Reciprocal Ia inhibition between ankle flexors and extensors in man

Intrinsic properties of spinal motoneurons degrade ankle torque control in humans

Motoneurons are the final common pathway for all motor commands and possess intrinsic electrical properties that must be tuned to control muscle across the full range of motor behaviours. Neuromodulatory input from the brainstem is probably essential for adapting motoneuron properties to match this diversity of motor tasks. A primary mechanism of this adaptation, control of dendritic persistent inward currents (PICs) in motoneurons by brainstem monoaminergic systems, generates both amplification and prolongation of synaptic inputs. While essential, there is an inherent tension between this amplification and prolongation. Although amplification by PICs allows for quick recruitment and acceleration of motoneuron discharge, PICs must be deactivated to derecruit motoneurons upon movement cessation. In contrast, during stabilizing or postural tasks, PIC-induced prolongation of synaptic inputs is critical for sustained motoneuron discharge. Here, we designed two motor tasks that challenged the inhibitory control of PICs, generating unduly PIC prolongation that increases variability in human torque control. This included a paradigm combining a discrete motor task with a stabilizing task and another involving muscle length-induced changes to the balance of excitatory and inhibitory inputs available for controlling PICs. We show that prolongation from PICs introduces difficulties in ankle torque control and that these difficulties are further degraded at shorter muscle lengths when PIC prolongation is greatest. These results highlight the necessity for inhibitory control of PICs and showcase issues introduced when inhibitory control is constrained. Our findings suggest that, like sensory systems, errors are inherent in motor systems. These errors are not due to problems in the perception of movement-related sensory input but are embedded in the final stage of motor output. This has many implications relevant to clinical conditions (e.g. chronic stroke) where pathological shifts in monoamines may further amplify these errors. KEY POINTS: All motor commands are processed via spinal motoneurons, whose intrinsic electrical properties are adapted by brainstem neuromodulatory input. The effects of these neuromodulatory inputs (i.e. persistent inward currents; PICs) must be tightly regulated by inhibitory inputs to allow for the large repertoire of human motor behaviours. We designed two motor tasks to restrict the ability of inhibitory synaptic inputs to control PICs and show that this generates substantial errors that reduce the precision of motor output in humans. Our findings suggest that errors are inherent in motor systems and embedded in the final stage of motor output. This has many implications relevant to clinical conditions (e.g. chronic stroke) and may, speculatively, shed light on contributing factors to muscle cramps.

Neurophysiological effects of latent trigger point dry needling on spinal reflexes

Deep dry needling (DDN) is a method to treat muscle trigger points (TrPs) often found in persons with neuromuscular pain and spasticity. Currently, its neurophysiological actions are not well established. Thus, to understand how DDN affects spinal cord physiology, we investigated the effects of TrP DDN on spinal reflexes. In 17 adults with latent TrPs in the medial gastrocnemius (MG) without known neurological or orthopedic injuries, the H reflex, M wave, and reciprocal inhibition in the soleus, MG, and lateral gastrocnemius (LG) and passive ankle range of motion (ROM) were measured before and immediately, 90 min, and 72 h after a single bout of DDN at the MG TrPs. The MG maximum M wave (Mmax) amplitude was decreased immediately and 90 min post DDN (by -14% and -18%) and returned to pre-DDN level at 72 h post. LG and soleus Mmax did not change. The maximum H reflex (Hmax) amplitude did not change in any of the triceps surae. Soleus inhibition was increased significantly immediately (+30%) and 72 h (+36%) post DDN. ROM was increased by ≈4° immediately and ≈3° at 72 h post DDN. Temporary reduction of MG (but not soleus or LG) Mmax amplitude after DDN and its recovery at 72 h post indicate temporary and specific effects of DDN in the treated muscle. The immediate and 72 h post increases in the ROM and soleus inhibition with no changes in Hmax suggest complex effects of DDN at the spinal level.NEW & NOTEWORTHY In this study, we examined the effects of deep dry needling (DDN) on spinal reflexes in the triceps surae. We found that the H reflex (an excitatory reflex) did not change after DDN but soleus inhibition was increased immediately and 72 h after DDN, corresponding to increases in ankle range of motion. Differential effects of DDN on excitatory and inhibitory reflexes over the first 72 h may reflect its complex neurophysiological effects at the spinal level.

