Rhythmic arm cycling produces a non-specific signal that suppresses Soleus H-reflex amplitude in stationary legs

Changes in intra- and interlimb reflexes from forelimb cutaneous afferents after staggered thoracic lateral hemisections during locomotion in cats

In quadrupeds, such as cats, cutaneous afferents from the forepaw dorsum signal external perturbations and send inputs to spinal circuits to co-ordinate the activity in muscles of all four limbs. How these cutaneous reflex pathways from forelimb afferents are reorganized after an incomplete spinal cord injury is not clear. Using a staggered thoracic lateral hemisections paradigm, we investigated changes in intralimb and interlimb reflex pathways by electrically stimulating the left and right superficial radial nerves in seven adult cats and recording reflex responses in five forelimb and ten hindlimb muscles. After the first (right T5-T6) and second (left T10-T11) hemisections, forelimb-hindlimb co-ordination was altered and weakened. After the second hemisection, cats required balance assistance to perform quadrupedal locomotion. Short-, mid- and long-latency homonymous and crossed reflex responses in forelimb muscles and their phase modulation remained largely unaffected after staggered hemisections. The occurrence of homolateral and diagonal mid- and long-latency responses in hindlimb muscles evoked with left and right superficial radial nerve stimulation was significantly reduced at the first time point after the first hemisection, but partially recovered at the second time point with left superficial radial nerve stimulation. These responses were lost or reduced after the second hemisection. When present, all reflex responses, including homolateral and diagonal, maintained their phase-dependent modulation. Therefore, our results show a considerable loss in cutaneous reflex transmission from cervical to lumbar levels after incomplete spinal cord injury, albeit with preservation of phase modulation, probably affecting functional responses to external perturbations. KEY POINTS: Cutaneous afferent inputs co-ordinate muscle activity in the four limbs during locomotion when the forepaw dorsum contacts an obstacle. Thoracic spinal cord injury disrupts communication between spinal locomotor centres located at cervical and lumbar levels, impairing balance and limb co-ordination. We investigated cutaneous reflexes from forelimb afferents during quadrupedal locomotion by electrically stimulating the superficial radial nerve bilaterally, before and after staggered lateral thoracic hemisections in cats. We showed a loss/reduction of mid- and long-latency homolateral and diagonal reflex responses in hindlimb muscles early after the first hemisection that partially recovered with left superficial radial nerve stimulation, before being reduced after the second hemisection. Targeting cutaneous reflex pathways from forelimb afferents projecting to the four limbs could help develop therapeutic approaches aimed at restoring transmission in ascending and descending spinal pathways.

Changes in intra- and interlimb reflexes from forelimb cutaneous afferents after staggered thoracic lateral hemisections during locomotion in cats

In quadrupeds, such as cats, cutaneous afferents from the forepaw dorsum signal external perturbations and send signals to spinal circuits to coordinate the activity in muscles of all four limbs. How these cutaneous reflex pathways from forelimb afferents are reorganized after an incomplete spinal cord injury is not clear. Using a staggered thoracic lateral hemisections paradigm, we investigated changes in intralimb and interlimb reflex pathways by electrically stimulating the left and right superficial radial nerves in seven adult cats and recording reflex responses in five forelimb and ten hindlimb muscles. After the first (right T5-T6) and second (left T10-T11) hemisections, forelimb-hindlimb coordination was altered and weakened. After the second hemisection, cats required balance assistance to perform quadrupedal locomotion. Short-, mid- and long-latency homonymous and crossed reflex responses in forelimb muscles and their phase modulation remained largely unaffected after staggered hemisections. The occurrence of homolateral and diagonal mid- and long-latency responses in hindlimb muscles evoked with left and right superficial radial nerve stimulation was significantly reduced at the first time point after the first hemisection, but partially recovered at the second time point with left superficial radial nerve stimulation. These responses were lost or reduced after the second hemisection. When present, all reflex responses, including homolateral and diagonal, maintained their phase-dependent modulation. Therefore, our results show a considerable loss in cutaneous reflex transmission from cervical to lumbar levels after incomplete spinal cord injury, albeit with preservation of phase modulation, likely affecting functional responses to external perturbations.

Intermuscular coherence analysis in older adults reveals that gait-related arm swing drives lower limb muscles via subcortical and cortical pathways

KEY POINTS

Gait-related arm swing in humans supports efficient lower limb muscle activation, indicating a neural coupling between the upper and lower limbs during gait. Intermuscular coherence analyses of gait-related electromyography from upper and lower limbs in 20 healthy participants identified significant coherence in alpha and beta/gamma bands indicating that upper and lower limbs share common subcortical and cortical drivers that coordinate the rhythmic four-limb gait pattern. Additional directed connectivity analyses revealed that upper limb muscles drive and shape lower limb muscle activity during gait via subcortical and cortical pathways and to a lesser extent vice versa. The results provide a neural underpinning that arm swing may serve as an effective rehabilitation therapy concerning impaired gait in neurological diseases.

ABSTRACT

Human gait benefits from arm swing, as it enhances efficient lower limb muscle activation in healthy participants as well as patients suffering from neurological impairment. The underlying neuronal mechanisms of such coupling between upper and lower limbs remain poorly understood. The aim of the present study was to examine this coupling by intermuscular coherence analysis during gait. Additionally, directed connectivity analysis of this coupling enabled assessment of whether gait-related arm swing indeed drives lower limb muscles. To that end, electromyography recordings were obtained from four lower limb muscles and two upper limb muscles bilaterally, during gait, of 20 healthy participants (mean (SD) age 67 (6.8) years). Intermuscular coherence analysis revealed functional coupling between upper and lower limb muscles in the alpha and beta/gamma band during muscle specific periods of the gait cycle. These effects in the alpha and beta/gamma bands indicate involvement of subcortical and cortical sources, respectively, that commonly drive the rhythmic four-limb gait pattern in an efficiently coordinated fashion. Directed connectivity analysis revealed that upper limb muscles drive and shape lower limb muscle activity during gait via subcortical and cortical pathways and to a lesser extent vice versa. This indicates that gait-related arm swing reflects the recruitment of neuronal support for optimizing the cyclic movement pattern of the lower limbs. These findings thus provide a neural underpinning for arm swing to potentially serve as an effective rehabilitation therapy concerning impaired gait in neurological diseases.

The Effect of Crank Resistance on Arm Configuration and Muscle Activation Variances in Arm Cycling Movements

Arm cycling on an ergometer is common in sports training and rehabilitation protocols. The hand movement is constrained along a circular path, and the user is working against a resistance, maintaining a cadence. Even if the desired hand trajectory is given, there is the flexibility to choose patterns of joint coordination and muscle activation, given the kinematic redundancy of the upper limb. With changing external load, motor noise and changing joint stiffness may affect the pose of the arm even though the endpoint trajectory is unchanged. The objective of this study was to examine how the crank resistance influences the variances of joint configuration and muscle activation. Fifteen healthy participants performed arm cranking on an arm-cycle ergometer both unimanually and bimanually with a cadence of 60 rpm against three crank resistances. Joint configuration was represented in a 3-dimensional joint space defined by inter-segmental joint angles, while muscle activation in a 4-dimensional "muscle activation space" defined by EMGs of 4 arm muscles. Joint configuration variance in the course of arm cranking was not affected by crank resistance, whereas muscle activation variance was proportional to the square of muscle activation. The shape of the variance time profiles for both joint configuration and muscle activation was not affected by crank resistance. Contrary to the prevailing assumption that an increased motor noise would affect the variance of auxiliary movements, the influence of noise doesn't appear at the joint configuration level even when the system is redundant. Our results suggest the separation of kinematic- and force-control, via mechanisms that are compensating for dynamic nonlinearities. Arm cranking may be suitable when the aim is to perform training under different load conditions, preserving stable and secure control of joint movements and muscle activations.

