) of trials at latencies 89 ± 4 ms (PD) and 97 ± 3 ms (control) earlier than Control trials. The temporal profile of APA preparation was similar between groups. However, peak EMG, GRF, and mediolateral CoP amplitudes were reduced in PD. SAS-evoked APAs at 0 ms matched Control trial APAs and were enhanced compared with self-initiated stepping. These results demonstrate that people with mild to moderate PD can plan and prepare the appropriate APA sequence prior to the expected cue to initiate gait; however, the prepared APAs are underscaled in magnitude.

Considerations for the use of a startling acoustic stimulus in studies of motor preparation in humans

Recent studies have used a loud (> 120 dB) startle-eliciting acoustic stimulus as a probe to investigate early motor response preparation in humans. The use of a startle in these studies has provided insight into not only the neurophysiological substrates underlying motor preparation, but also into the behavioural response strategies associated with particular stimulus-response sets. However, as the use of startle as a probe for preparation is a relatively new technique, a standard protocol within the context of movement paradigms does not yet exist. Here we review the recent literature using startle as a probe during the preparation phase of movement tasks, with an emphasis on how the experimental parameters affect the results obtained. Additionally, an overview of the literature surrounding the startle stimulus parameters is provided, and factors affecting the startle response are considered. In particular, we provide a review of the factors that should be taken into consideration when using a startling stimulus in human research.

Voluntary activation of ankle muscles is accompanied by subcortical facilitation of their antagonists

Flexion and extension movements are organized reciprocally, so that extensor motoneurones in the spinal cord are inhibited when flexor muscles are active and vice versa. During and just prior to dorsiflexion of the ankle, soleus motoneurones are thus inhibited as evidenced by a depression of the soleus H-reflex. It is therefore surprising that soleus motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) have been found not to be reduced and even facilitated during a voluntary dorsiflexion. The objective of this study was to investigate if MEPs, evoked by TMS, show a similar facilitation prior to and at the onset of contraction of muscles that are antagonists to the muscle in which the MEP is evoked and if so, examine the origin of such a facilitatory motor programme. Eleven seated subjects reacted to an auditory cue by contracting either the tibialis anterior (TA) or soleus muscle of the left ankle. TMS was applied to the hotspot of TA and soleus muscles on separate days. Stimuli were delivered prior to and at the beginning of contraction. Soleus MEPs were significantly facilitated when TMS was applied 50 ms prior to onset of plantar flexion. Surprisingly, soleus MEPs were also facilitated (although to a lesser extent) at a similar time in relation to the onset of dorsiflexion. TA MEPs were facilitated 50 ms prior to onset of dorsiflexion and neither depressed nor facilitated prior to plantar flexion. No difference was found between the facilitation of the soleus MEP and motor evoked responses to cervicomedullary stimulation prior to dorsiflexion, suggesting that the increased soleus MEPs were not caused by changes at a cortical level. This was confirmed by the observation that short-latency facilitation of the soleus H-reflex by subthreshold TMS was increased prior to plantar flexion, but not prior to dorsiflexion. These findings suggest that voluntary contraction at the ankle is accompanied by preceding facilitation of antagonists by a subcortical motor programme. This may help to ensure that the direction of movement may be changed quickly and efficiently during functional motor tasks.

Motor preparation is modulated by the resolution of the response timing information

In the present experiment, the temporal predictability of response time was systematically manipulated to examine its effect on the time course of motor pre-programming and release of the intended movement by an acoustic startle stimulus. Participants performed a ballistic right wrist extension task in four different temporal conditions: 1) a variable foreperiod simple RT task, 2) a fixed foreperiod simple RT task, 3) a low resolution countdown anticipation-timing task, and 4) a high resolution anticipation-timing task. For each task, a startling acoustic stimulus (124dB) was presented at several intervals prior to the "go" signal ("go" -150ms, -500ms, and -1500ms). Results from the startle trials showed that the time course of movement pre-programming was affected by the temporal uncertainty of the imperative "go" cue. These findings demonstrate that the resolution of the timing information regarding the response cue has a marked effect on the timing of movement preparation such that under conditions of low temporal resolution, participants plan the movement well in advance in accordance with the anticipated probability of onset of the cue, whereas movement preparation is delayed until less than 500ms prior to response time when continuous temporal information is provided.

