Age comparison of H-reflex modulation with the Jendrássik maneuver and postural complexity

Mechanomyography and acceleration show interlimb asymmetries in Parkinson patients without tremor compared to controls during a unilateral motor task

The mechanical muscular oscillations are rarely the objective of investigations regarding the identification of a biomarker for Parkinson's disease (PD). Therefore, the aim of this study was to investigate whether or not this specific motor output differs between PD patients and controls. The novelty is that patients without tremor are investigated performing a unilateral isometric motor task. The force of armflexors and the forearm acceleration (ACC) were recorded as well as the mechanomyography of the biceps brachii (MMGbi), brachioradialis (MMGbra) and pectoralis major (MMGpect) muscles using a piezoelectric-sensor-based system during a unilateral motor task at 70% of the MVIC. The frequency, a power-frequency-ratio, the amplitude variation, the slope of amplitudes and their interlimb asymmetries were analysed. The results indicate that the oscillatory behavior of muscular output in PD without tremor deviates from controls in some parameters: Significant differences appeared for the power-frequency-ratio (p = 0.001, r = 0.43) and for the amplitude variation (p = 0.003, r = 0.34) of MMGpect. The interlimb asymmetries differed significantly concerning the power-frequency-ratio of MMGbi (p = 0.013, r = 0.42) and MMGbra (p = 0.048, r = 0.39) as well as regarding the mean frequency (p = 0.004, r = 0.48) and amplitude variation of MMGpect (p = 0.033, r = 0.37). The mean (M) and variation coefficient (CV) of slope of ACC differed significantly (M: p = 0.022, r = 0.33; CV: p = 0.004, r = 0.43). All other parameters showed no significant differences between PD and controls. It remains open, if this altered mechanical muscular output is reproducible and specific for PD.

Interrogating interneurone function using threshold tracking of the H reflex in healthy subjects and patients with motor neurone disease

OBJECTIVE

The excitability of the lower motoneurone pool is traditionally tested using the H reflex and a constant-stimulus paradigm, which measures changes in the amplitude of the reflex response. This technique has limitations because reflex responses of different size must involve the recruitment or inhibition of different motoneurones. The threshold-tracking technique ensures that the changes in excitability occur for an identical population of motoneurones. We aimed to assess this technique and then apply it in patients with motor neurone disease (MND).

METHODS

The threshold-tracking approach was assessed in 17 healthy subjects and 11 patients with MND. The soleus H reflex was conditioned by deep peroneal nerve stimulation producing reciprocal Ia and so-called D1 and D2 inhibitions, which are believed to reflect presynaptic inhibition of soleus Ia afferents.

RESULTS

Threshold tracking was quicker than the constant-stimulus technique and reliable, properties that may be advantageous for clinical studies. D1 inhibition was significantly reduced in patients with MND.

CONCLUSIONS

Threshold tracking is useful and may be preferable under some conditions for studying the excitability of the motoneurone pool. The decreased D1 inhibition in the patients suggests that presynaptic inhibition may be reduced in MND.

SIGNIFICANCE

Reduced presynaptic inhibition could be evidence of an interneuronopathy in MND. It is possible that the hyperreflexia is a spinal pre-motoneuronal disorder, and not definitive evidence of corticospinal involvement in MND.

Parkinson patients without tremor show changed patterns of mechanical muscle oscillations during a specific bilateral motor task compared to controls

The pathophysiology of Parkinson's disease (PD) is still not understood. There are investigations which show a changed oscillatory behaviour of brain circuits or changes in variability of, e.g., gait parameters in PD. The aim of this study was to investigate whether or not the motor output differs between PD patients and healthy controls. Thereby, patients without tremor are investigated in the medication off state performing a special bilateral isometric motor task. The force and accelerations (ACC) were recorded as well as the Mechanomyography (MMG) of the biceps brachii, the brachioradialis and of the pectoralis major muscles using piezoelectric-sensors during the bilateral motor task at 60% of the maximal isometric contraction. The frequency, a specific power ratio, the amplitude variation and the slope of amplitudes were analysed. The results indicate that the oscillatory behaviour of motor output in PD patients without tremor deviates from controls: thereby, the 95%-confidence-intervals of power ratio and of amplitude variation of all signals are disjoint between PD and controls and show significant differences in group comparisons (power ratio: p = 0.000-0.004, r = 0.441-0.579; amplitude variation: p = 0.000-0.001, r = 0.37-0.67). The mean frequency shows a significant difference for ACC (p = 0.009, r = 0.43), but not for MMG. It remains open, whether this muscular output reflects changes of brain circuits and whether the results are reproducible and specific for PD.

