Stretch reflexes of the proximal arm in a patient with mirror movements: absence of bilateral long-latency components

Long-latency Responses to a Mechanical Perturbation of the Index Finger Have a Spinal Component

In an uncertain external environment, the motor system may need to respond rapidly to an unexpected stimulus. Limb displacement causes muscle stretch; the corrective response has multiple activity bursts, which are suggested to originate from different parts of the neuraxis. The earliest response is so fast, it can only be produced by spinal circuits; this is followed by slower components thought to arise from primary motor cortex (M1) and other supraspinal areas.

In an uncertain external environment, the motor system may need to respond rapidly to an unexpected stimulus. Limb displacement causes muscle stretch; the corrective response has multiple activity bursts, which are suggested to originate from different parts of the neuraxis. The earliest response is so fast, it can only be produced by spinal circuits; this is followed by slower components thought to arise from primary motor cortex (M1) and other supraspinal areas. Spinal cord (SC) contributions to the slower components are rarely considered. To address this, we recorded neural activity in M1 and the cervical SC during a visuomotor tracking task, in which 2 female macaque monkeys moved their index finger against a resisting motor to track an on-screen target. Following the behavioral trial, an increase in motor torque rapidly returned the finger to its starting position (lever velocity >200°/s). Many cells responded to this passive mechanical perturbation (M1: 148 of 211 cells, 70%; SC: 67 of 119 cells, 56%). The neural onset latency was faster for SC compared with M1 cells (21.7 ± 11.2 ms vs 25.5 ± 10.7 ms, respectively, mean ± SD). Using spike-triggered averaging, some cells in both regions were identified as likely premotor cells, with monosynaptic connections to motoneurons. Response latencies for these cells were compatible with a contribution to the muscle responses following the perturbation. Comparable fractions of responding neurons in both areas were active up to 100 ms after the perturbation, suggesting that both SC circuits and supraspinal centers could contribute to later response components.

SIGNIFICANCE STATEMENT Following a limb perturbation, multiple reflexes help to restore limb position. Given conduction delays, the earliest part of these reflexes can only arise from spinal circuits. By contrast, long-latency reflex components are typically assumed to originate from supraspinal centers. We recorded from both spinal and motor cortical cells in monkeys responding to index finger perturbations. Many spinal interneurons, including those identified as projecting to motoneurons, responded to the perturbation; the timing of responses was compatible with a contribution to both short- and long-latency reflexes. We conclude that spinal circuits also contribute to long-latency reflexes in distal and forearm muscles, alongside supraspinal regions, such as the motor cortex and brainstem.

Spike Timing-Dependent Plasticity in the Long-Latency Stretch Reflex Following Paired Stimulation from a Wearable Electronic Device

The long-latency stretch reflex (LLSR) in human elbow muscles probably depends on multiple pathways; one possible contributor is the reticulospinal tract. Here we attempted to induce plastic changes in the LLSR by pairing noninvasive stimuli that are known to activate reticulospinal pathways, at timings predicted to cause spike timing-dependent plasticity in the brainstem. In healthy human subjects, reflex responses in flexor muscles were recorded following extension perturbations at the elbow. Subjects were then fitted with a portable device that delivered auditory click stimuli through an earpiece, and electrical stimuli around motor threshold to the biceps muscle via surface electrodes. We tested the following four paradigms: biceps stimulus 10 ms before click (Bi-10ms-C); click 25 ms before biceps (C-25ms-Bi); click alone (C only); and biceps alone (Bi only). The average stimulus rate was 0.67 Hz. Subjects left the laboratory wearing the device and performed normal daily activities. Approximately 7 h later, they returned, and stretch reflexes were remeasured. The LLSR was significantly enhanced in the biceps muscle (on average by 49%) after the Bi-10ms-C paradigm, but was suppressed for C-25ms-Bi (by 31%); it was unchanged for Bi only and C only. No paradigm induced LLSR changes in the unstimulated brachioradialis muscle. Although we cannot exclude contributions from spinal or cortical pathways, our results are consistent with spike timing-dependent plasticity in reticulospinal circuits, specific to the stimulated muscle. This is the first demonstration that the LLSR can be modified via paired-pulse methods, and may open up new possibilities in motor systems neuroscience and rehabilitation.

