Modulation of flexor carpi radialis H reflex by lateral tilts in man

Cervical root compression monitoring by flexor carpi radialis H-reflex in healthy subjects

STUDY DESIGN

One-group, pretest-postest experimental research with repeated measures.

OBJECTIVE

To determine the effect of head postural modification on the flexor carpi radialis H-reflex in healthy subjects.

SUMMARY OF BACKGROUND DATA

H-reflex testing has been reported to be useful in evaluating and treating patients with lumbosacral and cervical radiculopathy. The idea behind this technique is that postural modification can cause further H-reflex inhibition, indicating more compression of the impinged nerve root, or recovery, indicating decompression of the root. Such assumptions cannot be supported unless the influence of normal head postural modification on the H-reflex in healthy subjects is studied.

METHODS

Twenty-two healthy subjects participated in this study (14 men, 8 women; mean age, 39 +/- 9 years). The median nerve of the subjects at the cubital fossa was electrically stimulated (0.5 msec; 0.2 pulses per second [pps] at H-max), whereas the flexor carpi radialis muscle H-reflex was recorded by electromyography. The H-reflexes were recorded after the subject randomly maintained the end range of head-forward flexion, backward extension, rotation to the right and the left, lateral bending to the right and the left, retraction and protraction. These were compared with the H-reflex recorded during comfortable neutral positions. Data were recorded after the subject maintained the position for 30 seconds, to avoid the effect of dynamic postural modification on the H-reflex. Four traces were recorded in each position. During recording, the H-reflex was monitored by the M-response to avoid any changes in the stimulation-recording condition.

RESULTS

Repeated multivariate analysis of variance was used to evaluate the significance of the difference among the H-reflex, amplitude, and latency, in various head positions. The H-reflex amplitude showed statistically significant changes (P < 0.001) with head postural modification. All head positions, except flexion, facilitated the H-reflex. Extension, lateral bending, and rotation toward the side of the recording produced higher reflex facilitation than the other positions. These results indicate that H-reflex changes may be caused by spinal root compression-decompression mechanisms. It may also indicate that relative spinal root decompression occurs in most head-neck postures except forward flexion.

CONCLUSIONS

Head postural modification significantly influences the H-reflex amplitude but not the latency. This indicates that the H-reflex is a more sensitive predictor of normal physiologic changes than are latencies. The H-reflex modulation in various head positions may be-caused by relative spinal root compression-decompression mechanisms.

Late facilitation of the human soleus H reflex induced by sustained isometric maneuver

Studying the effect of spinal cord reinforcement maneuvers (SCRMs) on H reflex assists in understanding aspects of motor control. Our objective was as follows: (1) to elucidate the effects of four neck positions (neck resting at neutral position (control); passive hyperflexion of the neck; hyperextension of the neck with simultaneous abdominal contraction; and sustained active neck hyperflexion); (2) to evaluate the temporal changes of soleus H reflexes repeatedly evoked after a period of sustained neck flexion. We used a prospective, intrinsically controlled trial of the effects of these SCRMs on the H reflexes and M-responses in ten healthy volunteers. Pre- and postmaneuver measures included H reflex and M-response latencies and amplitudes, H/M maximum amplitude ratio, and H threshold. The four maneuvers showed no significant effect on the H reflex or M-response measures. To investigate temporal changes in the H reflex amplitude, H reflexes were repeatedly evoked at two-minute intervals after a one-minute period of active neck flexion. The amplitude of the H reflex was enhanced (P = 0.0356; analysis of variance), and the post hoc least significant difference test was significant at four minutes postmaneuver. Peak magnitude of the H reflex occurred at four minutes after relaxation, and the response returned to pretest baseline at eight minutes. The results of this study document the time course of repeated H reflexes after SCRM, and the timing of the H reflex was found to be a contributing variable that should be considered in future study designs.

Facilitation of motor evoked potentials by somatosensory afferent stimulation

The effect of an electrically induced peripheral afferent volley upon electrical and magnetic motor evoked potentials (MEPs) from muscles of the upper and lower extremities was studied in 16 healthy volunteers. A standard conditioning-test (C-T) paradigm was employed whereby the test stimulus (transcranial electric or magnetic) was applied at random time intervals, from 10 msec prior to 90 msec after the conditioning stimulus (peripheral nerve stimulus). MEP amplitude facilitation was observed for the majority of the upper extremity muscles tested at two distinct periods, one occurring at short, and the other at long C-T intervals. This bimodal trend of MEP facilitation was found to be equally as prominent in the lower extremity muscles tested. The period of short C-T interval facilitation is consistent with modifications in the spinal excitability of the segmental motoneuron pool. On the other hand, the period of long C-T interval facilitation is suggested to be due to alterations in excitability of the motor cortex as a result of the arrival of the orthodromic sensory volley. Although most pronounced in muscles innervated by the nerve to which the conditioning stimulus was applied, this bimodal facilitatory effect was also observed in adjacent muscles not innervated by the stimulated nerve. Qualitatively, the conditioned MEPs from the upper and lower extremities responded similarly to both electrical and magnetic trans-cranial stimulation. In addition, our study demonstrates that the C-T paradigm has potential for use in the assessment of spinal and cortical sensorimotor integration by providing quantitative information which cannot be obtained through isolated assessment of sensory and/or motor pathways.(ABSTRACT TRUNCATED AT 250 WORDS)

Modulation of soleus H reflex by lateral tilting in man

Static vestibular influences on extensor tone of the lower limbs in man were studied by analyzing the changes in right soleus H-reflex (RSHR) area in relation to lateral tiltings. Eight normal adult volunteers were tested in an experimental situation designed to minimize all afferent inputs, except the vestibular ones. Each subject was seated on a chair which could be tilted laterally from the vertical to both sides. Lateral tiltings were applied at a random order from the vertical (0 degree, control position) to 4 degrees, 8 degrees, 12 degrees, 16 degrees, and 20 degrees of both sides (test positions). The results showed inhibition in SHR area of the leg ipsilateral to the tilting and facilitation of the contralateral SHR. These data indicate that, in man, as in the decerebrate cat, tonic labyrinth reflexes act asymmetrically and that, in static condition, the vestibular system modulates muscle tone of the lower limbs adequately to counteract lateral perturbation of upright position.

Interaction of tonic labyrinth and neck reflexes in man

Interaction of tonic labyrinth and neck reflexes was studied in 3 healthy volunteers by analyzing changes in Soleus H-Reflex (SHR) area in relation to both lateral tiltings and neck rotations. By using a Kermath chair each subject was tilted laterally from the vertical to the left and to the right up 15 degrees in steps of 5 degrees and at the same time the longitudinal body axis, keeping the head fixed, was rotated to the right and to the left up to 15 degrees in steps of 5 degrees. All combinations of lateral tiltings and neck rotations were tested. Each test position was followed by a return to 0 degree for both rotation and tilting (control position). Twelve H-reflexes of right soleus muscle were recorded in each test and control position and the changes in RSHR area were expressed as percentage variations from the mean value absorbed in the pretest and post-test control position. Our data indicate that in man, as in animals, labyrinth and neck reflexes act in the opposite direction, and that in the static condition their contribution to postural stabilization is equal.