Repeated and patterned stimulation of cutaneous reflex pathways amplifies spinal cord excitability

Priming with patterned stimulation of antagonist muscle afferents induces modulation of spinal cord excitability as evidenced by changes in group Ia reciprocal inhibition. When assessed transiently with a condition-test pulse paradigm, stimulating cutaneous afferents innervating the foot reduces Ia presynaptic inhibition and facilitates soleus Hoffmann (H)-reflex amplitudes. Modulatory effects (i.e., priming) of longer lasting sensory stimulation of cutaneous afferents innervating the foot have yet to be examined. As a first step, we examined how priming with 20 min of patterned and alternating stimulation between the left and right foot affects spinal cord excitability. During priming, stimulus trains (550 ms; consisting of twenty-eight 1-ms pulses at 51 Hz, 1.2 times the radiating threshold) were applied simultaneously to the sural and plantar nerves of the ankle. Stimulation to the left and right ankle was out of phase by 500 ms. We evoked soleus H-reflexes and muscle compound action potentials (M waves) before and following priming stimulation to provide a proxy measure of spinal cord excitability. H-reflex and M-wave recruitment curves were recorded at rest, during brief (<2 min) arm cycling, and with sural conditioning [train of five 1-ms pulses at 2 times the radiating threshold (RT) with a condition-test interval (C-T) = 80 ms]. Data indicate an increase in H-reflex excitability following priming via patterned sensory stimulation. Transient sural conditioning was less effective following priming, indicating that the increased excitability of the H-reflex is partially attributable to reductions in group Ia presynaptic inhibition. Sensory stimulation to cutaneous afferents, which enhances spinal cord excitability, may prove useful in both rehabilitation and performance settings.NEW & NOTEWORTHY Priming via patterned stimulation of the nervous system induces neuroplasticity. Yet, accessing previously known cutaneous reflex pathways to alter muscle reflex excitability has not yet been examined. Here, we show that sensory stimulation of the cutaneous afferents that innervate the foot sole can amplify spinal cord excitability, which, in this case, is attributed to reductions in presynaptic inhibition.

Transcutaneous spinal cord stimulation of the cervical cord modulates lumbar networks

It has been established that coordinated arm and leg (A&L) cycling facilitates corticospinal drive and modulation of cervico-lumbar connectivity and ultimately improves overground walking in people with incomplete spinal cord injury or stroke. This study examined the effect of noninvasive transcutaneous spinal cord stimulation (tSCS) on the modulation of cervico-lumbar connectivity. Thirteen neurologically intact adults participated in the study. The excitability of the Hoffmann (H) reflex elicited in the soleus muscle was examined under multiple conditions involving either the arms held in a static position or rhythmic arm cycling while tSCS was applied to either the cervical or lumbar cord. As expected, soleus H-reflex amplitude was significantly suppressed by 19.2% during arm cycling (without tSCS) relative to arms static (without tSCS). Interestingly, tSCS of the cervical cord with arms static significantly suppressed the soleus H-reflex (−22.9%), whereas tSCS over the lumbar cord did not suppress the soleus H-reflex (−3.8%). The combination of arm cycling with cervical or lumbar tSCS did not yield additional suppression of the soleus H-reflex beyond that obtained with arm cycling alone or cervical tSCS alone. The results demonstrate that activation of the cervical spinal cord through both rhythmic arm cycling and tonic tSCS significantly modulates the activity of lumbar networks. This highlights the potential for engaging cervical spinal cord networks through tSCS during rehabilitation interventions to enhance cervico-lumbar connectivity. This connectivity is influential in facilitating improvements in walking function after neurological impairment.

NEW & NOTEWORTHY This is the first study to investigate the modulatory effects of transcutaneous spinal cord stimulation (tSCS) on cervico-lumbar connectivity. We report that both rhythmic activation of the cervical spinal cord through arm cycling and tonic activation of the cervical cord through tSCS significantly modulate the activity of lumbar networks. This suggests that engaging cervical spinal cord networks through tSCS during locomotor retraining interventions may not only enhance cervico-lumbar connectivity but also further improve walking capacity.

Robot controlled, continuous passive movement of the ankle reduces spinal cord excitability in participants with spasticity: a pilot study

Spasticity of the ankle reduces quality of life by impeding walking and other activities of daily living. Robot-driven continuous passive movement (CPM) is a strategy for lower limb spasticity management but effects on spasticity, walking ability and spinal cord excitability (SCE) are unknown. The objectives of this experiment were to evaluate (1) acute changes in SCE induced by 30 min of CPM at the ankle joint, in individuals without neurological impairment and those with lower limb spasticity; and, (2) the effects of 6 weeks of CPM training on SCE, spasticity and walking ability in those with lower limb spasticity. SCE was assessed using soleus Hoffmann (H-) reflexes, collected prior to and immediately after CPM for acute assessments, whereas a multiple baseline repeated measures design assessed changes following 18 CPM sessions. Spasticity and walking ability were assessed using the Modified Ashworth Scale, the 10 m Walk test, and the Timed Up and Go test. Twenty-one neurologically intact and nine participants with spasticity (various neurological conditions) were recruited. In the neurologically intact group, CPM caused bi-directional modulation of H-reflexes creating 'facilitation' and 'suppression' groups. In contrast, amongst participants with spasticity, acute CPM facilitated H-reflexes. After CPM training, H-reflex excitability on both the more-affected and less-affected sides was reduced; on the more affected side H@Thres, H@50 and H@100 all significantly decreased following CPM training by 96.5 ± 7.7%, 90.9 ± 9.2%, and 62.9 ± 21.1%, respectively. After training there were modest improvements in walking and clinical measures of spasticity for some participants. We conclude that CPM of the ankle can significantly alter SCE. The use of CPM in those with spasticity can provide a temporary period of improved walking, but efficacy of treatment remains unknown.

Exploiting cervicolumbar connections enhances short-term spinal cord plasticity induced by rhythmic movement

Arm cycling causes suppression of soleus (SOL) Hoffmann (H-) reflex that outlasts the activity period. Arm cycling presumably activates propriospinal networks that modulate Ia presynaptic inhibition. Interlimb pathways are thought to relate to the control of quadrupedal locomotion, allowing for smooth, coordinated movement of the arms and legs. We examined whether the number of active limb pairs affects the amount and duration of activity-dependent plasticity of the SOL H-reflex. On separate days, 14 participants completed 4 randomly ordered 30 min experimental sessions: (1) quiet sitting (CTRL); (2) arm cycling (ARM); (3) leg cycling (LEG); and (4) arm and leg cycling (A&L) on an ergometer. SOL H-reflex and M-wave were evoked via electrical stimulation of the tibial nerve. M-wave and H-reflex recruitment curves were recorded, while the participants sat quietly prior to, 10 and 20 min into, immediately after, and at 2.5, 5, 7.5, 10, 15, 20, 25, and 30 min after each experimental session. Normalized maximal H-reflexes were unchanged in CTRL, but were suppressed by > 30% during the ARM, LEG, and A&L. H-reflex suppression outlasted activity duration for ARM (≤ 2.5 mins), LEG (≤ 5 mins), and A&L (≤ 30 mins). The duration of reflex suppression after A&L was greater than the algebraic summation of ARM and LEG. This non-linear summation suggests that using the arms and legs simultaneously-as in typical locomotor synergies-amplifies networks responsible for the short-term plasticity of lumbar spinal cord excitability. Enhanced activity of spinal networks may have important implications for the implementation of locomotor training for targeted rehabilitation.

