Motoneuron activation by low intensity tetanic stimulation of muscle afferents in man

Asynchronous recruitment of low-threshold motor units during repetitive, low-current stimulation of the human tibial nerve

Motoneurons receive a barrage of inputs from descending and reflex pathways. Much of our understanding about how these inputs are transformed into motor output in humans has come from recordings of single motor units during voluntary contractions. This approach, however, is limited because the input is ill-defined. Herein, we quantify the discharge of soleus motor units in response to well-defined trains of afferent input delivered at physiologically-relevant frequencies. Constant frequency stimulation of the tibial nerve (10–100 Hz for 30 s), below threshold for eliciting M-waves or H-reflexes with a single pulse, recruited motor units in 7/9 subjects. All 25 motor units recruited during stimulation were also recruited during weak (<10% MVC) voluntary contractions. Higher frequencies recruited more units (n = 3/25 at 10 Hz; n = 25/25 at 100 Hz) at shorter latencies (19.4 ± 9.4 s at 10 Hz; 4.1 ± 4.0 s at 100 Hz) than lower frequencies. When a second unit was recruited, the discharge of the already active unit did not change, suggesting that recruitment was not due to increased synaptic drive. After recruitment, mean discharge rate during stimulation at 20 Hz (7.8 Hz) was lower than during 30 Hz (8.6 Hz) and 40 Hz (8.4 Hz) stimulation. Discharge was largely asynchronous from the stimulus pulses with “time-locked” discharge occurring at an H-reflex latency with only a 24% probability. Motor units continued to discharge after cessation of the stimulation in 89% of trials, although at a lower rate (5.8 Hz) than during the stimulation (7.9 Hz). This work supports the idea that the afferent volley evoked by repetitive stimulation recruits motor units through the integration of synaptic drive and intrinsic properties of motoneurons, resulting in “physiological” recruitment which adheres to Henneman’s size principle and results in relatively low discharge rates and asynchronous firing.

H-reflexes reduce fatigue of evoked contractions after spinal cord injury

INTRODUCTION

Neuromuscular electrical stimulation (NMES) over a muscle belly (mNMES) generates contractions predominantly through M-waves, while NMES over a nerve trunk (nNMES) can generate contractions through H-reflexes in people who are neurologically intact. We tested whether the differences between mNMES and nNMES are present in people with chronic motor-complete spinal cord injury and, if so, whether they influence contraction fatigue.

METHODS

Plantar-flexion torque and soleus electromyography were recorded from 8 participants. Fatigue protocols were delivered using mNMES and nNMES on separate days.

RESULTS

nNMES generated contractions that fatigued less than mNMES. Torque decreased the least when nNMES generated contractions, at least partly through H-reflexes (n = 4 participants; 39% decrease), and torque decreased the most when contractions were generated through M-waves, regardless of NMES site (nNMES 71% decrease, n = 4; mNMES, 73% decrease, n = 8).

CONCLUSIONS

nNMES generates contractions that fatigue less than mNMES, but only when H-reflexes contribute to the evoked contractions.

Motor unit recruitment when neuromuscular electrical stimulation is applied over a nerve trunk compared with a muscle belly: quadriceps femoris

