Effects of repeated ankle plantar-flexions on H-reflex and body sway during standing

Comparison of acute responses in spinal excitability between older and young people after neuromuscular electrical stimulation

PURPOSE

This study aims at comparing acute responses in spinal excitability, as measured by H-reflex, between older and young individuals, following a single session of NMES superimposed onto voluntary isometric contractions of the ankle plantar-flexor muscles (NMES+), with respect to passive NMES (pNMES) and voluntary isometric contractions only (ISO).

METHODS

Thirty-two volunteers, 16 older (OLDER) and 16 young (YOUNG), were asked to sustain a constant force at 20% of maximal voluntary isometric contraction (MVIC) of the ankle plantar-flexor muscles in the dominant limb during each of the 3 conditions (NMES+ , pNMES and ISO). Fifteen repetitions of 6 s were performed, with a resting interval of 6 s between repetitions. Before and after each condition, soleus H-reflexes were elicited by percutaneous electrical stimulation of the posterior tibial nerve and H-reflex amplitudes recorded by surface EMG.

RESULTS

In OLDER, H-reflex amplitude did not change following any experimental condition (ISO: p = 0.203; pNMES: p = 0.542; NMES+: p = 0.431) compared to baseline. On the contrary, in YOUNG, H-reflex amplitudes significantly increased (p < 0.000) and decreased (p = 0.001) following NMES+ and pNMES, respectively, while there was no significant change in reflex responses following ISO (p = 0.772).

CONCLUSION

The lack of change in H-reflex responses following either NMES+ or pNMES might reflect a reduced ability of older people in modulating spinal excitability after the conditions. Specifically, an age-related alteration in controlling mechanisms at presynaptic level was suggested.

Sex differences concerning the effects of ankle muscle fatigue on static postural control and spinal proprioceptive input at the ankle

Aims

The main aim of this study was to determine sex differences in postural control changes with ankle muscle fatigue during a standing forward leaning (FL) task under different vision conditions. The secondary aim was to examine sex differences in the effect of fatigue on soleus (SOL) H-reflex amplitude, a measure of motoneuron excitability with activation of Ia afferents.

Methods

Fifteen healthy young adult males (mean age: 28.0 years) and 16 healthy young adult females (mean age: 26.1 years) were asked to perform four consecutive FL tasks [30 s; two with eyes open (EO) and two with eyes closed (EC)] before, and immediately following a fatiguing exercise consisting of alternating ankle plantarflexion (6 s) and dorsiflexion (2 s) maximal isometric contractions, and at 5 and 10 min of recovery. Center of pressure (COP) sway variables (mean position, standard deviation, ellipse area, average velocity, and frequency), an ankle co-contraction index, and a ratio of SOL H-reflex to the maximum amplitude of the compound muscle action potential (M-max) were obtained during the FL tasks. A rating of perceived fatigue (RPF) was also documented at the different time points.

Results

Time to task failure (reduction of 50% in maximal voluntary isometric contraction torque of ankle plantar flexors) and the increase in RPF value were not significantly different between males and females. Both sex groups showed similar and significant increases (p < 0.05) in mean COP sway velocity with no significant changes in co-contraction indices. No significant effects of fatigue and related interactions were found for SOL H/M-max ratio.

Discussion

The absence of a significant sex difference in postural control change (sway and co-contraction) with fatigue could be explained by similar perceived (RPF) and performance fatigability (exercise duration) between males and females in the present study. Fatigue did not lead to significant changes in SOL spinal motoneuron excitability with activation of Ia afferents.

The Impact of Hoffmann Reflex on Standing Postural Control Complexity in the Elderly with Impaired Plantar Sensation

In people with peripheral neuropathy (PN), impaired plantar sensation can cause adaptive changes in the central nervous system (CNS), resulting in changes in the standing postural control, which is reflected in the variability of standing output signals. Standard deviation (SD) and entropy are reliable indicators of system variability, especially since entropy is highly sensitive to diseased populations. The relation between SD and entropy, CNS and center of pressure (COP) variability is unclear for people with severe PN. The purpose of this study was to explore the adaptability of the CNS to the severe of PN and its effect on the degree and complexity of COP variability. Here, people with PN were divided into less affected (LA) and more affected (MA) groups based on plantar pressure sensitivity. We studied Hoffmann reflex (H-reflex) and standing balance performance with the control group (n = 8), LA group (n = 10), and MA group (n = 9), recording a 30 s COP time series (30,000 samples) of double-leg standing with eyes open. We observed that the more affected group had less COP complexity than people without PN. There is a significant negative correlation between the SD and sample entropy in people without PN, less affected and more affected. The COP complexity in people without PN was inversely correlated with H-reflex. We concluded that: (1) The complexity of COP variability in patients with severe plantar sensory impairment is changed, which will not affect the degree of COP variability; (2) The independence of the COP entropy in the AP and ML directions decreased, and the interdependence increased in people with PN; (3) Although the CNS of people with PN has a greater contribution to standing balance, its modulation of standing postural control is decreased.