Reduced H-reflex gain in soleus during isometric plantar flexor and dorsiflexor muscle contractions in old adults

The modulation of the Hoffmann (H) reflex amplitude during agonist and antagonist muscle contractions provides relevant information on the neural control of leg muscles but remains largely unknown in older adults. This study investigated the H-reflex gain in the soleus muscle at rest and during plantar flexor (PF) and dorsiflexor (DF) muscle contractions performed at 10%, 20%, and 30% of the maximal electromyographic (EMG) activity (EMGMVC) in 12 young (23-35 years) and 12 old adults (61-76 years). The reflex gain was measured as the slope of the relation between H-reflex amplitude and background EMG activity. The stimulation intensity was set to evoke at rest an H reflex in the ascending phase of its recruitment curve preceded by an M wave (5%-10% of its maximal amplitude; Mmax). During PF contractions, the H-reflex amplitude increased with the increase in contraction intensity in both groups with a greater reflex gain (p = 0.024) in young (1.2 (0.5)% Mmax/% EMGMVC) than older adults (0.7 (0.4)% Mmax/% EMGMVC). During DF contractions, the H-reflex amplitude decreased in both groups, with a more negative reflex gain (p = 0.009) in young (-6.8 (2.8)% Mmax/% EMGMVC) than older adults (-2.7 (4.0)% Mmax/% EMGMVC). The decrease in H-reflex amplitude was linearly associated with the increase in tibialis anterior EMG in both groups. The present study showed a smaller reflex gain in older adults in soleus during submaximal PF and DF contractions, suggesting a decreased ability to adjust the excitatory afferent inputs during PF contractions, and to modulate reciprocal inhibition during DF contractions.

Cognitive effect of passively induced kinesthetic perception associated with virtual body augmentation modulates spinal reflex

The virtual movement of an augmented body, perceived as part of oneself, forms the basis of kinesthetic perception induced by visual stimulation (KINVIS). KINVIS is a visually induced virtual kinesthetic perception that clinically suppresses spasticity. The present study hypothesized that central neural network activity during KINVIS affects subcortical neural circuits. The present study aimed to elucidate whether reciprocal and presynaptic inhibition occurs during KINVIS. Seventeen healthy participants were recruited (mean age: 27.9 ± 3.6 yr), and their soleus Hoffmann-reflexes (H-reflexes) were recorded by peripheral nerve stimulation while perceiving the dorsiflexion kinesthetic illusion in the right-side foot (seated in a comfortable chair). Two control conditions were set to observe the same foot video without the kinesthetic illusion while focusing on the static foot image. Unconditioned H-reflex and two types of conditioned H-reflexes were measured: Ia (reciprocal inhibition) and D1 (presynaptic inhibition). Reciprocal Ia and D1 inhibition of the soleus muscle was significantly enhanced during the kinesthetic illusion compared with the condition without kinesthetic illusion (a post hoc analysis using the Bonferroni test: Ia inhibition, P = 0.002; D1 inhibition, P = 0.049). This study indicates that kinesthetic illusion elicits an inhibitory effect on the monosynaptic reflex loop of Ia afferents, potentially inhibiting the hyperexcitability of the stretch reflex. These findings demonstrate that brain activity associated with visually induced kinesthetic illusions acts on spinal inhibition circuits. These insights may be valuable in clinical rehabilitation practice, specifically for the treatment of spasticity.NEW & NOTEWORTHY Neural effects in visual-induced kinesthetic illusion expand into the spinal reflex. Kinesthetic illusion inhibits the monosynaptic reflex in an antagonistic muscle via reciprocal and presynaptic inhibition. Visually induced kinesthetic illusion is a suitable treatment for spasticity in patients with stroke.