Effect of cervicolumbar coupling on spinal reflexes during cycling after incomplete spinal cord injury

Spinal networks in the cervical and lumbar cord are actively coupled during locomotion to coordinate arm and leg activity. The goals of this project were to investigate the intersegmental cervicolumbar connectivity during cycling after incomplete spinal cord injury (iSCI) and to assess the effect of rehabilitation training on improving reflex modulation mediated by cervicolumbar pathways. Two studies were conducted. In the first, 22 neurologically intact (NI) people and 10 people with chronic iSCI were recruited. The change in H-reflex amplitude in flexor carpi radialis (FCR) during leg cycling and H-reflex amplitude in soleus (SOL) during arm cycling were investigated. In the second study, two groups of participants with chronic iSCI underwent 12 wk of cycling training: one performed combined arm and leg cycling (A&L) and the other legs only cycling (Leg). The effect of training paradigm on the amplitude of the SOL H-reflex was assessed. Significant reduction in the amplitude of both FCR and SOL H-reflexes during dynamic cycling of the opposite limbs was found in NI participants but not in participants with iSCI. Nonetheless, there was a significant reduction in the SOL H-reflex during dynamic arm cycling in iSCI participants after training. Substantial improvements in SOL H-reflex properties were found in the A&L group after training. The results demonstrate that cervicolumbar modulation during rhythmic movements is disrupted in people with chronic iSCI; however, this modulation is restored after cycling training. Furthermore, involvement of the arms simultaneously with the legs during training may better regulate the leg spinal reflexes.

NEW & NOTEWORTHY This work systematically demonstrates the disruptive effect of incomplete spinal cord injury on cervicolumbar coupling during rhythmic locomotor movements. It also shows that the impaired cervicolumbar coupling could be significantly restored after cycling training. Actively engaging the arms in rehabilitation paradigms for the improvement of walking substantially regulates the excitability of the lumbar spinal networks. The resulting regulation may be better than that obtained by interventions that focus on training of the legs only.

Time course of interlimb strength transfer after unilateral handgrip training

"Cross-education" is the increase in strength or functional performance of an untrained limb after unilateral training. A major limitation for clinical translation from unilateral injury includes knowledge on the minimum time for the emergence of crossed effects. Therefore, the primary purpose was to characterize the time course of bilateral strength changes during both "traditional" ( n = 11) and "daily" ( n = 8) unilateral handgrip training in neurologically intact participants. Traditional training included five sets of five maximal voluntary handgrip contractions 3 times/wk for 6 wk whereas daily training included the same number of sessions and contractions but over 18 consecutive days. Three pre- and one posttest session evaluated strength, muscle activation, and reflex excitability bilaterally. Time course information was assessed by recording handgrip force for every contraction in the trained limb and from a single contraction on every third training session in the untrained limb. Six weeks of traditional training increased handgrip strength in the trained limb after the 9th session whereas the untrained limb was stronger after the 12th session. This was accompanied by increased peak muscle activation and bilateral alterations in Hoffmann reflex excitability. Daily training revealed a similar number of sessions (15) were required to induce significant strength gains in the untrained limb (7.8% compared with 12.5%) in approximately half the duration of traditional training. Therefore, minimizing rest days may improve the efficiency of unilateral training when the trained limb is not the focus. Establishing a "dose" for the time course of adaptation to strength training is paramount for effective translation to rehabilitative interventions. NEW & NOTEWORTHY Unilateral handgrip training using a "traditional" protocol (3 times/wk; 6 wk) increased strength bilaterally after 9 (trained arm) and 12 (untrained arm) sessions. "Daily" training (18 consecutive days) increased strength in the untrained limb in a similar number of training sessions, which was accomplished in approximately half the time. Within clinical populations when the focus is on the untrained limb, reducing rest days may optimize the recovery of strength.

Sherlock Holmes and the curious case of the human locomotor central pattern generator

Evidence first described in reduced animal models over 100 years ago led to deductions about the control of locomotion through spinal locomotor central pattern-generating (CPG) networks. These discoveries in nature were contemporaneous with another form of deductive reasoning found in popular culture, that of Arthur Conan Doyle's detective, Sherlock Holmes. Because the invasive methods used in reduced nonhuman animal preparations are not amenable to study in humans, we are left instead with deducing from other measures and observations. Using the deductive reasoning approach of Sherlock Holmes as a metaphor for framing research into human CPGs, we speculate and weigh the evidence that should be observable in humans based on knowledge from other species. This review summarizes indirect inference to assess "observable evidence" of pattern-generating activity that leads to the logical deduction of CPG contributions to arm and leg activity during locomotion in humans. The question of where a CPG may be housed in the human nervous system remains incompletely resolved at this time. Ongoing understanding, elaboration, and application of functioning locomotor CPGs in humans is important for gait rehabilitation strategies in those with neurological injuries.

Non-gait-specific intervention for the rehabilitation of walking after SCI: role of the arms

Arm movements modulate leg activity and improve gait efficiency; however, current rehabilitation interventions focus on improving walking through gait-specific training and do not actively involve the arms. The goal of this project was to assess the effect of a rehabilitation strategy involving simultaneous arm and leg cycling on improving walking after incomplete spinal cord injury (iSCI). We investigated the effect of 1) non-gait-specific training and 2) active arm involvement during training on changes in over ground walking capacity. Participants with iSCI were assigned to simultaneous arm-leg cycling (A&L) or legs only cycling (Leg) training paradigms, and cycling movements were assisted with electrical stimulation. Overground walking speed significantly increased by 0.092 ± 0.022 m/s in the Leg group and 0.27 ± 0.072m/s in the A&L group after training. Whereas the increases in the Leg group were similar to those seen after current locomotor training strategies, increases in the A&L group were significantly larger than those in the Leg group. Walking distance also significantly increased by 32.12 ± 8.74 m in the Leg and 91.58 ± 36.24 m in the A&L group. Muscle strength, sensation, and balance improved in both groups; however, the A&L group had significant improvements in most gait measures and had more regulated joint kinematics and muscle activity after training compared with the Leg group. We conclude that electrical stimulation-assisted cycling training can produce significant improvements in walking after SCI. Furthermore, active arm involvement during training can produce greater improvements in walking performance. This strategy may also be effective in people with other neural disorders or diseases. NEW & NOTEWORTHY This work challenges concepts of task-specific training for the rehabilitation of walking and encourages coordinated training of the arms and legs after spinal cord injury. Cycling of the legs produced significant improvements in walking that were similar in magnitude to those reported with gait-specific training. Moreover, active engagement of the arms simultaneously with the legs generated nearly double the improvements obtained by leg training only. The cervico-lumbar networks are critical for the improvement of walking.