SIGNIFICANCE STATEMENT

This report is the first demonstration that the long-latency stretch reflex can be modified by repeated, precisely timed pairing of stimuli known to activate brainstem pathways. Furthermore, pairing was achieved with a portable electronic device capable of delivering many more stimulus repetitions than conventional laboratory studies. Our findings open up new possibilities for basic research into these underinvestigated pathways, which are important for motor control in healthy individuals. They may also lead to paradigms capable of enhancing rehabilitation in patients recovering from damage, such as after stroke or spinal cord injury.

Fast feedback control involves two independent processes utilizing knowledge of limb dynamics

Corrective muscle responses occurring 50-100 ms after a mechanical perturbation are tailored to the mechanical features of the limb and its environment. For example, the evoked response by the shoulder's extensor muscle counters an imposed shoulder torque, rather than local shoulder motion, by integrating motion information from the shoulder and elbow appropriate for their dynamic interaction. Previous studies suggest that arm muscle activity within this epoch, alternately termed the R2/3 response, or long-latency reflex, reflects the summed result of two distinct components: an activity-dependent component which scales with the background muscle activity, and a task-dependent component which scales with the required vigor of the behavioral task. Here we examine how the knowledge of limb dynamics expressed during the shoulder muscle's R2/3 epoch is related to these two functional components. Subjects countered torque steps applied to their shoulder and/or elbow under different conditions of background torque and target size to recruit the activity-dependent and task-dependent component in varying degrees. Experiment 1 involved four torque perturbations, two levels of background torques and two target sizes; this design revealed that both background torque and target size impacted the shoulder's R2/3 activity, indicative of knowledge of limb dynamics. Experiment 2 involved two perturbation torques, five levels of background torque and two target sizes; this design demonstrated that the two factors had an independent impact on the R2/3 activity indicative of knowledge of limb dynamics. We conclude that a sophisticated feature of upper limb feedback control reflects the summation of two processes having a common capability.

Long-Latency and Voluntary Responses to an Arm Displacement Can Be Rapidly Attenuated By Perturbation Offset

Feedback control of our limbs must account for the unexpected offset of mechanical perturbations. Here we examine the evoked activity of elbow flexor and extensor muscles to torque pulses lasting 22–152 ms and how torque offset impacts activity in the long-latency (45–100 ms) and voluntary epochs (120–180 ms). For each pulse width, we found a significant attenuation of muscle activity ∼30 ms after the offset of torque compared with when the torque was sustained. The brief time between the offset of torque and the attenuation of muscle activity implicates group I afferents acting through a spinal pathway, because this route is the only one fast enough and short enough to be responsible. Moreover, elbow muscle activity in the subsequent 20–45 ms following torque-offset was ∼35% smaller than when the torque was sustained. These results show that a fast spinal process can powerfully attenuate corrective responses of the arm to a torque perturbation.

Tizanidine does not affect the linear relation of stretch duration to the long latency M2 response of m. flexor carpi radialis

The long latency M2 electromyographic response of a suddenly stretched active muscle is stretch duration dependent of which the nature is unclear. We investigated the influence of the group II afferent blocker tizanidine on M2 response characteristics of the m. flexor carpi radialis (FCR). M2 response magnitude and eliciting probability in a group of subjects receiving 4 mg of tizanidine orally were found to be significantly depressed by tizanidine while tizanidine did not affect the significant linear relation of the M2 response to stretch duration. The effect of tizanidine on the M2 response of FCR is supportive of a group II afferent contribution to a compound response of which the stretch duration dependency originates from a different mechanism, e.g., rebound Ia firing.