Neuromuscular electrical stimulation (NMES) can be delivered over a nerve trunk or muscle belly and both can generate contractions through peripheral and central pathways. Generating contractions through peripheral pathways is associated with a nonphysiological motor unit recruitment order, which may limit the efficacy of NMES rehabilitation. Presently, we compared recruitment through peripheral and central pathways for contractions of the knee extensors evoked by NMES applied over the femoral nerve vs. the quadriceps muscle. NMES was delivered to evoke 10 and 20% of maximum voluntary isometric contraction torque 2–3 s into the NMES (time1) in two patterns: 1) constant frequency (15 Hz for 8 s); and 2) step frequency (15–100-15 Hz and 25–100-25 Hz for 3–2-3 s, respectively). Torque and electromyographic activity recorded from vastus lateralis and medialis were quantified at the beginning (time1) and end (time2; 6–7 s into the NMES) of each pattern. M-waves (peripheral pathway), H-reflexes, and asynchronous activity (central pathways) during NMES were quantified. Torque did not differ regardless of NMES location, pattern, or time. For both muscles, M-waves were ∼7–10 times smaller and H-reflexes ∼8–9 times larger during NMES over the nerve compared with over the muscle. However, unlike muscles studied previously, neither torque nor activity through central pathways were augmented following 100 Hz NMES, nor was any asynchronous activity evoked during NMES at either location. The coefficient of variation was also quantified at time2to determine the consistency of each dependent measure between three consecutive contractions. Torque, M-waves, and H-reflexes were most variable during NMES over the nerve. In summary, NMES over the nerve produced contractions with the greatest recruitment through central pathways; however, considering some of the limitations of NMES over the femoral nerve, it may be considered a good complement to, as opposed to a replacement for, NMES over the quadriceps muscle for maintaining muscle quality and reducing contraction fatigue during NMES rehabilitation.

Motor unit recruitment when neuromuscular electrical stimulation is applied over a nerve trunk compared with a muscle belly: triceps surae

Neuromuscular electrical stimulation (NMES) can be delivered over a nerve trunk or muscle belly and can generate contractions by activating motor (peripheral pathway) and sensory (central pathway) axons. In the present experiments, we compared the peripheral and central contributions to plantar flexion contractions evoked by stimulation over the tibial nerve vs. the triceps surae muscles. Generating contractions through central pathways follows Henneman's size principle, whereby low-threshold motor units are activated first, and this may have advantages for rehabilitation. Statistical analyses were performed on data from trials in which NMES was delivered to evoke 10–30% maximum voluntary torque 2–3 s into the stimulation (Time1). Two patterns of stimulation were delivered: 1) 20 Hz for 8 s; and 2) 20–100-20 Hz for 3–2-3 s. Torque and soleus electromyography were quantified at the beginning (Time1) and end (Time2; 6–7 s into the stimulation) of each stimulation train. H reflexes (central pathway) and M waves (peripheral pathway) were quantified. Motor unit activity that was not time-locked to each stimulation pulse as an M wave or H reflex (“asynchronous” activity) was also quantified as a second measure of central recruitment. Torque was not different for stimulation over the nerve or the muscle. In contrast, M waves were approximately five to six times smaller, and H reflexes were approximately two to three times larger during NMES over the nerve vs. the muscle. Asynchronous activity increased by 50% over time, regardless of the stimulation location or pattern, and was largest during NMES over the muscle belly. Compared with NMES over the triceps surae muscles, NMES over the tibial nerve produced contractions with a relatively greater central contribution, and this may help reduce muscle atrophy and fatigue when NMES is used for rehabilitation.

Vibration-induced extra torque during electrically-evoked contractions of the human calf muscles

Background

High-frequency trains of electrical stimulation applied over the lower limb muscles can generate forces higher than would be expected from a peripheral mechanism (i.e. by direct activation of motor axons). This phenomenon is presumably originated within the central nervous system by synaptic input from Ia afferents to motoneurons and is consistent with the development of plateau potentials. The first objective of this work was to investigate if vibration (sinusoidal or random) applied to the Achilles tendon is also able to generate large magnitude extra torques in the triceps surae muscle group. The second objective was to verify if the extra torques that were found were accompanied by increases in motoneuron excitability.

Methods

Subjects (n = 6) were seated on a chair and the right foot was strapped to a pedal attached to a torque meter. The isometric ankle torque was measured in response to different patterns of coupled electrical (20-Hz, rectangular 1-ms pulses) and mechanical stimuli (either 100-Hz sinusoid or gaussian white noise) applied to the triceps surae muscle group. In an additional investigation, M_max and F-waves were elicited at different times before or after the vibratory stimulation.