Spinal Cord Excitability and Sprint Performance Are Enhanced by Sensory Stimulation During Cycling

Spinal cord excitability, as assessed by modulation of Hoffmann (H-) reflexes, is reduced with fatiguing isometric contractions. Furthermore, spinal cord excitability is reduced during non-fatiguing arm and leg cycling. Presynaptic inhibition of Ia terminals is believed to contribute to this suppression of spinal cord excitability. Electrical stimulation to cutaneous nerves reduces Ia presynaptic inhibition, which facilitates spinal cord excitability, and this facilitation is present during arm cycling. Although it has been suggested that reducing presynaptic inhibition may prolong fatiguing contractions, it is unknown whether sensory stimulation can alter the effects of fatiguing exercise on performance or spinal cord excitability. Thus, the aim of this experiment was to determine if sensory stimulation can interfere with fatigue-related suppression of spinal cord excitability, and alter fatigue rates during cycling sprints. Thirteen participants randomly performed three experimental sessions that included: unloaded cycling with sensory stimulation (CONTROL + STIM), sprints with sensory stimulation (SPRINT + STIM) and sprints without stimulation (SPRINT). Seven participants also performed a fourth session (CONTROL), which consisted of unloaded cycling. During SPRINT and SPRINT + STIM, participants performed seven, 10 s cycling sprints interleaved with 3 min rest. For CONTROL and CONTROL + STIM, participants performed unloaded cycling for ~30 min. During SPRINT + STIM and CONTROL + STIM, participants received patterned sensory stimulation to nerves of the right foot. H-reflexes and M-waves of the right soleus were evoked by stimulation of the tibial nerve at multiple time points throughout exercise. Sensory stimulation facilitated soleus H-reflexes during unloaded cycling, whereas sprints suppressed soleus H-reflexes. While receiving sensory stimulation, there was less suppression of soleus H-reflexes and slowed reduction in average power output, compared to sprints without stimulation. These results demonstrate that sensory stimulation can substantially mitigate the fatiguing effects of sprints.

Rhythmic arm cycling training improves walking and neurophysiological integrity in chronic stroke: the arms can give legs a helping hand in rehabilitation

Training locomotor central pattern-generating networks (CPGs) through arm and leg cycling improves walking in chronic stroke. These outcomes are presumed to result from enhanced interlimb connectivity and CPG function. The extent to which rhythmic arm training activates interlimb CPG networks for locomotion remains unclear and was assessed by studying chronic stroke participants before and after 5 wk of arm cycling training. Strength was assessed bilaterally via maximal voluntary isometric contractions in the legs and hands. Muscle activation during arm cycling and transfer to treadmill walking were assessed in the more affected (MA) and less affected (LA) sides via surface electromyography. Changes to interlimb coupling during rhythmic movement were evaluated using modulation of cutaneous reflexes elicited by electrical stimulation of the superficial radial nerve at the wrist. Bilateral soleus stretch reflexes were elicited at rest and during 1-Hz arm cycling. Clinical function tests assessed walking, balance, and motor function. Results show significant changes in function and neurophysiological integrity. Training increased bilateral grip strength, force during MA plantarflexion, and muscle activation. "Normalization" of cutaneous reflex modulation was found during arm cycling. There was enhanced activity in the dorsiflexor muscles on the MA side during the swing phase of walking. Enhanced interlimb coupling was shown by increased modulation of MA soleus stretch reflex amplitudes during arm cycling after training. Clinical evaluations showed enhanced walking ability and balance. These results are consistent with training-induced changes in CPG function and interlimb connectivity and underscore the need for arm training in the functional rehabilitation of walking after neurotrauma. NEW & NOTEWORTHY It has been suggested but not tested that training the arms may influence rehabilitation of walking due to activation of interneuronal patterning networks after stroke. We show that arm cycling training improves strength, clinical function, coordination of muscle activity during walking, and neurological connectivity between the arms and the legs. The arms can, in fact, give the legs a helping hand in rehabilitation of walking after stroke.

Modulation of corticospinal input to the legs by arm and leg cycling in people with incomplete spinal cord injury

The spinal cervico-lumbar interaction during rhythmic movements in humans has recently been studied; however, the role of arm movements in modulating the corticospinal drive to the legs is not well understood. The goals of this study were to investigate the effect of active rhythmic arm movements on the corticospinal drive to the legs (study 1) and assess the effect of simultaneous arm and leg training on the corticospinal pathway after incomplete spinal cord injury (iSCI) (study 2). In study 1, neurologically intact (NI) participants or participants with iSCI performed combinations of stationary and rhythmic cycling of the arms and legs while motor evoked potentials (MEPs) were recorded from the vastus lateralis (VL) muscle. In the NI group, arm cycling alone could facilitate the VL MEP amplitude, suggesting that dynamic arm movements strongly modulate the corticospinal pathway to the legs. No significant difference in VL MEP between conditions was found in participants with iSCI. In study 2, participants with iSCI underwent 12 wk of electrical stimulation-assisted cycling training: one group performed simultaneous arm and leg (A&L) cycling and the other legs-only cycling. MEPs in the tibialis anterior (TA) muscle were compared before and after training. After training, only the A&L group had a significantly larger TA MEP, suggesting increased excitability in the corticospinal pathway. The findings demonstrate the importance of arm movements in modulating the corticospinal drive to the legs and suggest that active engagement of the arms in lower limb rehabilitation may produce better neural regulation and restoration of function.NEW & NOTEWORTHY This study aimed to demonstrate the importance of arm movements in modulating the corticospinal drive to the legs. It provides direct evidence in humans that active movement of the arms could facilitate corticospinal transmission to the legs and, for the first time, shows that facilitation is absent after spinal cord injury. Active engagement of the arms in lower limb rehabilitation increased the excitability of the corticospinal pathway and may produce more effective improvement in leg function.

Bilateral Reflex Fluctuations during Rhythmic Movement of Remote Limb Pairs

The modulation of spinal cord excitability during rhythmic limb movement reflects the neuronal coordination underlying actions of the arms and legs. Integration of network activity in the spinal cord can be assessed by reflex variability between the limbs, an approach so far very little studied. The present work addresses this question by eliciting Hoffmann (H-) reflexes in both limbs to assess if common drive onto bilateral pools of motoneurons influence spinal cord excitability simultaneously or with a delay between sides. A cross-covariance (CCV) sequence between reflexes in both arms or legs was evaluated under conditions providing common drive bilaterally through voluntary muscle contraction and/or rhythmic movement of the remote limbs. For H-reflexes in the flexor carpi radialis (FCR) muscle, either contraction of the FCR or leg cycling induced significant reduction in the amplitude of the peak at the zero lag in the CCV sequence, indicating independent variations in spinal excitability between both sides. In contrast, for H-reflexes in the soleus (SO) muscle, arm cycling revealed no reduction in the amplitude of the peak in the CCV sequence at the zero lag. This suggests a more independent control of the arms compared with the legs. These results provide new insights into the organization of human limb control in rhythmic activity and the behavior of bilateral reflex fluctuations under different motor tasks. From a functional standpoint, changes in the co-variability might reflect dynamic adjustments in reflex excitability that are subsumed under more global control features during locomotion.

Knee extensors neuromuscular fatigue changes the corticospinal pathway excitability in biceps brachii muscle

Equivocal evidence indicates that high-intensity muscle contractions can affect the corticospinal responses in muscles not directly involved in the task. In the present study, the responsiveness of corticomotor pathway innervating non-dominant biceps brachii was measured in eleven healthy participants before and after: (i) two 100-s isometric unilateral knee extension maximal voluntary contractions (MVCs) on dominant leg (FATIGUE) and (ii) rest (CONTROL). Transcranial magnetic stimulation, transmastoid electrical and brachial plexus electrical stimulation were used to evoke motor evoked potential (MEP), cervicomedullary motor evoked potential (CMEP) and compound muscle action potential (Mmax) in biceps brachii muscle. The three stimuli were elicited at 2, 3.5 and 5s while participants were performing 6-s elbow flexion contractions at 100, 50, and 5% of MVC interspersed with 10-s rest. The results demonstrated opposing behaviors of MEP responses at 100% (23% higher, p=0.08) and 5% MVC (34% lower, p=0.019) following FATIGUE compared to CONTROL. Similarly, MEP·CMEP^-1 ratio changes indicated that the supraspinal motor response was significantly higher during 100% (42%, p=0.027) but lower during 5% MVC (28%, p=0.009) following FATIGUE. Yet, the elbow flexor MVC force did not exhibit any difference between FATIGUE and CONTROL conditions. These results suggest that the upper limb muscles' corticomotor pathway responsiveness recorded during voluntary contractions were modulated by lower limbs fatiguing contractions and this modulation depends on the force produced during testing, i.e. level of central motor drive. However, these changes have little effect on upper limb muscle maximal performance.