Comparison of Soleus H-Reflexes in Two Groups of Individuals With Motor Incomplete Spinal Cord Injury Walking With and Without a Walker

Objective: To compare phase- and task-dependent H-reflex modulation in standing and walking in 2 spinal cord injury (SCI) groups with and without a walker. Methods: Fourteen subjects with American Spinal Injury Association Impairment Scale D SCI (40±10 years) participated. Tibial nerve was stimulated to evoke 15 H-reflexes (at M-wave 7%-13% of maximum-M). Results: H-reflex was greater in the walker group during stance (but not standing/swing). Conclusion: Differences in H-reflex modulation between groups walking with and without a walker may be explained by sensory mechanism that enhances central excitation, difference in motor activation levels between groups, and other complex mechanisms that influence balance or stability.

Muscle synergy space: learning model to create an optimal muscle synergy

Muscle redundancy allows the central nervous system (CNS) to choose a suitable combination of muscles from a number of options. This flexibility in muscle combinations allows for efficient behaviors to be generated in daily life. The computational mechanism of choosing muscle combinations, however, remains a long-standing challenge. One effective method of choosing muscle combinations is to create a set containing the muscle combinations of only efficient behaviors, and then to choose combinations from that set. The notion of muscle synergy, which was introduced to divide muscle activations into a lower-dimensional synergy space and time-dependent variables, is a suitable tool relevant to the discussion of this issue. The synergy space defines the suitable combinations of muscles, and time-dependent variables vary in lower-dimensional space to control behaviors. In this study, we investigated the mechanism the CNS may use to define the appropriate region and size of the synergy space when performing skilled behavior. Two indices were introduced in this study, one is the synergy stability index (SSI) that indicates the region of the synergy space, the other is the synergy coordination index (SCI) that indicates the size of the synergy space. The results on automatic posture response experiments show that SSI and SCI are positively correlated with the balance skill of the participants, and they are tunable by behavior training. These results suggest that the CNS has the ability to create optimal sets of efficient behaviors by optimizing the size of the synergy space at the appropriate region through interacting with the environment.

Long-term neuromechanical results of selective tibial neurotomy in patients with spastic equinus foot

BACKGROUND

The neuromechanical consequences of tibial neurotomy have not been extensively studied.

METHODS

Fifteen patients were evaluated before and after selective tibial neurotomy (after 2 months and after 15 months) by means of clinical, neurophysiological [tendon (T) reflexes, Hoffmann (H) reflexes and maximum motor response, Mmax] and mechanical parameters (passive stiffness of plantar flexors at the ankle). The neurotomy concerned the soleus (100 % of cases), gastrocnemius (20 % of cases), posterior tibial (60 % of cases) and flexor digitorum longus (47 % of cases) nerves.

RESULTS

Neurotomy provided more than 90 % improvement of clinical spasticity scores, 20 % improvement of walking scores and the angle of passive dorsiflexion (APDF) of the ankle (mean angle: 7°), temporary reduction of the soleus Mmax (18 % at 2 months with return to the preoperative value at 15 months), and lasting reduction of the soleus Hmax/Mmax (68 % at 2 months, 78 % at 15 months) and T/Mmax (84 % at 2 months, 80 % at 15 months). M and H responses of the gastrocnemius (whether or not they were included in the neurotomy) were not modified, while T/Mmax decreased to the same degree as for soleus. Passive stiffness was lastingly decreased from 64.0 Nm/rad to 49.0 Nm/rad (2 months) and 49.5 Nm/rad (15 months).