The effect of task instruction on the excitability of spinal and supraspinal reflex pathways projecting to the biceps muscle

There is controversy within the literature regarding the influence of task instruction on the size of the long-latency stretch reflex (M2) elicited by a joint displacement. The aim of this study was to investigate if the previously reported task-dependent modulation of the M2 is specific to the M2 or can be explained by an early release of the intended voluntary response. We took advantage of the fact that the M2 is absent when the duration of the applied perturbation is less than a critical time period. This allowed us to examine modulation of muscle activity with and without the contribution of the M2. In addition, we applied transcranial magnetic stimulation (TMS) over the primary motor cortex to examine the modulation of corticomotor excitability with task instruction. Elbow joint extension displacements were used to elicit a stretch reflex in the biceps muscle. Subjects were instructed to "do not intervene" (DNI) with the applied perturbation, or to oppose the perturbation by activating the elbow flexors in response to the perturbation (FLEX). Electromyographic (EMG) activity in the time period corresponding to the M2 was significantly facilitated in the FLEX task instruction both with and without the presence of the M2. Motor evoked potentials (MEPs) elicited by TMS were also facilitated during the FLEX condition in the absence of the M2. EMG and MEP responses were not facilitated until immediately prior to the onset of the M2. Paired-pulse TMS revealed a significant reduction in short-interval intracortical inhibition (SICI) during the M2 response, but the level of SICI was not altered by the task instruction. We conclude that the task-dependent modulation of the biceps M2 results, at least in part, from an early release of the prepared movement and is accompanied by an increase in corticospinal excitability that is not specific to the M2 pathway. Task-dependent modulation of the response cannot be explained by an alteration in the excitability of intracortical inhibitory circuits.

The influence of perturbation duration and velocity on the long-latency response to stretch in the biceps muscle

Different neural pathways are proposed to mediate the long-latency stretch reflex response (M2) in muscles spanning distal and proximal joints of the upper limb. The M2 at the wrist joint is present only if the duration of the perturbation exceeds a critical time. Lee and Tatton put forward a converging input hypothesis, requiring an interaction of excitatory volleys at the spinal cord, to account for this feature. The goal of the present study was to examine the influence of the duration of perturbation on M2 responses elicited in a muscle spanning the elbow joint. Reflex responses were induced in the biceps brachii muscle by applying ramp-and-hold position displacements to the elbow. It was found that the M2 was strongly dependent on the duration of the perturbation. On average, responses were not elicited following perturbations of less than 35+/-5 ms. Using a novel double-movement paradigm, we were unable to provide support for the converging input hypothesis. The effect of the duration of perturbation on the M2 may account for the conflicting characteristics of the M2 that have been provided by previous studies applying mechanical or electrical perturbations of varying time durations.

Investigating the cortical origins of motor overflow

Motor overflow refers to the involuntary movements which may accompany the production of voluntary movements. While overflow is not usually seen in the normal population, it does present in children and the elderly, as well as those suffering certain neurological dysfunctions. Advancements in methodology over the last decade have allowed for more convincing conclusions regarding the cortical origins of motor overflow. However, despite significant research, the exact mechanism underlying the production of motor overflow is still unclear. This review presents a more comprehensive conceptualization of the theories of motor overflow, which have often been only vaguely defined. Further, the major findings are explored in an attempt to differentiate the competing theories of motor overflow production. This exploration is done in the context of a range of neurological and psychiatric disorders, in order to elucidate the possible underlying mechanisms of overflow.

Proposed cortical and sub-cortical contributions to the long-latency stretch reflex in the forearm

The short- and long-latency (SLSR, LLSR) components of the stretch reflex response were investigated in the forearm using a paired transcranial magnetic stimulation (TMS)-stretch reflex protocol. Responses to TMS were recorded in the flexor and extensor carpi radialis muscles (FCR, ECR) after conditioning with a rapid wrist extension movement. The cortical stimuli were timed to elicit a motor-evoked potential (MEP) at either the SLSR or LLSR onset in the FCR muscle. Responses were also collected in TMS-alone and stretch reflex-alone conditions. Six intensities of magnetic stimulation were applied in all conditions. In the FCR muscle, MEP amplitude when timed to arrive at the LLSR onset was significantly greater than the sum of the MEP and stretch reflex responses when given separately. MEP amplitudes at the SLSR onset in the FCR muscle and in the ECR muscle at both SLSR and LLSR onset were not significantly different from that expected from the sum of the two stimuli given separately. This indicates heightened corticospinal excitability at a time corresponding to the passage of an afferent volley induced by the stretch, and raises the possibility of a transcortical loop of the LLSR in the forearm. The extent of MEP facilitation was generally consistent across all stimulus intensities tested. A reduced component of the LLSR was evident when the stretch response was timed to arrive during the silent period following the cortical stimulus, suggesting both cortical and sub-cortical components to the reflex response.