Long-Term Plasticity in Reflex Excitability Induced by Five Weeks of Arm and Leg Cycling Training after Stroke

Neural connections remain partially viable after stroke, and access to these residual connections provides a substrate for training-induced plasticity. The objective of this project was to test if reflex excitability could be modified with arm and leg (A &amp; L) cycling training. Nineteen individuals with chronic stroke (more than six months postlesion) performed 30 min of A &amp; L cycling training three times a week for five weeks. Changes in reflex excitability were inferred from modulation of cutaneous and stretch reflexes. A multiple baseline (three pretests) within-subject control design was used. Plasticity in reflex excitability was determined as an increase in the conditioning effect of arm cycling on soleus stretch reflex amplitude on the more affected side, by the index of modulation, and by the modulation ratio between sides for cutaneous reflexes. In general, A &amp; L cycling training induces plasticity and modifies reflex excitability after stroke.

Neuromechanical interactions between the limbs during human locomotion: an evolutionary perspective with translation to rehabilitation

During bipedal locomotor activities, humans use elements of quadrupedal neuronal limb control. Evolutionary constraints can help inform the historical ancestry for preservation of these core control elements support transfer of the huge body of quadrupedal non-human animal literature to human rehabilitation. In particular, this has translational applications for neurological rehabilitation after neurotrauma where interlimb coordination is lost or compromised. The present state of the field supports including arm activity in addition to leg activity as a component of gait retraining after neurotrauma.

Effect of muscle relaxation in the foot on simultaneous muscle contraction in the contralateral hand

We investigated the effects of foot muscle relaxation and contraction on muscle activities in the hand on both ipsilateral and contralateral sides. The subjects sat in an armchair with hands in the pronated position. They were able to freely move their right/left hand and foot. They performed three tasks for both ipsilateral (right hand and right foot) and contralateral limb coordination (left hand and right foot for a total of six tasks). These tasks involved: (1) wrist extension from a flexed (resting) position, (2) wrist extension with simultaneous ankle dorsiflexion from a plantarflexed (resting) position, and (3) wrist extension with simultaneous ankle relaxation from a dorsiflexed position. The subjects performed each task as fast as possible after hearing the start signal. Reaction time for the wrist extensor contraction (i.e. the degree to which it preceded the motor reaction time), as observed in electromyography (EMG), became longer when it was concurrently done with relaxation of the ankle dorsiflexor. Also, the magnitude of EMG activity became smaller, as compared with activity when wrist extensor contraction was done alone or with contraction of the ankle dorsiflexor. These effects were observed not only for the ipsilateral hand, but also for the contralateral hand. Our findings suggest that muscle relaxation in one limb interferes with muscle contraction in both the ipsilateral and contralateral limbs.

Soleus Hoffmann reflex amplitudes are specifically modulated by cutaneous inputs from the arms and opposite leg during walking but not standing

Electrical stimulation of cutaneous nerves innervating heteronymous limbs (the arms or contralateral leg) modifies the excitability of soleus Hoffmann (H-) reflexes. The differences in the sensitivities of the H-reflex pathway to cutaneous afferents from different limbs and their modulation during the performance of motor tasks (i.e., standing and walking) are not fully understood. In the present study, we investigated changes in soleus H-reflex amplitudes induced by electrical stimulation of peripheral nerves. Selected targets for conditioning stimulation included the superficial peroneal nerve, which innervates the foot dorsum in the contralateral ankle (cSP), and the superficial radial nerve, which innervates the dorsum of the hand in the ipsilateral (iSR) or contralateral wrist (cSR). Stimulation and subsequent reflex assessment took place during the standing and early-stance phase of treadmill walking in ten healthy subjects. Cutaneous stimulation produced long-latency inhibition (conditioning-test interval of ~100 ms) of the H-reflex during the early-stance phase of walking, and the inhibition was stronger following cSP stimulation compared with iSR or cSR stimulation. In contrast, although similar conditioning stimulation significantly facilitated the H-reflex during standing, this effect remained constant irrespective of the different conditioning sites. These findings suggest that cutaneous inputs from the arms and contralateral leg had reversible effects on the H-reflex amplitudes, including inhibitions with different sensitivities during the early-stance phase of walking and facilitation during standing. Furthermore, the differential sensitivities of the H-reflex modulations were expressed only during walking when the locations of the afferent inputs were functionally relevant.

Rhythmic arm swing enhances patterned locomotor-like muscle activity in passively moved lower extremities

The use of driven gait orthosis (DGO) has drawn attention in gait rehabilitation for patients after central nervous system (CNS) lesions. By imposing a passive locomotor-like kinematic pattern, the neural mechanisms responsible for locomotion can be activated as in a normal gait. To further enhance this activity, discussions on possible intervention are necessary. Given the possible functional linkages between the upper and lower limbs, we investigated in healthy subjects the degree of modification in the lower limb muscles during DGO-induced passive gait by the addition of swing movement in the upper extremity. The results clearly showed that muscle activity in the ankle dorsiflexor TA muscle was significantly enhanced when the passive locomotor-like movement was accompanied by arm swing movement. The modifications in the TA activity were not a general increase through the stride cycles, but were observed under particular phases as in normal gaits. Voluntary effort to swing the arms may have certain effects on the modification of the muscle activity. The results provide clinical implications regarding the usefulness of voluntary arm swing movement as a possible intervention in passive gait training using DGO, since ordinary gait training using DGO does not induce spontaneous arm swing movement despite its known influence on the lower limb movement.

After stroke bidirectional modulation of soleus stretch reflex amplitude emerges during rhythmic arm cycling

OBJECTIVES

after stroke a typical presentation is exaggerated stretch reflexes (SRs) on the more affected (MA) side. The present study evaluated the contribution of presynaptic inhibition (PSI) induced by arm cycling and homosynaptic depression (HD) to the modulation of hyperreflexia at the ankle after stroke. Possible asymmetry of these effects between the MA and less affected (LA) legs was also assessed.

METHODS

soleus SR was conditioned by: arm cycling at 1 Hz (to increase Ia PSI); or, a preceding conditioning tendon tap applied 1 s before the test stimulus (to induce HD). The extent of conditioning effects was compared between the MA and the LA legs.

RESULTS

for both MA and LA legs, rhythmic arm movement induced a bidirectional effect in different participants, either increasing or decreasing SR amplitude (p < 0.05). HD had a significant effect in both legs (p < 0.05), however, the effect of both a previous muscle stretch and arm cycling was not different between the MA and the LA legs.

CONCLUSION

our data reveal a bidirectional reflex modulation induced by arm cycling that produced facilitation in some and suppression in other participants after stroke. Relative SR amplitude modulation did not differ between the LA and MA legs. We speculate that alterations in SR amplitude modulation after stroke may reflect specific changes in both presynaptic afferent transmission mechanisms and fusimotor control.

SIGNIFICANCE

the present findings open new perspectives on the characterization of pathophysiology of stroke during the performance of functionally relevant motor tasks.