CONCLUSION

Selective tibial neurotomy of the soleus nerve induces long-term reduction of reflex hyperexcitability and passive stiffness of plantar flexors in spastic patients, with no lasting impairment of motor efferents. In parallel, it modifies the tendon reflexes of synergistic muscles (gastrocnemius) not concerned by the neurotomy.

Motor unit activity when young and old adults perform steady contractions while supporting an inertial load

The purpose of the study was to compare the discharge characteristics of biceps brachii motor units of young and old adults when they performed steady, submaximal contractions while the arm supported different inertial loads. Young (28 ± 4 yr; n = 16) and old (75 ± 4 yr; n = 14) adults performed steady contractions with the elbow flexors at target forces set at either small (11.7 ± 4.4% maximum) or large (17.8 ± 6.5% maximum) differences below the recruitment threshold force of the motor unit (n = 40). The task was to maintain an elbow angle at 1.57 rad until the motor unit was recruited and discharged action potentials for ∼120 s. Time to recruitment was longer for the larger target force difference (187 ± 227 s vs. 23 ± 46 s, P < 0.001). Once recruited, motor units discharged action potentials either repetitively or intermittently, with a greater proportion of motor units exhibiting the repetitive pattern for old adults. Discharge rate at recruitment and during the steady contraction was similar for the two target force differences for old adults but was greater for the small target force difference for young adults. Discharge variability was similar at recruitment for the two age groups but less for the old adults during the steady contraction. The greatest difference between the present results and those reported previously when the arm pulled against a rigid restraint was that old adults modulated discharge rate less than young adults across the two contraction intensities for both load types.

Effects of Long-Term Tai Chi Practice on Balance and H-Reflex Characteristics

The purpose of the present study was to examine the effects of long-term Tai Chi practice on postural balance and H-reflex. Sixteen healthy volunteers, eight with three or more years of experience in Tai Chi training (Tai Chi Group-TCG), and eight with no experience in Tai Chi training (Control Group-CG) participated in the study. Postural sways were measured under four experimental conditions: (1) Standing still with eyes open (EO); (2) Standing still with eyes closed (EC); (3) Standing and turning head to left and right with eyes open (EOT); and (4) Standing and turning head to left and right with eyes closed (ECT). Paired reflex depression (PRD) of the soleus muscle was measured under two conditions: supine and standing. Less significant postural sway was observed in the TCG than in the CG under four conditions including EO, EC, EOT, and ECT (p < 0.01). The TCG demonstrated 14.1%, 30.6%, 33.3% and 22.7% less postural sway, respectively. Significant PRD change from a supine to standing position was observed between TCG and CG (p < 0.05). A significant correlation between PRD change (from supine to standing) and years of Tai Chi practice was observed (r = 0.80, p < 0.05). The findings of this study support the positive effects of Tai Chi exercise on balance control under different conditions. Long-term Tai Chi exercisers also demonstrated different reflex modulation from a supine to standing position, and long-term Tai Chi practice may lead to a change of PRD modulation as neuroadaptation.

Artificial balancer - supporting device for postural reflex

The evolutionarily novel ability to keep ones body upright while standing or walking, the human balance, deteriorates in old age or can be compromised after accidents or brain surgeries. With the aged society, age related balance problems are on the rise. Persons with balance problems are more likely to fall during their everyday life routines. Especially in elderly, falls can lead to bone fractures making the patient bedridden, weakening the body and making it more prone to other diseases. Health care expenses for a fall patient are often very high. There is a great deal of research being done on exoskeletons and power assists. However, these technologies concentrate mainly on the amplifications of human muscle power while balance has to be provided by the human themself. Our research has been focused on supporting human balance in harmony with the human's own posture control mechanisms such as postural reflexes. This paper proposes an artificial balancer that supports human balance through acceleration of a flywheel attached to the body. Appropriate correcting torques are generated through our device based on the measurements of body deflections. We have carried out experiments with test persons standing on a platform subject to lateral perturbations and ambulatory experiments while walking on a balance beam. These experiments have demonstrated the effectiveness of our device in supporting balance and the possibility of enhancing balance-keeping capability in human beings through the application of external torque.

Reliability of soleus H-reflexes in standing and walking post-incomplete spinal cord injury

OBJECTIVE

To establish the reliability of soleus H-reflex in individuals with incomplete spinal cord injury (SCI) during the standing and the swing and stance phases of overground walking.