Transcutaneous spinal cord stimulation neuromodulates pre- and postsynaptic inhibition in the control of spinal spasticity

Aside from enabling voluntary control over paralyzed muscles, a key effect of spinal cord stimulation is the alleviation of spasticity. Dysfunction of spinal inhibitory circuits is considered a major cause of spasticity. These circuits are contacted by Ia muscle spindle afferents, which are also the primary targets of transcutaneous lumbar spinal cord stimulation (TSCS). We hypothesize that TSCS controls spasticity by transiently strengthening spinal inhibitory circuit function through their Ia-mediated activation. We show that 30 min of antispasticity TSCS improves activity in post- and presynaptic inhibitory circuits beyond the intervention in ten individuals with traumatic spinal cord injury to normative levels established in 20 neurologically intact individuals. These changes in circuit function correlate with improvements in muscle hypertonia, spasms, and clonus. Our study opens the black box of the carryover effects of antispasticity TSCS and underpins a causal role of deficient post- and presynaptic inhibitory circuits in spinal spasticity.

Voluntary co-contraction of ankle muscles alters motor unit discharge characteristics and reduces estimates of persistent inward currents

Motoneuronal persistent inward currents (PICs) are facilitated by neuromodulatory inputs but are highly sensitive to local inhibitory circuits. Estimates of PICs are reduced by group Ia reciprocal inhibition, and increased with the diffuse actions of neuromodulators released during remote muscle contraction. However, it remains unknown how motoneurons function in the presence of simultaneous excitatory and inhibitory commands. To probe this topic, we investigated motor unit discharge patterns and estimated PICs during voluntary co-contraction of ankle muscles, which simultaneously demands the contraction of agonist-antagonist pairs. Twenty participants performed triangular ramps of both co-contraction (simultaneous dorsiflexion and plantar flexion) and isometric dorsiflexion to a peak of 30% of their maximum muscle activity from a maximal voluntary contraction. Motor unit spike trains were decomposed from high-density surface EMG activity recorded from tibialis anterior using blind source separation algorithms. Voluntary co-contraction altered motor unit discharge rate characteristics. Discharge rate at recruitment and peak discharge rate were modestly reduced (∼6% change; P < 0.001; d = 0.22) and increased (∼2% change; P = 0.001, d = -0.19), respectively, in the entire dataset but no changes were observed when motor units were tracked across conditions. The largest effects during co-contraction were that estimates of PICs (ΔF) were reduced by ∼20% (4.47 vs. 5.57 pulses per second during isometric dorsiflexion; P < 0.001, d = 0.641). These findings suggest that, during voluntary co-contraction, the inhibitory input from the antagonist muscle overcomes the additional excitatory and neuromodulatory drive that may occur due to the co-contraction of the antagonist muscle, which constrains PIC behaviour. KEY POINTS: Voluntary co-contraction is a unique motor behaviour that concurrently provides excitatory and inhibitory synaptic input to motoneurons. Co-contraction of agonist-antagonist pairs alters agonist motor unit discharge characteristics, consistent with reductions in persistent inward current magnitude.

Reciprocal Inhibition and Coactivation of Ankle Muscles in Low- and High-Velocity Forward and Backward Perturbations

Reciprocal inhibition and coactivation are strategies of the central nervous system used to perform various daily tasks. In automatic postural responses (APR), coactivation is widely investigated in the ankle joint muscles, however reciprocal inhibition, although clear in manipulative motor actions, has not been investigated in the context of APRs. The aim was to identify whether reciprocal inhibition can be observed as a strategy in the recruitment of gastrocnemius Medialis (GM), Soleus (So) and Tibialis Anterior (TA) muscles in low- and high-velocity forward and backward perturbations. We applied two balance perturbations with a low and a high velocity of displacement of the movable platform in forward and backward conditions and we evaluated the magnitude and latency time of TA, GM and So activation latency, measured by electromyography (EMG). In forward perturbations, coactivation of the three muscles was observed, with greater activation amplitude of the GM and lesser amplitude of the So and TA muscles. For backward, the pattern of response observed was activation of the TA muscle, a decrease in the EMG signal, which characterizes reciprocal inhibition of the GM muscle and maintenance of the basal state of the So muscle. This result indicates that backward perturbations are more challenging.