The Reduced Adaptability of H-Reflex Parameters to Postural Change With Deficiency of Foot Plantar Sensitivity

Purpose: The project was to examine the influence of peripheral neuropathy (PN) severity on the relationship between Hoffmann-reflex (H-reflex) and postures.

Methods: A total of 34 participants were recruited. H-reflex (H/M ratio and H-index) during prone, standing, and the heel-contact phase of walking was tested, along with foot sole sensitivity.

Results: The participants were divided into three groups based on the severity of the foot sole sensitivity deficit: control, less (LA), and more (MA) affected with both feet 5.07 monofilament test scores ranging 10, 0–5, and 6–9, respectively. A significant group by the posture interaction was observed in the H/M ratio (F_{3.0, 41.9} = 2.904, p = 0.046, η_p² = 0.172). In the control group, the H/M ratio of prone (22 ± 7%) was greater than that of the standing (13 ± 3%, p = 0.013) and heel-contact phase (10 ± 2%, p = 0.004). In the MA group, the H/M ratio of standing (13 ± 3%) was greater than that of the heel-contact phase (8 ± 2%, p = 0.011). The H-index was significantly different among groups (F_2,28 = 5.711, p = 0.008, and η_p²= 0.290). Post hoc analysis showed that the H-index of the control group (80.6 ± 11.3) was greater than that of the LA (69.8 ± 12.1, p = 0.021) and MA groups (62.0 ± 10.6, p = 0.003).

Conclusion: In a non-PN population, the plantar sensory input plays an important role in maintaining standing postural control, while as for the PN population with foot sole sensitivity deficiency, type Ⅰ afferent fibers reflex loop (H-reflex) contributes more to the standing postural control. The H-index parameter is an excellent method to recognize the people with and without PN but not to distinguish the severity of PN with impaired foot sole sensitivity.

Kinematic Comparisons of Increased Exercise Repetitions and Intensities on the Dominant and Non-Dominant Upper Limbs for Prevention of Dyskinesia

Background:

Increased exercise repetitions and intensities need to be compared between dominant and non-dominant sides to prevent asymmetrically conducted movements for possible dyskinesia.

Methods:

A total of 20 participants were enrolled from Inha University, Incheon, Korea in 2019. They were assessed for comparisons of asymmetrical motion between the dominant and non-dominant arms during the abduction and adduction lateral raises during more than fifteen repetitions and low and high exercise intensity by giving different weight loads based on 1-RM.

Results:

Repetition led to significant reductions in range of motion for both dominant and non-dominant sides. In addition, increased repetitions led to significant greater reductions in range of motion especially toward the last phases of repetitions. Moreover, the dominant side showed significantly increased accelerations with increased intensities.

Conclusion:

Increased repetitions and exercise intensity led to reduced range of motion and increased accelerations especially for the dominant sides. Dispersing kinematics should be considered to minimize possible dyskinesia between the symmetric sides when performing repetitive and loading physical activity.

Whole body vibration of different frequencies inhibits H-reflex but does not affect voluntary activation

This study aimed to investigate the effects of whole-body vibration (WBV) at a frequency spectrum from 20 to 50 Hz on the Hoffmann (H) reflex and the voluntary motor output of ankle plantar-flexor muscles. A single-group (n: 8), repeated measures design was adopted with four conditions: standing (no vibration), 20, 35 and 50 Hz, each lasting one minute. H-reflex of the soleus muscle, maximal voluntary contraction (MVC) and central activation ratio (CAR) of the plantar-flexors were evaluated before, 1 and 5 min after each frequency condition. H-reflex decreased by 36.7% at 20 Hz, by 28% at 35 Hz, and by 34.8% at 50 Hz after one minute from WBV compared to baseline. Neither MVC nor CAR changed after WBV at all frequency conditions. The short-term, acute inhibition of the H-reflex after WBV at 20, 35 and 50 Hz suggested that decreased excitability of spinal motoneurons is not frequency dependent. On the other hand, the lack of vibration induced effects on MVC and CAR indicated that a 1-min WBV stimulus is not sufficient to affect the voluntary motor output.