Walking phase modulates H-reflex amplitude in flexor carpi radialis

It is well established that remote whole-limb rhythmic movement (e.g., cycling or stepping) induces suppression of the Hoffman (H-) reflex evoked in stationary limbs. However, the dependence of reflex amplitude on the phase of the movement cycle (i.e., phase-dependence) has not been consistent across this previous research. The authors investigated the phase-dependence of flexor carpi radialis (FCR) H-reflex amplitudes during active walking and in kinematically matched static postures across the gait cycle. FCR H-reflexes were elicited in the stationary forearm with electrical stimulation to the median nerve. Significant phase-dependent modulation occurred during walking when the gait cycle was examined with adequate phase resolution. The suppression was greatest during midstance and midswing, suggesting increased ascending communication during these phases. There was no phase-dependent modulation in static standing postures and no correlation between lower limb background electromyography levels and H-reflex amplitude during active walking. This evidence, along with previous research demonstrating no phase modulation during passive walking, suggests that afferent feedback associated with joint position and leg muscle activation levels are not the sole source of the phase modulation seen during active walking. Possible sources of phase modulation include combinations of afferent feedback related to active movement or central motor commands or both.

Arm sway holds sway: locomotor-like modulation of leg reflexes when arms swing in alternation

It has been argued that arm movements are important during human gait because they affect leg activity due to neural coupling between arms and legs. Consequently, one would expect that locomotor-like alternating arm swing is more effective than in-phase swing in affecting the legs' motor output. Other alternating movements such as trunk rotation associated to arm swing could also affect leg reflexes. Here, we assessed how locomotor-like movement patterns would affect soleus H-reflexes in 13 subjects performing arm swing in the sagittal plane (ipsilateral, contralateral and bilateral in-phase versus locomotor-like anti-phase arm movements) and trunk rotation with the legs stationary, and leg stepping with the arms stationary. Findings revealed that soleus H-reflexes were suppressed for all arm, trunk or leg movements. However, a marked reflex modulation occurred during locomotor-like anti-phase arm swing, as was also the case during leg stepping, and this modulation flattened out during in-phase arm swing. This modulation had a peculiar bell shape and showed maximum suppression at a moment where the heel-strike would occur during a normal walking cycle. Furthermore, this modulation was independent from electromyographic activity, suggesting a spinal processing at premotoneuronal level. Therefore, trunk movement can affect legs' output, and a special neural coupling occurs between arms and legs when arms move in alternation. This may have implications for gait rehabilitation.

Neural mechanisms influencing interlimb coordination during locomotion in humans: presynaptic modulation of forearm H-reflexes during leg cycling

Presynaptic inhibition of transmission between Ia afferent terminals and alpha motoneurons (Ia PSI) is a major control mechanism associated with soleus H-reflex modulation during human locomotion. Rhythmic arm cycling suppresses soleus H-reflex amplitude by increasing segmental Ia PSI. There is a reciprocal organization in the human nervous system such that arm cycling modulates H-reflexes in leg muscles and leg cycling modulates H-reflexes in forearm muscles. However, comparatively little is known about mechanisms subserving the effects from leg to arm. Using a conditioning-test (C-T) stimulation paradigm, the purpose of this study was to test the hypothesis that changes in Ia PSI underlie the modulation of H-reflexes in forearm flexor muscles during leg cycling. Subjects performed leg cycling and static activation while H-reflexes were evoked in forearm flexor muscles. H-reflexes were conditioned with either electrical stimuli to the radial nerve (to increase Ia PSI; C-T interval  = 20 ms) or to the superficial radial (SR) nerve (to reduce Ia PSI; C-T interval  = 37-47 ms). While stationary, H-reflex amplitudes were significantly suppressed by radial nerve conditioning and facilitated by SR nerve conditioning. Leg cycling suppressed H-reflex amplitudes and the amount of this suppression was increased with radial nerve conditioning. SR conditioning stimulation removed the suppression of H-reflex amplitude resulting from leg cycling. Interestingly, these effects and interactions on H-reflex amplitudes were observed with subthreshold conditioning stimulus intensities (radial n., ∼0.6×MT; SR n., ∼ perceptual threshold) that did not have clear post synaptic effects. That is, did not evoke reflexes in the surface EMG of forearm flexor muscles. We conclude that the interaction between leg cycling and somatosensory conditioning of forearm H-reflex amplitudes is mediated by modulation of Ia PSI pathways. Overall our results support a conservation of neural control mechanisms between the arms and legs during locomotor behaviors in humans.

Differential modulation of reciprocal inhibition in ankle muscles during rhythmic arm cycling

Interlimb neural linkages relay activity related to rhythmic arm movement to the lumbar spinal cord. This is detected by modulated reflex amplitudes in muscles remote from the rhythmic movement. Improved understanding of modulation in ankle flexor and extensor muscles due to rhythmic arm movement can be gained using modulation of spinal excitability as a probe. The modulatory effect of rhythmic arm movement on Ia reciprocal inhibition (RI) between functional antagonists at the ankle has not been studied. We investigated the influence of rhythmic arm cycling on short latency (∼55ms post-stimulus) RI between ankle flexor (tibialis anterior, TA) and extensor (soleus, SOL) muscles at varying (0.9, 1.0, 1.2, 1.5 and 2.0× motor threshold (MT)) stimulus intensities. We hypothesized that arm cycling would increase RI between antagonists, but that movement conditioning would vary depending on stimulus intensity used to evoke the RI response. Amplitude of RI deduced from suppression of ongoing EMG activity was compared in static and arm cycling conditions. Arm cycling significantly (p<0.05) increased RI in SOL at 1.0×MT, but had no effect in TA at any stimulus intensity (p>0.05). Descending signals arising from rhythmic arm movement significantly alter transmission in RI pathways between ankle flexor and extensor muscles differentially. This may be due to differences in descending supraspinal inputs to ankle flexors vs. extensors, and could be related to functional requirements during locomotion.

Effect of afferent feedback and central motor commands on soleus H-reflex suppression during arm cycling

Suppression of soleus H-reflex amplitude in stationary legs is seen during rhythmic arm cycling. We examined the influence of various arm-cycling parameters on this interlimb reflex modulation to determine the origin of the effect. We previously showed the suppression to be graded with the frequency of arm cycling but not largely influenced by changes in peripheral input associated with crank length. Here, we more explicitly explored the contribution of afferent feedback related to arm movement on the soleus H-reflex suppression. We explored the influence of load and rate of muscle stretch by manipulating crank-load and arm-muscle vibration during arm cycling. Furthermore, internally driven ("Active") and externally driven ("Passive") arm cycling was compared. Soleus H-reflexes were evoked with tibial nerve stimulation during stationary control and rhythmic arm-cycling conditions, including: 1) six different loads; 2) with and without vibration to arm muscles; and 3) Active and Passive conditions. No significant differences were seen in the level of suppression between the different crank loads or between conditions with and without arm-muscle vibration. Furthermore, in contrast to the clear effect seen during active cycling, passive arm cycling did not significantly suppress the soleus H-reflex amplitude. Current results, in conjunction with previous findings, suggest that the afferent feedback examined in these studies is not the primary source responsible for soleus H-reflex suppression. Instead, it appears that central motor commands (supraspinal or spinal in origin) associated with frequency of arm cycling are relatively more dominant sources.