Separate ipsilateral and contralateral corticospinal projections in congenital mirror movements: Neurophysiological evidence and significance for motor rehabilitation

The neurophysiological hallmark of congenital mirror movements (MM) are fast-conducting corticospinal projections from the hand area of one primary motor cortex to both sides of the spinal cord. It is still unclear whether the abnormal ipsilateral projection originates through branching fibres from the normal contralateral projection or constitutes a separate ipsilateral projection. To clarify this question, we used focal paired-pulse transcranial magnetic stimulation to test task-related modulation of short-interval intracortical inhibition (SICI) in the abductor pollicis brevis (APB) muscles of a 15-year-old girl (Patient 1) and a 40-year-old woman (Patient 2) with congenital MM. In both patients, during intended unilateral APB contraction, SICI decreased markedly in the "task" APB but remained unchanged in the "mirror" APB when compared to muscle rest. In contrast, spinal excitability as tested with H reflexes increased similarly in the task and mirror flexor carpi radialis muscles. This dissociation of task-related SICI modulation strongly supports the existence of a separate ipsilateral fast-conducting corticospinal projection. In Patient 1, we tested the functional significance of this separate ipsilateral projection during 7 months of motor rehabilitation training, which was designed to facilitate unilateral finger movements. A marked reduction of MM was observed after training, suggesting that unwanted mirror activity in the ipsilateral pathway can be suppressed by learning.

Investigating human motor control by transcranial magnetic stimulation

In this review we discuss the contribution of transcranial magnetic stimulation (TMS) to the understanding of human motor control. Compound motor-evoked potentials (MEPs) may provide valuable information about corticospinal transmission, especially in patients with neurological disorders, but generally do not allow conclusions regarding the details of corticospinal function to be made. Techniques such as poststimulus time histograms (PSTHs) of the discharge of single, voluntarily activated motor units and conditioning of H reflexes provide a more optimal way of evaluating transmission in specific excitatory and inhibitory pathways. Through application of such techniques, several important issues have been clarified. TMS has provided the first real evidence that direct monosynaptic connections from the motor cortex to spinal motoneurons exist in man, and it has been revealed that the distribution of these projections roughly follows the same proximal-distal gradient as in other primates. However, pronounced differences also exist. In particular, the tibialis anterior muscle appears to receive as significant a monosynaptic corticospinal drive as muscles in the hand. The reason for this may be the importance of this muscle in controlling the foot trajectory in the swing phase of walking. Conditioning of H reflexes by TMS has provided evidence of changes in cortical excitability prior to and during various movements. These experiments have generally confirmed information obtained from chronic recording of the activity of corticospinal cells in primates, but information about the corticospinal contribution to movements for which information from other primates is sparse or lacking has also been obtained. One example is walking, where TMS experiments have revealed that the corticospinal tract makes an important contribution to the ongoing EMG activity during treadmill walking. TMS experiments have also documented the convergence of descending corticospinal projections and peripheral afferents on spinal interneurons. Current investigations of the functional significance of this convergence also rely on TMS experiments. The general conclusion from this review is that TMS is a powerful technique in the analysis of motor control, but that care is necessary when interpreting the data. Combining TMS with other techniques such as PSTH and H reflex testing amplifies greatly the power of the technique.

The deep tendon and the abdominal reflexes

The deep tendon reflexes (and the abdominal reflexes) are important physical signs which have a special place in neurological diagnosis, particularly in early disease when they alone may be abnormal. They act as "hard" signs in situations where clinical assessment is complicated by patient anxiety, and become more useful as clinical experience develops.