Results

The vibratory bursts could generate substantial self-sustained extra torques, either with or without the background 20-Hz electrical stimulation applied simultaneously with the vibration. The extra torque generation was accompanied by increased motoneuron excitability, since an increase in the peak-to-peak amplitude of soleus F waves was observed. The delivery of electrical stimulation following the vibration was essential to keep the maintained extra torques and increased F-waves.

Conclusions

These results show that vibratory stimuli applied with a background electrical stimulation generate considerable force levels (up to about 50% MVC) due to the spinal recruitment of motoneurons. The association of vibration and electrical stimulation could be beneficial for many therapeutic interventions and vibration-based exercise programs. The command for the vibration-induced extra torques presumably activates spinal motoneurons following the size principle, which is a desirable feature for stimulation paradigms.

Effect of a peripheral nerve block on torque produced by repetitive electrical stimulation

Neuromuscular electrical stimulation (NMES) generates contractions by activation of motor axons (peripheral mechanism), but the afferent volley also contributes by recruiting spinal motoneurons synaptically (central mechanism), which recruits motoneurons according to Henneman's size principle. Thus, we hypothesized that contractions that develop due to a combination of peripheral and central mechanisms will fatigue less rapidly than when electrically evoked contractions are generated by the activation of motor axons alone. Plantar-flexion torque evoked by NMES over the triceps surae was compared in five able-bodied subjects before (Intact) and during (Blocked) a complete anesthetic block of the tibial and common peroneal nerves. In the Blocked condition, plantar-flexion torque could only develop from the direct activation of motor axons beneath the stimulating electrodes. NMES was delivered using three protocols: protocol A, constant 100 Hz for 30 s; protocol B, four 2-s bursts of 100 Hz alternating with 20-Hz stimulation; and protocol C, alternating 100 Hz bursts (1 s on, 1 s off) for 30 s. The percent change in evoked plantar flexion torque from the beginning to the end of the stimulation differed ( P < 0.05) between Intact and Blocked conditions for all protocols (Intact: protocol A = +125%, B = +230%, C = +78%; Blocked: protocol A = −79%, B = −15%, C = −35%). These results corroborate previous evidence that NMES can evoke contractions via the recruitment of spinal motoneurons in addition to the direct recruitment of motor axons. We now show that NMES delivered for periods of up to 30 s generates plantar-flexion torque which decreases when only motor axons are recruited and increases when the central nervous system can contribute.

Evidence for increased activation of persistent inward currents in individuals with chronic hemiparetic stroke

Despite the prevalence of hyperactive stretch reflexes in the paretic limbs of individuals with chronic hemiparetic stroke, the fundamental pathophysiological mechanisms responsible for their expression remain poorly understood. This study tests whether the manifestation of hyperactive stretch reflexes following stroke is related to the development of persistent inward currents (PICs) leading to hyperexcitability of motoneurons innervating the paretic limbs. Because repetitive volleys of 1a afferent feedback can elicit PICs, this investigation assessed motoneuronal excitability by evoking the tonic vibration reflex (TVR) of the biceps muscle in 10 awake individuals with chronic hemiparetic stroke and measuring the joint torque and electromyographic (EMG) responses of the upper limbs. Elbow joint torque and the EMG activity of biceps, brachioradialis, and the long and lateral heads of triceps brachii were recorded during 8 s of 112-Hz biceps vibration (evoking the TVR) and for 5 s after cessation of stimulation. Repeated-measures ANOVA tests revealed significantly (P Collapse

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MESH Headings

• Aged
• Analysis of Variance
• Chronic Disease
• Elbow Joint/innervation
• Electromyography/methods
• Female
• Humans
• Male
• Middle Aged
• Motor Neurons/physiology
• Muscle Contraction
• Muscle, Skeletal/innervation
• Muscle, Skeletal/pathology
• Muscle, Skeletal/physiopathology
• Reflex, Stretch/physiology
• Stroke/pathology
• Stroke/physiopathology
• Torque
• Vibration

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Grants

• R01 NS054269 NINDS NIH HHS
• R01-NS-054269 NINDS NIH HHS

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Affiliation(s)

Jacob G McPherson Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
Michael D Ellis
C J Heckman
Julius P A Dewald

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Central Contributions to Contractions Evoked by Tetanic Neuromuscular Electrical Stimulation

Tetanic electrical stimulation applied over human muscle or peripheral nerve generates contractions by depolarizing motor axons beneath the stimulating electrodes. However, the simultaneous depolarization of sensory axons can also contribute to the contractions by the synaptic recruitment of spinal motoneurons. Maximizing this central contribution may be beneficial for reducing muscle atrophy or restoring movement for persons with movement disorders.