Do soleus responses to transcutaneous spinal cord stimulation show similar changes to H-reflex in response to Achilles tendon vibration?

INTRODUCTION/PURPOSE

Recently, the use of transcutaneous spinal cord stimulation (TSCS) has been proposed as a viable alternative to the H-reflex. The aim of the current study was to investigate to what extent the two modes of spinal cord excitability investigation would be similarly sensitive to the well-known vibration-induced depression.

METHODS

Fourteen healthy participants (8 men and 6 women; age: 26.7 ± 4.8 years) were engaged in the study. The right soleus H-reflex and TSCS responses were recorded at baseline (PRE), during right Achilles tendon vibration (VIB) and following 20 min of vibration exposure (POST-VIB). Care was taken to match H-reflex and TSCS responses amplitude at PRE and to maintain effective stimulus intensities constant throughout time points.

RESULTS

The statistical analysis showed a significant effect of time for the H-reflex, with VIB (13 ± 5% of maximal M-wave (Mmax) and POST-VIB (36 ± 4% of Mmax) values being lower than PRE-values (48 ± 6% of Mmax). Similarly, TSCS responses changed over time, VIB (9 ± 5% of Mmax) and POST-VIB (27 ± 5% of Mmax) values being lower than PRE-values (46 ± 6% of Mmax). Pearson correlation analyses revealed positive correlation between H-reflex and TSCS responses PRE-to-VIB changes, but not for PRE- to POST-VIB changes.

CONCLUSION

While the sensitivity of TSCS seems to be similar to the gold standard H-reflex to highlight the vibratory paradox, both responses showed different sensitivity to the effects of prolonged vibration, suggesting slightly different pathways may actually contribute to evoked responses of both stimulation modalities.

Reciprocal inhibition of the thigh muscles in humans: A study using transcutaneous spinal cord stimulation

Evaluating reciprocal inhibition of the thigh muscles is important to investigate the neural circuits of locomotor behaviors. However, measurements of reciprocal inhibition of thigh muscles using spinal reflex, such as H-reflex, have never been systematically established owing to methodological limitations. The present study aimed to clarify the existence of reciprocal inhibition in the thigh muscles using transcutaneous spinal cord stimulation (tSCS). Twenty able-bodied male individuals were enrolled. We evoked spinal reflex from the biceps femoris muscle (BF) by tSCS on the lumber posterior root. We examined whether the tSCS-evoked BF reflex was reciprocally inhibited by the following conditionings: (1) single-pulse electrical stimulation on the femoral nerve innervating the rectus femoris muscle (RF) at various inter-stimulus intervals in the resting condition; (2) voluntary contraction of the RF; and (3) vibration stimulus on the RF. The BF reflex was significantly inhibited when the conditioning electrical stimulation was delivered at 10 and 20 ms prior to tSCS, during voluntary contraction of the RF, and during vibration on the RF. These data suggested a piece of evidence of the existence of reciprocal inhibition from the RF to the BF muscle in humans and highlighted the utility of methods for evaluating reciprocal inhibition of the thigh muscles using tSCS.

Voluntary co-contraction of ankle muscles alters motor unit discharge characteristics and reduces estimates of persistent inward currents

Motoneuronal persistent inward currents (PICs) are both facilitated by neuromodulatory inputs and highly sensitive to local inhibitory circuits (e.g., Ia reciprocal inhibition). Methods aimed to increase group Ia reciprocal inhibition from the antagonistic muscle have been successful in decreasing PICs, and the diffuse actions of neuromodulators released during activation of remote muscles have increased PICs. However, it remains unknown how motoneurons function in the presence of simultaneous excitatory and inhibitory commands. To probe this topic, we investigated motor unit (MU) discharge patterns and estimated PICs during voluntary co-contraction of ankle muscles, which simultaneously demands the contraction of agonist-antagonist pairs. Twenty young adults randomly performed triangular ramps (10s up and down) of both co-contraction (simultaneous dorsiflexion and plantarflexion) and isometric dorsiflexion to a peak of 30% of their maximum muscle activity from a maximal voluntary contraction. Motor unit spike trains were decomposed from high-density surface electromyography recorded over the tibialis anterior (TA) using blind source separation algorithms. Voluntary co-contraction altered motor unit discharge rate characteristics, decreasing estimates of PICs by 20% (4.47 pulses per second (pps) vs 5.57 pps during isometric dorsiflexion). These findings suggest that, during voluntary co-contraction, the inhibitory input from the antagonist muscle overcomes the additional excitatory and neuromodulatory drive that may occur due to the co-contraction of the antagonist muscle, which constrains PIC behavior.