Neural control of rhythmic arm cycling after stroke

Disordered reflex activity and alterations in the neural control of walking have been observed after stroke. In addition to impairments in leg movement that affect locomotor ability after stroke, significant impairments are also seen in the arms. Altered neural control in the upper limb can often lead to altered tone and spasticity resulting in impaired coordination and flexion contractures. We sought to address the extent to which the neural control of movement is disordered after stroke by examining the modulation pattern of cutaneous reflexes in arm muscles during arm cycling. Twenty-five stroke participants who were at least 6 mo postinfarction and clinically stable, performed rhythmic arm cycling while cutaneous reflexes were evoked with trains (5 × 1.0-ms pulses at 300 Hz) of constant-current electrical stimulation to the superficial radial (SR) nerve at the wrist. Both the more (MA) and less affected (LA) arms were stimulated in separate trials. Bilateral electromyography (EMG) activity was recorded from muscles acting at the shoulder, elbow, and wrist. Analysis was conducted on averaged reflexes in 12 equidistant phases of the movement cycle. Phase-modulated cutaneous reflexes were present, but altered, in both MA and LA arms after stroke. Notably, the pattern was "blunted" in the MA arm in stroke compared with control participants. Differences between stroke and control were progressively more evident moving from shoulder to wrist. The results suggest that a reduced pattern of cutaneous reflex modulation persists during rhythmic arm movement after stroke. The overall implication of this result is that the putative spinal contributions to rhythmic human arm movement remain accessible after stroke, which has translational implications for rehabilitation.

Rhythmic arm cycling differentially modulates stretch and H-reflex amplitudes in soleus muscle

During rhythmic arm cycling, soleus H-reflex amplitudes are reduced by modulation of group Ia presynaptic inhibition. This suppression of reflex amplitude is graded to the frequency of arm cycling with a threshold of 0.8 Hz. Despite the data on modulation of the soleus H-reflex amplitude induced by rhythmic arm cycling, comparatively little is known about the modulation of stretch reflexes due to remote limb movement. Therefore, the present study was intended to explore the effect of arm cycling on stretch and H-reflex amplitudes in the soleus muscle. In so doing, additional information on the mechanism of action during rhythmic arm cycling would be revealed. Although both reflexes share the same afferent pathway, we hypothesized that stretch reflex amplitudes would be less suppressed by arm cycling because they are less inhibited by presynaptic inhibition. Failure to reject this hypothesis would add additional strength to the argument that Ia presynaptic inhibition is the mechanism modulating soleus H-reflex amplitude during rhythmic arm cycling. Participants were seated in a customized chair with feet strapped to footplates. Three motor tasks were performed: static control trials and arm cycling at 1 and 2 Hz. Soleus H-reflexes were evoked using single 1 ms pulses of electrical stimulation delivered to the tibial nerve at the popliteal fossa. A constant M-wave and ~6% MVC activation of soleus were maintained across conditions. Stretch reflexes were evoked using a single sinusoidal pulse at 100 Hz given by a vibratory shaker placed over the triceps surae tendon and controlled by a custom-written LabView program. Results demonstrated that rhythmic arm cycling that was effective for conditioning soleus H-reflexes did not show a suppressive effect on the amplitude of the soleus stretch reflex. We suggest this indicates that stretch reflexes are less sensitive to conditioning by rhythmic arm movement, as compared to H-reflexes, due to the relative insensitivity to Ia presynaptic inhibition.

Robotic-assisted stepping modulates monosynaptic reflexes in forearm muscles in the human

Although the amplitude of the Hoffmann (H)-reflex in the forelimb muscles is known to be suppressed during rhythmic leg movement, it is unknown which factor plays a more important role in generating this suppression-movement-related afferent feedback or feedback related to body loading. To specifically explore the movement- and load-related afferent feedback, we investigated the modulation of the H-reflex in the flexor carpi radialis (FCR) muscle during robotic-assisted passive leg stepping. Passive stepping and standing were performed using a robotic gait-trainer system (Lokomat). The H-reflex in the FCR, elicited by electrical stimulation to the median nerve, was recorded at 10 different phases of the stepping cycle, as well as during quiet standing. We confirmed that the magnitude of the FCR H-reflex was suppressed significantly during passive stepping compared with during standing. The suppressive effect on the FCR H-reflex amplitude was seen at all phases of stepping, irrespective of whether the stepping was conducted with body weight loaded or unloaded. These results suggest that movement-related afferent feedback, rather than load-related afferent feedback, plays an important role in suppressing the FCR H-reflex amplitude.

Bilateral neuromuscular plasticity from unilateral training of the ankle dorsiflexors

Training a muscle group in one limb yields strength gains bilaterally-the so-called cross-education effect. However, to date there has been little study of the targeted application of this phenomenon in a manner relevant to clinical rehabilitation. For example, it may be applicable post-stroke, where hemiparesis leads to ankle flexor weakness. The purpose of this study was to examine the effects of high-intensity unilateral dorsiflexion resistance training on agonist (tibialis anterior, TA) and antagonist (plantarflexor soleus, SOL) muscular strength and H-reflex excitability in the trained and untrained limbs. Ankle flexor and extensor torque, as well as SOL and TA H-reflexes evoked during low-level contraction, were measured before and after 5 weeks of dorsiflexion training (n = 19). As a result of the intervention, dorsiflexor maximal voluntary isometric contraction force (MVIC) significantly increased (P < 0.05) in both the trained and untrained limbs by 14.7 and 8.4%, respectively. No changes in plantarflexor MVIC force were observed in either limb. Significant changes in H-reflex excitability threshold were also detected: H(@thresh) significantly increased in the trained TA and SOL; and H(@max) decreased in both SOL muscles. These findings reveal that muscular crossed effects can be obtained in the ankle dorsiflexor muscles and provide novel information on agonist and antagonist spinal adaptations that accompany unilateral training. It is possible that the ability to strengthen the ankle dorsiflexors bilaterally could be applied in post-stroke rehabilitation, where ankle flexor weakness could be counteracted via dorsiflexor training in the less-affected limb.

Phase-dependent modulation of soleus H-reflex amplitude induced by rhythmic arm cycling

Rhythmic arm cycling is known to suppress the Hoffmann (H-) reflex amplitudes in the soleus (Sol) muscles of stationary legs. However, it has remained unclear if this suppression is modulated according to the phase of movement in the cycle path or is rather a general setting of excitability level related to rhythmic movement. In the present study we investigated the phase-dependent modulation of the Sol H-reflex induced by rhythmic arm cycling by examining reflex amplitudes at 12 phases of the arm cycle movement. Arm cycling tasks consisted of bilateral, ipsilateral and contralateral movement. Additionally, data were also sampled at 12 static arm positions mimicking those occurring during movement. H-reflexes were evoked and recorded at constant motor wave amplitudes across all conditions. Suppression of Sol H-reflex amplitude was dependent upon the phase of movement (main effect p<0.0001) during arm cycling, but not during static positioning. Results suggest that locomotor central pattern generators may contribute to the phasic reflex modulation observed in this study. The phasic modulation was more pronounced during bilateral movement, however aspects of the neural control driving this modulation were also present during ipsilateral and contralateral movement.

The effect of immobilization of the head and trunk on arm-cycling-induced depression of soleus motoneuron pool excitability

The purpose of this study was to investigate the effects of immobilization of the head and trunk on arm-cycling-induced depression of leg motoneuron pool excitability. Seven healthy humans participated in this study. The subjects sat on a chair with or without immobilization of the head and trunk. The subjects rhythmically cycled a crank of the ergometer with their hands at a frequency of 1 Hz. Soleus H-reflexes were evoked during arm cycling and during stational arm position. The H-reflexes were not significantly depressed during arm cycling when the head and trunk were immobilized, but were significantly depressed during arm cycling when the head and trunk were not immobilized. The H-reflex depression during arm cycling in the non-immobilized condition was significantly larger than that in the immobilized condition. These findings support our hypothesis that the depression of leg motoneuron pool excitability induced by arm cycling is partially related to postural activity in the head and trunk.