Wide-pulse-width, high-frequency neuromuscular stimulation: implications for functional electrical stimulation

Electrical stimulation (1-ms pulses, 100 Hz) produces more torque than expected from motor axon activation (extra contractions). This experiment investigates the most effective method of delivering this stimulation for neuromuscular electrical stimulation. Surface stimulation (1-ms pulses; 20 Hz for 2 s, 100 Hz for 2 s, 20 Hz for 3 s) was delivered to triceps surae and wrist flexors (muscle stimulation) and to median and tibial nerves (nerve stimulation) at two intensities. Contractions were evaluated for amplitude, consistency, and stability. Surface electromyograph was collected to assess how H-reflexes and M-waves contribute. In the triceps surae, muscle stimulation produced the largest absolute contractions (23% maximal voluntary contraction), evoked the largest extra contractions as torque increased by 412% after the 100-Hz stimulation, and was more consistent and stable compared with tibial nerve stimulation. Absolute and extra contraction amplitude, consistency, and stability of evoked wrist flexor torques were similar between stimulation types: torques reached 11% maximal voluntary contraction, and extra contractions increased torque by 161%. Extra contractions were 10 times larger in plantar flexors compared with wrist flexors with muscle stimulation but were similar with nerve stimulation. For triceps surae, H reflexes were 3.4 times larger than M waves during nerve stimulation, yet M waves were 15 times larger than H reflexes during muscle stimulation. M waves in the wrist flexors were larger than H reflexes during nerve (8.5 times) and muscle (18.5 times) stimulation. This is an initial step toward utilizing extra contractions for neuromuscular electrical stimulation and the first to demonstrate their presence in the wrist flexors.

Contribution of M-waves and H-reflexes to contractions evoked by tetanic nerve stimulation in humans

Tetanic neuromuscular stimulation evokes contractions by depolarizing motor axons beneath the stimulating electrodes. However, we have shown that extra torque can develop due to the discharge of spinal neurons recruited by the evoked sensory volley. The present experiments investigated whether extra torque in the ankle plantar- and dorsiflexors was associated with enhanced H-reflexes. The tibial and common peroneal nerves were stimulated using 7-s trains (20 Hz for 2 s, 100 Hz for 2 s, 20 Hz for 3 s). Extra torque was defined as significantly more torque during 20-Hz stimulation after the 100-Hz burst (time2) than before it (time1). In 9 of 11 subjects, extra plantarflexion torque developed during stimulation just above motor threshold. In these nine subjects, torque increased from 8 to 13% MVC (time1 to time2), the soleus H-reflex increased from 13 to 19% Mmax and the M-wave of approximately 2% Mmax did not change significantly. To evoke extra dorsiflexion torque, greater stimulation intensities were required. In 6 of 13 subjects, extra torque developed at intensities that evoked an M-wave of 5-20% Mmax at time1. In these six subjects, torque doubled from 2 to 4% MVC (time1 to time2), whereas tibialis anterior (TA) H-reflexes and M-waves did not change significantly (H-reflex from 0.8 to 2% Mmax; M-wave from 12 to 14% Mmax). In 7 of 13 subjects, extra torque developed at higher stimulation intensities (35-65% Mmax). In these seven subjects, torque increased from 13 to 20% MVC, whereas TA H-reflexes and M-waves were not significantly different (H-reflex from 0.7 to 1% Mmax; M-wave from 49 to 54% Mmax). Thus enhanced H-reflexes contributed to extra plantarflexion, however, other factors generated extra dorsiflexion.