Unexpected reflex response to transmastoid stimulation in human subjects during near-maximal effort

1. In human subjects, a high-voltage electrical pulse between electrodes fixed over the mastoid processes activates descending tract axons at the level of the cervico-medullary junction to produce motor responses (cevicomedullary evoked responses; CMEPs) in the biceps brachii and brachioradialis muscles. 2. During isometric maximal voluntary contractions (MVCs) of the elbow flexors, CMEPs in the biceps brachii and brachioradialis muscles are sometimes followed by a second compound muscle action potential. This response can be observed in single trials (amplitude of up to 60 % of the maximal M wave) and follows the CMEP by about 16 ms in both muscles. The response only occurs during very strong voluntary contractions. 3. The second response following transmastoid stimulation appears with stimulation intensities that are at the threshold for evoking a CMEP in the contracting muscles. The response grows with increasing stimulus intensity, but then decreases in amplitude and finally disappears at high stimulation intensities. 4. A single stimulus to the brachial plexus during MVCs can also elicit a second response (following the M wave) in the biceps brachii and brachioradialis muscles. The latency of this response is 3-4 ms longer than that of the second response observed following transmastoid stimulation. This difference in latency is consistent with a reflex response to stimulation of large-diameter afferents. 5. The amplitude of the second response to transmastoid stimulation can be reduced by appropriately timed subthreshold transcranial magnetic stimuli. This result is consistent with intracortical inhibition of the response. 6. We suggest that transmastoid stimulation can elicit a large transcortical reflex response in the biceps brachii and brachioradialis muscles. The response travels via the motor cortex but is only apparent during near-maximal voluntary efforts.

Motor control in simple bimanual movements: a transcranial magnetic stimulation and reaction time study

OBJECTIVE

Simple reaction time (RT) can be influenced by transcranial magnetic stimulation (TMS) to the motor cortex. Since TMS differentially affects RT of ipsilateral and contralateral muscles a combined RT and TMS investigation sheds light on cortical motor control of bimanual movements.

METHODS

Ten normal subjects and one subject with congenital mirror movements (MM) were investigated with a RT paradigm in which they had to move one or both hands in response to a visual go-signal. Suprathreshold TMS was applied to the motor cortex ipsilateral or contralateral to the moving hand at various interstimulus intervals (ISIs) after presentation of the go-signal. EMG recordings from the thenar muscles of both hands were used to determine the RT.

RESULTS

TMS applied to the ipsilateral motor cortex shortened RT when TMS was delivered simultaneously with the go-signal. With increasing ISI between TMS and go-signal the RT was progressively delayed. This delay was more pronounced if TMS was applied contralateral to the moving hand. When normal subjects performed bimanual movements the TMS-induced changes in RT were essentially the same as if they had used the hand in an unimanual task. In the subject with MM, TMS given at the time of the go-signal facilitated both the voluntary and the MM. With increasing ISI, however, RT for voluntary movements and MM increased in parallel.

CONCLUSIONS

Ipsilateral TMS affects the timing of hand movements to the same extent regardless of whether the hand is engaged in an unimanual or a bimanual movement. It can be concluded, therefore, that in normal subjects simple bimanual movements are controlled by each motor cortex independently. The results obtained in the subject with MM are consistent with the hypothesis that mirror movements originate from uncrossed corticospinal fibres. The alternative hypothesis that a deficit in transcallosal inhibition leads to MM in the contralateral motor cortex is not compatible with the presented data, because TMS applied to the motor cortex ipsilateral to a voluntary moved hand affected voluntary movements and MM to the same extent.