The effects of an auditory startle on obstacle avoidance during walking

Movement execution is speeded up when a startle auditory stimulus is applied with an imperative signal in a simple reaction time task experiment, a phenomenon described as StartReact. The effect has been recently observed in a step adjustment task requiring fast selection of specific movements in a choice reaction time task. Therefore, we hypothesized that inducing a StartReact effect may be beneficial in obstacle avoidance under time pressure, when subjects have to perform fast gait adjustments. Twelve healthy young adults walked on a treadmill and obstacles were released in specific moments of the step cycle. On average the EMG onset latency in the biceps femoris shortened by 20% while amplitude increased by 50%, in trials in which an auditory startle accompanied obstacle avoidance. The presentation of a startle increased the probability of using a long step strategy, enlarged stride length modifications and resulted in higher success rates, to avoid the obstacle. We also examined the effects of the startle in a condition in which the obstacle was not present in comparison to a condition in which the obstacle was visibly present but it did not fall. In the latter condition, the obstacle avoidance reaction occurred with a similar latency but smaller amplitude as in trials in which the obstacle was actually released. Our results suggest that the motor programmes used for obstacle avoidance are probably stored at subcortical structures. The release of these motor programmes by a startling auditory stimulus may combine intersensory facilitation and the StartReact effect.

Preparation of anticipatory postural adjustments prior to stepping

Step initiation involves anticipatory postural adjustments (APAs) that propel the body mass forward and laterally before the first step. This study used a startle-like acoustic stimulus (SAS) and transcranial magnetic stimulation (TMS) to examine the preparation of APAs before forward stepping. After an instructed delay period, subjects initiated forward steps in reaction to a visual "go" cue. TMS or SAS was delivered before (-1,400 or -100 ms), on (0 ms), or after (+100 ms for TMS, +200 ms for SAS) the imperative "go" cue. Ground reaction forces and electromyographic activity were recorded. In control trials, the mean reaction time was 217 +/- 38 ms. In contrast, the SAS evoked APAs that had an average onset of 110 +/- 54 ms, whereas the incidence, magnitude, and duration of the APA increased as the stimulus timing approached the "go" cue. A facilitation of motor-evoked potentials in the initial agonist muscle was observed only when TMS was applied at +100 ms. These findings indicate that there was an initial phase of movement preparation during which the APA-stepping sequence was progressively assembled, and that this early preparation did not involve the corticomotor pathways activated by TMS. The subsequent increase in corticomotor excitability between the imperative stimulus and onset of the APA suggests that corticospinal pathways contribute to the voluntary initiation of the prepared APA-stepping sequence. These findings are consistent with a feedforward mode of neural control whereby the motor sequence, including the associated postural adjustments, is prepared before voluntary movement.

Unilateral reaction time task is delayed during contralateral movements

Performing unlearned unimanual tasks when simultaneously carrying out another task with the contralateral hand is known to be difficult. The dual task interference theory predicts that reaction time will be delayed if the investigated task is performed in the course of ongoing contralateral movements. Ballistic movements can be performed at maximal speed in simple reaction time (SRT) experiments when subjects have adequately prepared the motor system needed for movement execution. When fully prepared, activation of subcortical motor pathways by a startling auditory stimulus (SAS) triggers the whole reaction. In this study, we have examined dual task interference with reaction time in eight healthy volunteers. They were presented with a visual imperative signal to perform unilateral SRT either in a baseline condition (control trials) or while carrying out contralateral rhythmic oscillatory movements (test trials). A SAS was introduced in 25% of the trials in both conditions. SRT was significantly delayed in the interference test trial when compared to control trials either with or without SAS (P<0.001). Control and test trials with SAS were significantly faster than those without SAS in both conditions (P<0.001). However, there were no significant differences in the percentage SRT shortening induced by SAS or in the percentage SRT delay observed in the test trials. Our results suggest that performing rhythmic oscillatory movements with one limb slows SRT in the contralateral limb and that this effect is likely related to motor preparation changes. The effect described here can be of interest for physiological studies of interlimb coordination and the mechanisms underlying the dual task interference phenomenon.

Excitability of subcortical motor circuits in Go/noGo and forced choice reaction time tasks

The size of the response to a startling auditory stimulus (SAS) may reflect the excitability of the reticulospinal tract. In this study, we examined whether there was any excitability change in the reticulospinal tract during preparation for execution of two types of choice reaction time task: a forced choice reaction time task (fCRT) and a Go/no-Go task (GnG). In 13 healthy volunteers we used three types of trials: control trials in which subjects were requested to perform ballistic wrist movements during fCRT or GnG tasks; test trials in which a SAS was presented with the visual cue, and baseline trials in which SAS was presented alone. Latency and area of the responses to SAS were measured in the orbicularis oculi and in the sternocleidomastoid (SCM) muscles. The results obtained in baseline trials were used to calculate the mean resting baseline excitability level of the reticulospinal tract for each individual, and the values obtained in test trials were expressed as percentages of mean baseline for normalization of data from all individuals. The area of the responses to SAS in SCM was significantly larger in fCRT than in GnG (p=0.002). There was a significant shortening of reaction time in test trials that was inversely correlated with area of SCM (p<0.05). We conclude that the subcortical motor tracts activated by SAS are more excitable during fCRT tasks than GnG tasks. Changing the excitability of subcortical motor structures may be a strategy used by the central nervous system in motor control that is selected according to the motor program.