Sustained muscle contractions maintained by autonomous neuronal activity within the human spinal cord

It is well known that muscle contraction can be easily evoked in the human soleus muscle by applying single-pulse electrical stimulation to the tibial nerve at the popliteal fossa. We herein reveal the unexpected phenomenon of muscle contractions that can be observed when train stimulation is used instead. We found, in 11 human subjects, that transient electrical train stimulation (1-ms pulses, 50 Hz, 2 s) was able to induce sustained muscle contractions in the soleus muscle that outlasted the stimulation period for greater than 1 min. Subjects were unaware of their own muscle activity, suggesting that this is an involuntary muscle contraction. In fact, the excitability of the primary motor cortex (M1) with the sustained muscle contractions evaluated by transcranial magnetic stimulation was lower than the excitability with voluntary muscle contractions even when both muscle contraction levels were matched. This finding indicates that M1 was less involved in maintaining the muscle contractions. Furthermore, the muscle contractions did not come from spontaneous activity of muscle fibers or from reverberating activity within closed neuronal circuits involving motoneurons. These conclusions were made based on the respective evidence: 1) the electromyographic activity was inhibited by stimulation of the common peroneal nerve that has inhibitory connections to the soleus motoneuron pool and 2) it was not abolished after stopping the reverberation (if any) for approximately 100 ms by inducing the silent period that followed an H-reflex. These findings indicate that the sustained muscle contractions induced in this study are most likely to be maintained by autonomous activity of motoneurons and/or interneurons within the human spinal cord.

Recent evidence for plateau potentials in human motoneurones

Motoneurones in reduced animal preparations can exhibit plateau potentials that amplify their response to synaptic inputs and can persist for prolonged periods in the absence of synaptic drive. There is mounting evidence that a similar mechanism may be an integral part of the normal activation of motoneurones. Some of the work describing plateau potentials in reduced animal preparations is reviewed and then evidence that similar properties contribute to the normal activation of motoneurones in rats and humans is presented. Recent data have shown that during high-frequency electrical stimulation over human muscle, large contractions can develop which originate within the central nervous system and are present in addition to the contraction due to the direct activation of motor axons. These "extra" contractions may in part be due to plateau potentials in spinal motoneurones. It is becoming clear that intrinsic properties of human motoneurones may make a large contribution to muscle contractions during normal movements. The extent to which the nervous system uses this as a gain control mechanism to tailor motor output for a given task needs to be further explored.

Large involuntary forces consistent with plateau-like behavior of human motoneurons

When electrical stimulation is applied over human muscle, the evoked force is generally considered to be of peripheral origin. However, in relaxed humans, stimulation (1 msec pulses, 100 Hz) over the muscles that plantarflex the ankle produced more than five times more force than could be accounted for by peripheral properties. This additional force was superimposed on the direct response to motor axon stimulation, produced up to 40% of the force generated during a maximal voluntary contraction, and was abolished during anesthesia of the tibial nerve proximal to the stimulation site. It therefore must have resulted from the activation of motoneurons within the spinal cord. The additional force could be initiated by stimulation of low-threshold afferents, distorted the classical relationship between force and stimulus frequency, and often outlasted the stimulation. The mean firing rate of 27 soleus motor units recorded during the sustained involuntary activity after the stimulation was 5.8 +/- 0.2 Hz. The additional force increments were not attributable to voluntary intervention because they were present in three sleeping subjects and in two subjects with lesions of the thoracic spinal cord. The phenomenon is consistent with activation of plateau potentials within motoneurons and, if so, the present findings imply that plateau potentials can make a large contribution to forces produced by the human nervous system.