METHODS

Fourteen SCI (40 +/- 10 years) and eight noninjured subjects (32 +/- 9 years) participated. The noninjured and SCI subjects walked at self-selected speed overground. H-reflexes in the soleus muscle (at M-wave 7%-13% maximum-M) were tested on two separate days by stimulating the tibial nerve. Intraclass correlation coefficients (two-way mixed model-ICC (1, 2)) and standard error of measurement (SEM) were calculated.

RESULTS

Relative reliability of the H-reflexes was good to excellent; intra-class correlation coefficients (ICCs) ranged from 0.64-0.91 in noninjured and SCI subjects. SEM expressed as percentage of the mean H-reflex was 13%-62% in noninjured and 12%-18% in SCI individuals.

CONCLUSIONS

H-reflexes can be reliably assessed in standing and walking in post-SCI and noninjured subjects.

SIGNIFICANCE

H-reflexes can be reliably used in longitudinal studies to investigate mechanisms of recovery post-SCI.

Spinal and supraspinal adaptations associated with balance training and their functional relevance

Traditionally, balance training has been used to rehabilitate ankle injuries and postural deficits. Prospective studies have shown preventive effects with respect to ankle and knee joint injuries. Presently, balance training is not only applied for rehabilitation and prevention but also for improving motor performance, especially muscle power. The recent application of noninvasive electrophysiological and brain imaging techniques revealed insights into the central control of posture and the adaptations induced by balance training. This information is important for our understanding of the basic control and adaptation mechanisms and to conceptualize appropriate training programmes for athletes, elderly people and patients. The present review presents neurophysiological adaptations induced by balance training and their influence on motor behaviour. It emphasizes the plasticity of the sensorimotor system, particularly the spinal and supraspinal structures. The relevance of balance training is highlighted with respect to athletic performance, postural control within elderly people as well as injury prevention and rehabilitation.

Motor unit firing behavior during prolonged 50% MVC dorsiflexion contractions in young and older adults

The purpose of this study was to investigate changes in motor unit firing behavior during prolonged contractions in young and older adults. Motor unit activity was recorded from the tibialis anterior of 16 subjects (8 young and 8 older), while they performed isometric dorsiflexion at 50% MVC until task failure. Mean motor unit firing rate, the standard deviation (SD), and coefficient of variation (CV) of the interspike intervals, and number of doublet discharges were calculated for a total of 52 motor units, tracked for an average of 92.9+/-68.6s. There was no age-related difference in the time to task failure. A modest decline in firing rate was observed in 71% of the motor units, with no significant age-related difference. The SD and CV of the interspike interval had a positive slope in 65% and 69% of the motor units, respectively, with no significant age-related differences. The number of doublet discharges remained stable throughout the contraction. Both groups exhibited motor unit dropout (discharge cessation) during the contraction. Thus, a fatiguing task producing modest changes in firing rate in young and older adults is accompanied by an appreciable increase in firing rate variability. The incidence of doublet discharges is not increased during fatiguing contractions.

Reflexes in prior polio and their relation to weakness and anterior horn cell loss

The aim of this study was to evaluate the reflex pattern in patients with prior polio and to relate these findings to the degree of anterior horn cell (AHC) involvement and loss of muscle force. Twenty-five prior polio subjects were investigated with electromyography (EMG), force testing and reflex studies, which included the patellar and Achilles reflex, H-reflex, T-response and interlimb reflex (ILR). The clinical reflexes, H/M-ratio and T-response amplitude at rest were positively correlated with force and negatively correlated with the degree of AHC loss. The H/M-ratio was decreased compared with age matched controls. ILR was present in 68% of the prior polio patients but did not exist in controls. The presence of the ILR was not correlated with the degree of AHC loss or force. The reflex studies gave two main findings. The first is reduced excitability of monosynaptic connections in the motor neuron pool, which is related to weakness. The other is the presence of ILR as an indicator of interneuronal hyper-excitability, which is not related to weakness.