Local vibration inhibits H-reflex but does not compromise manual dexterity and does not increase tremor

The present work aimed at investigating the effects of local vibration on upper limb postural and kinetic tremor, on manual dexterity and on spinal reflex excitability. Previous studies have demonstrated a decrease in spinal reflex excitability and in force fluctuations in the lower limb but an increase in force fluctuation in the upper limbs. As hand steadiness is of vital importance in many daily-based tasks, and local vibration may also be applied in movement disorders, we decided to further explore this phenomenon. Ten healthy volunteers (26±3years) were tested for H reflex, postural and kinetic tremor and manual dexterity through a Purdue test. EMG was recorded from flexor carpi radialis (FCR) and extensor digitorum communis (EDC). Measurements were repeated at baseline, after a control period during which no vibration was delivered and after vibration. Intervention consisted in holding for two minutes a vibrating handle (frequency 75Hz, displacement∼7mm), control consisted in holding for two minutes the same handle powered off. Reflex excitability decreased after vibration whilst postural tremor and manual dexterity were not affected. Peak kinetic tremor frequency increased from baseline to control measurements (P=0.002). Co-activation EDC/FCR increased from control to vibration (P=0.021). These results show that two minutes local vibration lead to a decrease in spinal excitability, did not compromise manual dexterity and did not increase tremor; however, in contrast with expectations, tremor did not decrease. It is suggested that vibration activated several mechanisms with opposite effects, which resulted in a neutral outcome on postural and kinetic tremor.

Decrease of the electrical potentials measured on the surface of the knee and produced by cartilage compression during successive loading cycles

Electroarthrography (EAG) is a new technique for measuring electrical potentials appearing on the knee surface during loading that reflects cartilage quality and joint contact force. Our objective was to investigate the evolution of EAG signals during successive loading cycles. The study was conducted on 20 standing subjects who shifted their body weight to achieve knee loading. Their EAG signals were recorded during 10 successive loading cycles, and during a subsequent sequence of 10 cycles recorded after a 15min exercise period. Multiple linear regression models estimated the electro-mechanical ratio (EMR) interpreting the ability of cartilage to generate a certain potential for a given ground reaction force by taking into account this force and the center of pressure displacements during unipedal stance. The results showed that the EMR values slowly decreased with successive cycles: during the initial sequence, the correlation coefficients between EMR values and sequence numbers were significant at 3 of the 4 electrode sites (p<0.05); for the post-exercise sequence, the EMR values still decreased and were significantly lower than during the initial sequence (p<0.001). The reduction of EMR values could arise from muscle activity and habituation of the stretch reflex, and also from the time dependent electromechanical properties of cartilage. In conclusion, refraining from physical activity before the EAG measurements is important to improve measurement repeatability because of the EMR decrease. The electromechanical model confirmed the role of EAG as a natural sensor of the changes in the knee contact force and also improved EAG measurement accuracy.

Acute effects of muscle fatigue on anticipatory and reactive postural control in older individuals: a systematic review of the evidence

BACKGROUND

Falls are the leading cause of traumatic brain injury and fractures and the No. 1 cause of emergency department visits by older adults. Although declines in muscle strength and sensory function contribute to increased falls in older adults, skeletal muscle fatigue is often overlooked as an additional contributor to fall risk. In an effort to increase awareness of the detrimental effects of skeletal muscle fatigue on postural control, we sought to systematically review research studies examining this issue.

PURPOSE

The specific purpose of this review was to provide a detailed assessment of how anticipatory and reactive postural control tasks are influenced by acute muscle fatigue in healthy older individuals.

METHODS

An extensive search was performed using the CINAHL, Scopus, PubMed, SPORTDiscus, and AgeLine databases for the period from inception of each database to June 2013. This systematic review used standardized search criteria and quality assessments via the American Academy for Cerebral Palsy and Developmental Medicine Methodology to Develop Systematic Reviews of Treatment Interventions (2008 version, revision 1.2, AACPDM, Milwaukee, Wisconsin).

RESULTS

A total of 334 citations were found. Six studies were selected for inclusion, whereas 328 studies were excluded from the analytical review. The majority of articles (5 of 6) utilized reactive postural control paradigms. All studies incorporated extrinsic measures of muscle fatigue, such as declines in maximal voluntary contraction or available active range of motion. The most common biomechanical postural control task outcomes were spatial measures, temporal measures, and end-points of lower extremity joint kinetics.