Spontaneous electromyographic activity in adult rat soleus muscle

Single-motor-unit and gross electromyograms (EMG) were recorded from the soleus muscle in six unrestrained rats. The median firing frequencies of nine motor units were in the 16-25 Hz range, in agreement with previous studies. One additional motor unit had a median firing frequency of 47 Hz. This unit and one of the lower-frequency units regularly fired doublets. Motor-unit firing frequency was well correlated to whole-muscle EMG during locomotion. Integrated rectified gross EMG revealed periods of continuous modulation, phasic high-amplitude events, and tonic low-amplitude segments. The tonic segments typically were caused by a small number of motor units firing at stable high frequencies (20-30 Hz) for extended periods of time without detectable activity in other units. This long-lasting firing in single motor units typically was initiated by transient mass activity, which recruited many units. However, only one or a few units continued firing at a stable high frequency. The tonic firing terminated spontaneously or in conjunction with an episode of mass activity. Different units were active in different tonic segments. Thus there was an apparent dissociation between activity in different single motor units and consequently between single-motor-unit activity and whole-muscle EMG. It is proposed that the maintained tonic motor-unit activity is caused by intrinsic motoneuron properties in the form of depolarizing plateau potentials.

Prolonged firing in motor units: evidence of plateau potentials in human motoneurons?

Serotonin (5-HT) and norepinephrine-dependent plateau potentials are found in spinal motoneurons in reduced turtle and cat preparations. Triggering the plateau potential by short-lasting synaptic excitation causes a prolonged self-sustained firing, which can be terminated by short-lasting synaptic inhibition. The presence of plateau potentials can also allow neurons to fire in a bistable manner, i.e., shifting between stable low and high firing frequencies. Such a bistable firing behavior has been found in soleus motor units in unrestrained rats. In the present study single motor-unit activity was recorded from low-threshold units in human soleus and tibialis anterior muscles to evaluate whether a bistable firing behavior and/or prolonged firing could be evoked. Vibration of the homonymous muscle tendon (30-100 Hz, 2-10 s) was used as excitatory input to the motoneuron pool. Brief excitation while the muscle was electrically silent induced firing during the vibration and sometimes recruited units into prolonged stable firing outlasting the vibratory stimulus. However, a bistable firing behavior, i.e., vibration-induced maintained shifts between two stable levels of firing, could not be convincingly demonstrated. The reason for this was twofold. First, low-threshold human motor units tended to jump to a "preferred firing range" shortly after voluntary recruitment. This firing range was the same as when units were recruited from silence into prolonged firing by vibration. Below the preferred firing range, maintained firing was unstable and usually only possible when subjects were listening to the spike potentials or had visual force-feedback. Second, vibration when units were firing in the preferred firing range caused a transient increase in firing frequency but no maintained frequency shifts. Recordings from pairs of motor units showed that short-lasting vibration could recruit one unit into prolonged firing, while a second unit, which already fired in its preferred firing range, only transiently increased its firing rate during the vibration. This suggests that the prolonged firing was not the result of an increase in the common synaptic drive to the motoneuron pool. We conclude that a bistable firing behavior as seen in intact rats is probably absent in human low-threshold motor units, but that prolonged firing could be seen in response to short-lasting excitation. This latter phenomenon is compatible with the existence of plateau potentials, which have to have a threshold close to the threshold for sodium spike generation.

Discharge pattern of single motor units in the tonic vibration reflex of human triceps surae

Using a single fibre EMG electrode the firing pattern of 46 motor units in the triceps surae has been studied during vibration of the Achilles tendon at frequencies of 25--200 Hz. Potentials activated in the tonic vibration reflex (TVR) were phase-locked to the vibration cycle but tended to become somewhat less so with continued vibration. The firing pattern of voluntarily activated motor units became locked to the waveform by the application of the vibrator. The discharges of 21 motor units were studied during low threshold (sub-M wave) tetanic stimulation of the tibial nerve at 25--100 Hz. No evidence was found of synchronization of potentials activated in the resulting tonic contraction. During weak voluntary contractions, stimulation also failed to regularize voluntarily activated motor units. The findings can be reconciled by postulating that, in normal man, vibration activates monosynaptic and polysynaptic pathways, the latter circuit being adequate to generate reflex contraction, while the former merely affects the temporal patterning of the motor outflow.