Effects of acoustic startle stimuli on interceptive action

In reaction time (RT) tasks, presentation of a startling acoustic stimulus (SAS) together with a visual imperative stimulus can dramatically reduce RT while leaving response execution unchanged. It has been suggested that a prepared motor response program is triggered early by the SAS but is not otherwise affected. Movements aimed at intercepting moving targets are usually considered to be similarly governed by a prepared program. This program is triggered when visual stimulus information about the time to arrival of the moving target reaches a specific criterion. We investigated whether a SAS could also trigger such a movement. Human experimental participants were trained to hit moving targets with movements of a specific duration. This permitted an estimate of when movement would begin (expected onset time). Startling and sub-startle threshold acoustic probe stimuli were delivered unexpectedly among control trials: 65, 85, 115 and 135 ms prior to expected onset (10:1 ratio of control to probe trials). Results showed that startling probe stimuli at 85 and 115 ms produced early response onsets but not those at 65 or 135 ms. Sub-threshold stimuli at 115 and 135 ms also produced early onsets. Startle probes led to an increased vigor in the response, but sub-threshold probes had no detectable effects. These data can be explained by a simple model in which preparatory, response-related activation builds up in the circuits responsible for generating motor commands in anticipation of the GO command. If early triggering by the acoustic probes is the mechanism underlying the findings, then the data support the hypothesis that rapid interceptions are governed by a motor program.

A startle speeds up the execution of externally guided saccades

The control of eye movements depends in part on subcortical motor centres. Gaze is often directed towards salient visual stimuli of our environment with no conscious voluntary commands. To further understand to what extent preprogrammed eye movements can be triggered subcortically, we carried out a study in normal volunteers to examine the effects of a startling auditory stimulus (SAS) on externally guided saccades. A peripheral visual cue was presented in the horizontal plane at a site distant 15 degrees from the fixation point, and subjects were instructed to make a saccade to it. SAS was presented together with the peripheral visual cue in 20% of trials. To force rapid visual fixation at the end of the saccade, targets were loaded with a second cue, a small arrow pointing towards the right or the left (or a neutral sign), not distinguishable with peripheral vision. Subjects were requested to perform a flexion/extension wrist movement, according to the direction of the arrow (or not to move if the second cue was the neutral sign). SAS presented together with the visual target caused a significant shortening of the latency of saccadic movements. The wrist movements performed as a response to the second cue had similar reaction times regardless of whether the trial contained a SAS or not. Our results show that voluntary saccades to peripheral targets are speeded up by activation of the startle circuit, and that this effect does not cause a significant disturbance in the execution of simple in-target cues. These results suggest that subcortical structures play a main role in preparation of externally guided saccades.

Temporal uncertainty does not affect response latencies of movements produced during startle reactions

Previous research has shown that a startle 'go' stimulus, presented at a constant latency with respect to a warning stimulus, is capable of eliciting an intended voluntary movement in a simple reaction time (RT) task at very short latencies without involvement of the cerebral cortex (Carlsen et al. in Exp Brain Res 152:510-518, 2003; J Motor Behav 36:253-264, 2004a; Exp Brain Res 159:301-309 2004b; Valls-Solé et al. in J Physiol 516:931-938, 1999). The purpose of the present experiment was to determine the effect of temporal uncertainty on response latency during an RT task that comprised a startle stimulus. Participants were required to perform an active 20 degrees wrist extension movement in response to an auditory tone that was presented 2,500 to 5,500 ms after a warning stimulus, in 1,000 ms increments. On certain trials the control auditory stimulus (80 dB) was unexpectedly replaced by the startle stimulus (124 dB). When participants were startled the intended voluntary movement was initiated at approximately 70 ms, regardless of foreperiod duration. The magnitude and invariance of response latencies to the startle stimulus suggest that the intended movement had indeed been prepared prior to the arrival of the imperative go stimulus, within 2.5 s of the warning stimulus. Furthermore, there was no evidence that the prepared movement decayed over a period of at least 3 s.