Neuromechanical considerations for incorporating rhythmic arm movement in the rehabilitation of walking

We have extensively used arm cycling to study the neural control of rhythmic movements such as arm swing during walking. Recently rhythmic movement of the arms has also been shown to enhance and shape muscle activity in the legs. However, restricted information is available concerning the conditions necessary to maximally alter lumbar spinal cord excitability. Knowledge on the neuromechanics of a task can assist in the determination of the type, level, and timing of neural signals, yet arm swing during walking and arm cycling have not received a detailed neuromechanical comparison. The purpose of this research was to provide a combined neural and mechanical measurement approach that could be used to assist in the determination of the necessary and sufficient conditions for arm movement to assist in lower limb rehabilitation after stroke and spinal cord injury. Subjects performed three rhythmic arm movement tasks: (1) cycling (cycle); (2) swinging while standing (swing); and (3) swinging while treadmill walking (walk). We hypothesized that any difference in neural control between tasks (i.e., pattern of muscle activity) would reflect changes in the mechanical constraints unique to each task. Three-dimensional kinematics were collected simultaneously with force measurement at the hand and electromyography from the arms and trunk. All data were appropriately segmented to allow a comparison between and across conditions and were normalized and averaged to 100% movement cycle based on shoulder excursion. Separate mathematical principal components analysis of kinematic and neural variables was performed to determine common task features and muscle synergies. The results highlight important neural and mechanical features that distinguish differences between tasks. For example, there are considerable differences in the anatomical positions of the arms during each task, which relate to the moments experienced about the elbow and shoulder. Also, there are differences between tasks in elbow flexion/extension kinematics alongside differential muscle activation profiles. As well, mechanical assistance and constraints during all tasks could affect muscle recruitment and the functional role of muscles. Overall, despite neural and mechanical differences, the results are consistent with conserved common central motor control mechanisms operational for cycle, walk, and swing but appropriately sculpted to demands unique to each task. However, changing the mechanical parameters could affect the role of afferent feedback altering neural control and the coupling to the lower limbs.

Suppression of soleus H-reflex amplitude is graded with frequency of rhythmic arm cycling

In humans, rhythmic arm cycling has been shown to significantly suppress the soleus H-reflex amplitude in stationary legs. The specific nature of the relationship between frequency of arm cycling and H-reflex modulation in the legs has not been explored. We speculated that the effect of arm cycling on reflexes in leg muscles is related to the neural control of arm movement; therefore, we hypothesized that a graded increase in arm cycling frequency would produce a graded suppression of the soleus H-reflex amplitude. We also hypothesized that a threshold frequency of arm cycling would be identified at which the H-reflex amplitude significantly differed from static control trials (i.e., the arms were stationary). Soleus H-reflexes were evoked in stationary legs with tibial nerve stimulation during both control and rhythmic arm cycling (0.03-2.0 Hz) trials. The results show a significant inverse linear relation between arm cycling frequency and soleus H-reflex amplitude (P<0.05). Soleus H-reflex amplitude significantly differed from control at an average threshold cycling frequency of 0.8 Hz. The results demonstrate that increased frequency of upper limb movement increases the intensity of interlimb influences on the neural activity in stationary legs. Further, a minimum threshold frequency of arm cycling is required to produce a significant effect. This suggests that achieving a threshold frequency of rhythmic arm movement may be important to incorporate in rehabilitation strategies to engage the appropriate interlimb neural pathways.

Short-term plasticity of spinal reflex excitability induced by rhythmic arm movement

Rhythmic arm movement reduces Hoffmann (H)-reflex amplitudes in leg muscles by modulation of presynaptic inhibition in group Ia transmission. To date only the acute effect occurring during arm movement has been studied. We hypothesized that the excitability of soleus H-reflexes would remain suppressed beyond a period of arm cycling conditioning. Subjects used a customized arm ergometer to perform rhythmic 1-Hz arm cycling for 30 min. H-reflexes were evoked before, during, and after arm cycling via stimulation of the tibial nerve in the popliteal fossa. The most important finding was that the H-reflex amplitudes were significantly suppressed during and <or=20 min after arm cycling had been terminated. Thus remote arm cycling can induce adaptive plasticity in the soleus H-reflex pathway that persists beyond the period of conditioning. In an additional experiment, the prolonged effect of arm cycling combined with cutaneous superficial radial (SR) nerve stimulation was investigated. Cutaneous stimulation cancelled the prolonged suppression of H-reflex amplitude induced by arm cycling. Because SR nerve stimulation facilitates soleus H-reflex via reducing the level of Ia presynaptic inhibition, persistence in presynaptic inhibitory pathways is suggested as the underlying neural mechanism. The simplest explanation of this observation is plateau potential-like behavior of interneurons mediating presynaptic inhibition of Ia afferent transmission.

Enhancement of Arm and Leg Locomotor Coupling With Augmented Cutaneous Feedback From the Hand

Cutaneous feedback from the hand could assist with coordination between the arms and legs during locomotion. Previously we used a reduced walking model of combined arm and leg (arm&leg) cycling to examine the separate effects of rhythmic arm (arm) and leg (leg) movement. Here we use this same paradigm to test the modulation H-reflexes with and without interlimb cutaneous conditioning evoked by stimulating a nerve innervating the hand (superficial radial, SR). It was hypothesized that both arm and leg would contribute significantly to suppression of H-reflex amplitude during arm&leg. We also predicted a conservation of interlimb cutaneous conditioning during movement and an interaction between arm and leg rhythmic movement control. Subjects were seated in a recumbent arm&leg cycle ergometer and maintained a low-level soleus contraction for all tasks. H-reflex amplitude was facilitated by cutaneous conditioning evoked by stimulation of the SR nerve. H-reflex amplitudes were taken from recruitment curves and included modulation of 50% Hmax and Hmax. The suppressive effect of arm was less than that for leg and arm&leg, while suppression during leg and arm&leg were generally equivalent. For H-reflexes conditioned by cutaneous input, amplitudes during arm&leg instead were in between those for arm and leg modulation. Multiple regression analysis revealed a significant contribution for arm only in trials when SR stimulation was used to condition H-reflex amplitudes. We suggest that there is a measurable interaction between neural activity regulating arm and leg movement during locomotion that is specifically enhanced when cutaneous input from the hand is present.

Rhythmic leg cycling modulates forearm muscle H-reflex amplitude and corticospinal tract excitability

Rhythmic arm cycling leads to suppression of H-reflexes in both leg and arm muscles, and a reduction in the excitability of corticospinal projections to the forearm flexors. It is unknown, however, whether leg cycling modulates excitability in neural projections to the arms. Here we studied the extent to which rhythmic movement of the legs alters reflex (Experiment 1) and corticospinal (Experiment 2) transmission to arm muscles. In experiment 1, flexor carpi radialis (FCR) H-reflex recruitment curves were recorded with the legs static, and during rhythmic leg movement, while the FCR was both contracted and relaxed. The results indicate that rhythmic leg movement suppresses reflex transmission, both when FCR is at rest and during tonic contraction, but that the effect is not phase-dependent. In experiment 2, we used transcranial magnetic stimulation (TMS) to elicit motor-evoked potentials in the contracted and relaxed FCR during static leg, and leg cycling conditions. Sub-threshold TMS was also used to condition H-reflexes in order to provide specific information about cortical excitability during leg cycling. Both resting and tonically contracting arm muscles showed a greater corticospinal excitability during leg cycling than during the static leg condition. The magnitude of TMS facilitation of H-reflexes was similar during leg cycling and rest, suggesting a considerable sub-cortical component to the increased corticospinal excitability. The results suggest a differential regulation of afferent and descending projections to the arms during leg cycling, and are consistent with the idea that there is a loose, but significant, neural coupling between the arms and legs during rhythmic movement.