Temperature dependence of soleus H-reflex and M wave in young and older women

The purpose of this study was to investigate the effect of altered local temperature on soleus H-reflex and compound muscle action potential (M wave) in young and older women. H-reflex and M wave responses were elicited in 10 young (22.3 +/- 3.3 years) and 10 older (72.5 +/- 3.2 years) women at three muscle temperatures: control (34.2 +/- 0.3 degrees C), cold (31.3+/-0.5 degrees C) and warm (37.1 +/- 0.2 degrees C). H-reflex output, expressed as the ratio between maximal H-reflex and maximal M wave (H(max)/M(max)), was lower in the older, compared with the younger, group, regardless of temperature. In control temperature conditions, for example, the H(max)/M(max) ratio was 36.8 +/- 24% in the young and 25.4 +/- 20% in the older (P<0.05). Warming had no effect on the H-reflex output in either group, whilst cooling increased H-reflex output only in the younger group (+28%). In both groups, cooling increased (+5.3%), and warming decreased (-5.5%) the H-reflex latency. This study confirms that older individuals experience a reduced ability to modulate the reflex output in response to a perturbation. In a cold environment, for example, the lack of facilitation in the reflex output, along with a delayed reflex response could be critical to an older individual in responding to postural perturbations thus potentially compromising both static and dynamic balance.

Attenuation of the effect of remote muscle contraction on the soleus H-reflex during plantar flexion

OBJECTIVE

We investigated to what extent the facilitation of the soleus (Sol) Hoffmann (H-) reflex during a phasic voluntary wrist flexion (Jendrássik maneuver, JM) can be modulated by graded plantar flexion force and conditioning wrist flexion force.

METHODS

The subjects were asked to perform phasic wrist flexion under a reaction time condition. Sol H-reflex was evoked by stimulating the right tibial nerve at various time intervals (50-400ms) after the 'Go' signal for initiating JM while the ankle was at rest and while plantarflexing. The level of tonic plantar flexion force (isometric contraction of 10, 20 and 30% of maximal EMG) and conditioning wrist flexion (isometric contraction of 30, 50 and 80% of maximum voluntary contraction) during JM was graded systematically.

RESULTS

Although JM facilitation could be seen 80-120ms after the flexor carpi radialis (FCR) EMG onset even while plantarflexing, the magnitude of JM facilitation under plantar flexion was significantly decreased compared to that at rest. The degree of decrease in JM facilitation did not depend on the level of plantar flexion force. In contrast, the degree of JM facilitation was proportional to the level of wrist flexion force while the ankle was at rest and while plantarflexing, though the amount of JM facilitation significantly decreased while plantarflexing.

CONCLUSIONS

JM facilitation of Sol H-reflex is decreased while performing tonic voluntary contraction of the homonymous muscle. The degree of decrease in JM facilitation is independent of the level of homonymous muscle contraction, but depends on the level of remote FCR contraction. In clinical application, when we intend to elicit a maximum stretch reflex by JM, full relaxation of homonymous muscle should be carefully confirmed.

SIGNIFICANCE

Our results provide evidence for better understanding of the features of JM and insight into its clinical application.

Reliability of the soleus H-reflex from supine to standing in young and elderly

OBJECTIVE

Many recent studies have used the soleus H-reflex methodology to examine age-related changes in neuromuscular function. However, reliability of the method has only been tested in young adults. The purpose of this study was to evaluate the inter-trial reliability of the soleus H-reflex in both young and elderly subjects during supine and standing conditions.

METHODS

The experiment was carried out on 10 young and 10 elderly subjects. For each subject, 10 standardized soleus H-reflex trials were collected during each of the postural conditions. Intraclass correlations were calculated for the first 4, 6, 8, and 10 trials for each group at each body position.

RESULTS

The largest decreases in reliability in this study were observed with a decrease in the number of trials used to estimate the elderly soleus H-reflex during the standing condition. The change from using ten trials to using four trials led to an 8% decrease in reliability.

CONCLUSIONS

Due to the decreased postural control ability in the elderly population, at least ten trials should be used to estimate soleus H-reflex characteristics during standing or other functional weight-bearing conditions.

SIGNIFICANCE

Using fewer than 10 trials could lead to an increase in statistical errors and misinterpretation of results.