Evidence for transcortical reflex pathways in the lower limb of man

The existence of transcortical reflex pathways in the control of distal arm and hand muscles in man is now widely accepted. Much more controversy exists regarding a possible contribution of such reflexes to the control of leg muscles. It is often assumed that transcortical reflex pathways play no, or only a minor, role in the control of leg muscles. Transcortical reflex pathways according to this view are reserved for the control of the distal upper limb and are seen in close relation to the evolution of the primate hand. Here we review data, which provide evidence that transcortical reflexes do exist for lower limb muscles and may play a significant role in the control of at least some of these muscles. This evidence is based on animal research, recent experiments combining transcranial magnetic stimulation with peripheral electrical and mechanical stimulation in healthy subjects and neurological patients. We propose that afferent activity from muscle and skin may play a role in the regulation of bipedal gait through transcortical pathways.

Evidence that a transcortical pathway contributes to stretch reflexes in the tibialis anterior muscle in man

1. In human subjects, stretch applied to ankle dorsiflexors elicited three bursts of reflex activity in the tibialis anterior (TA) muscle (labelled M1, M2 and M3) at mean onset latencies of 44, 69 and 95 ms, respectively. The possibility that the later of these reflex bursts is mediated by a transcortical pathway was investigated. 2. The stretch evoked a cerebral potential recorded from the somatosensory cortex at a mean onset latency of 47 ms in nine subjects. In the same subjects a compound motor-evoked potential (MEP) in the TA muscle, evoked by magnetic stimulation of the motor cortex, had a mean onset latency of 32 ms. The M1 and the M2 reflexes thus had too short a latency to be caused by a transcortical pathway (minimum latency, 79 ms (47 + 32)), whereas the later part of the M2 and all of the M3 reflex had a sufficiently long latency. 3. When the transcranial magnetic stimulation was timed so that the MEP arrived in the TA muscle at the same time as the M1 or M2 reflexes, no extra increase in the potential was observed. However, when the MEP arrived at the same time as the M3 reflex a significant (P < 0.01) extra-facilitation was observed in all twelve subjects investigated. 4. Peaks evoked by transcranial magnetic stimulation in the post-stimulus time histogram of the discharge probability of single TA motor units (n = 28) were strongly facilitated when they occurred at the same time as the M3 response. This was not the case for the first peaks evoked by electrical transcranial stimulation in any of nine units investigated. 5. We suggest that these findings are explained by an increased cortical excitability following TA stretch and that this supports the hypothesis that the M3 response in the TA muscle is - at least partly - mediated by a transcortical reflex.

Medium-latency response to muscle stretch in human lower limb: estimation of conduction velocity of group II fibres and central delay

In standing subjects, ankle dorsiflexion evoked short-latency responses (SLRs) at 41 and 57 ms, on the average, in soleus (Sol) and flexor digitorum brevis (FDB), respectively. Medium-latency responses (MLRs) occurred at 70 and 95 ms. The time between the MLRs was 25 ms and between the SLRs was 16 ms. The difference between these two values represents the extra-time to conduct the FDB volley for MLR from distal to proximal muscle, in excess to that for SLR. The velocity of the afferents mediating the FDB MLR (21.4 m/s on average) was estimated by dividing the distance between the two muscles by the sum of the above extra-time and the conduction time of Ia fibres along the same distance. The central delay of FDB MLR (6.7 ms on average) was obtained by dividing the distance between FDB and spinal cord by the sum of afferent and efferent MLR conduction times. The central delay of FDB SLR (1.4 ms) was analogously obtained. These findings give an estimation of the conduction velocity of the group II afferent fibres in humans and support the hypothesis that the FDB MLR is relayed through a spinal oligosynaptic pathway.

Force regulation is deficient in patients with parietal lesions: a system-analytic approach

By means of a quantitative system-analytic investigation strategy, the postural motor control of the fingers was evaluated, to characterise the possible deficit of force regulation in patients with parietal lesions. In spite of a normal response to short torque pulses, the parietal-lesion patients had difficulties in returning to the preload level after the application of an additional step torque load to fingers II-IV of their left or right hands. The control offset (measured 500 ms after step torque application) was significantly larger in the patient group. This deficit in the investigated patients with parietal lesions to compensate for step torque loads was not due to a paresis, but rather resulted from a disturbance in the generation of a sufficient counterforce against the applied step torque within an adequate time window and motor pattern. This distinct force-regulation deficit was found in patients with left- and right-sided parietal lesions.