CONCLUSION

On the basis of systematic review of relevant literature, it appears that muscle fatigue induces clear deteriorations in reactive postural control. A paucity of high-quality studies examining anticipatory postural control supports the need for further research in this area. These results should serve to heighten awareness regarding the potential negative effects of acute muscle fatigue on postural control and support the examination of muscle endurance training as a fall risk intervention in future studies.

Soleus H-reflex and its relation to static postural control

The Hoffmann reflex (H-reflex) test has been extensively used to investigate the responsiveness of Ia afferent spinal loop in animal and human studies. The H-reflex response is influenced by multiple neural pathways and the assessment of H-reflex variation is a useful tool in understanding the neural mechanisms in control of movement. Recently, several studies have examined the relationship between the H-reflex modulation and postural stability. For example, it has been reported that the amplitude of soleus (SOL) H-reflex is depressed in relation to increased body sway during upright standing on a soft surface compared to that on a solid surface. It has been suggested that the SOL H-reflex modulation under such condition is predominately affected by the presynaptic inhibitory mechanisms for avoiding oversaturation of the spinal motoneurons. It has also been reported that after balance training, the SOL H-reflex amplitude is down-modulated in parallel with improvement in balance control, suggesting a functional adaptation at the supraspinal levels. The aim of this review is to examine the current literature on the relationship between H-reflex modulation and postural control for a better understanding of the physiological mechanisms involved in control of posture in humans.

Effect of an acute bout of whole body vibration exercise on muscle force output and motor neuron excitability

The purpose of the current investigation was to assess the effect of an acute bout of whole body vibration (WBV) exercise on muscle force output and motor neuron excitability. Nineteen recreationally trained college-aged males were randomly assigned to a WBV (n = 10) or a sham (S, n = 9) group. The WBV group completed a series of static, body weight squats on a vibrating platform at 30 Hz and an amplitude of approximately 3.5 mm (vertical), whereas the S group performed the same series of exercises but without vibration. Measurements were performed before (Pre) and then immediately post-exercise (Imm Post), 8 minutes post-exercise (8-Min Post), or 16 minutes post-exercise (16-Min Post) during 3 different testing sessions. The measurements involved a ballistic isometric maximum voluntary contraction (MVC) of the triceps surae muscle complex and electrical stimulation of the tibial nerve for assessment of motor neuron excitability by analyzing H-reflex and M-wave responses (H(max)/M(max) ratio). Electromyography was also obtained from the triceps surae muscle complex during the MVCs. The WBV group significantly (p < or = 0.05) increased peak force at Imm Post (9.4%) and 8-Min Post (10.4%). No significant change in peak force was observed in the S group. No significant changes were observed in either group for average integrated EMG, H(max)/M(max) ratio, or rate of force development at Imm Post, 8-Min Post, or 16-Min Post. The results from this investigation indicate that an acute bout of static, body weight squat exercises, combined with WBV, increases muscle force output up to 8 minutes post-exercise. However, this increase in muscle force is not accompanied by a significant increase in motor neuron excitability or muscle activation. Thus, it is plausible to use WBV as a method for acute increase in muscle force output for athletes immediately before competition.

Role of vision and task complexity on soleus H-reflex gain

There exists extensive evidence supporting the presence of reflex modulation in humans during a variety of motor tasks. The soleus H-reflex has been shown to be modulated during static and dynamic balance conditions as well as during various motor tasks. The purpose of this study was to examine the effects of two different stance positions and visual conditions on soleus H-reflex gain in 15 apparently healthy adults (mean age=30.27+/-6.92 yrs). The soleus H-reflexes were examined in two experimental stance conditions: two-legged (stable) and one-leg (unstable), and two visual conditions: eyes open and eyes closed. To assess the reflex gain, subjects performed ten trials under each of the four conditions and a soleus H-reflex was elicited during the performance of each trial. For each condition the peak-to-peak amplitude of the H-reflex and the EMG activity 50 ms prior to the stimulus was recorded. Differences in the peak-to-peak amplitudes of the soleus H-reflex for the experimental conditions were compared with a 2x2 (Stance x Vision) repeated measures ANOVA. The level of significance was p<0.05. Results demonstrated significant differences in reflex gain for both the vision (F(l,15)=4.87, p<0.05) and the stance condition (F(l,15)=14.86, p<0.05). Although both the stance condition and vision significantly affected the H-reflex gain, there was no interaction between these two variables (F(l,15)=0.17). From these results, we conclude that H-reflex gain was decreased both as stance complexity increased and as visual inputs were removed. Consistent with previous reports, it may be speculated that changes in presynaptic inhibition to the soleus Ia fibers regulate these gain changes. We propose that vision and stability of stance affect soleus H-reflex gain, but do so without any interactive effects.