Mesencephalic Locomotor Region and Presynaptic Inhibition during Anticipatory Postural Adjustments in People with Parkinson's Disease

Individuals with Parkinson's disease (PD) and freezing of gait (FOG) have a loss of presynaptic inhibition (PSI) during anticipatory postural adjustments (APAs) for step initiation. The mesencephalic locomotor region (MLR) has connections to the reticulospinal tract that mediates inhibitory interneurons responsible for modulating PSI and APAs. Here, we hypothesized that MLR activity during step initiation would explain the loss of PSI during APAs for step initiation in FOG (freezers). Freezers (n = 34) were assessed in the ON-medication state. We assessed the beta of blood oxygenation level-dependent signal change of areas known to initiate and pace gait (e.g., MLR) during a functional magnetic resonance imaging protocol of an APA task. In addition, we assessed the PSI of the soleus muscle during APA for step initiation, and clinical (e.g., disease duration) and behavioral (e.g., FOG severity and APA amplitude for step initiation) variables. A linear multiple regression model showed that MLR activity (R2 = 0.32, p = 0.0006) and APA amplitude (R2 = 0.13, p = 0.0097) explained together 45% of the loss of PSI during step initiation in freezers. Decreased MLR activity during a simulated APA task is related to a higher loss of PSI during APA for step initiation. Deficits in central and spinal inhibitions during APA may be related to FOG pathophysiology.

Postinhibitory excitation in motoneurons can be facilitated by hyperpolarization-activated inward currents: A simulation study

Postinhibitory excitation is a transient overshoot of a neuron's baseline firing rate following an inhibitory stimulus and can be observed in vivo in human motoneurons. However, the biophysical origin of this phenomenon is still unknown and both reflex pathways and intrinsic motoneuron properties have been proposed. We hypothesized that postinhibitory excitation in motoneurons can be facilitated by hyperpolarization-activated inward currents (h-currents). Using an electrical circuit model, we investigated how h-currents can modulate the postinhibitory response of motoneurons. Further, we analyzed the spike trains of human motor units from the tibialis anterior muscle during reciprocal inhibition. The simulations revealed that the activation of h-currents by an inhibitory postsynaptic potential can cause a short-term increase in a motoneuron's firing probability. This result suggests that the neuron can be excited by an inhibitory stimulus. In detail, the modulation of the firing probability depends on the time delay between the inhibitory stimulus and the previous action potential. Further, the postinhibitory excitation's strength correlates with the inhibitory stimulus's amplitude and is negatively correlated with the baseline firing rate as well as the level of input noise. Hallmarks of h-current activity, as identified from the modeling study, were found in 50% of the human motor units that showed postinhibitory excitation. This study suggests that h-currents can facilitate postinhibitory excitation and act as a modulatory system to increase motoneuron excitability after a strong inhibition.

Participant attention on the intervention target during repetitive passive movement improved spinal reciprocal inhibition enhancement and joint movement function

This study aimed to evaluate the effects of the participant's attention target during repetitive passive movement (RPM) intervention on reciprocal inhibition (RI) and joint movement function. Twenty healthy adults participated in two experiments involving four attention conditions [control (forward attention with no RPM), forward attention (during RPM), monitor attention (monitor counting task during RPM), ankle joint attention (ankle movement counting task during RPM)] during 10-min RPM interventions on the ankle joint. Counting tasks were included to ensure the participant's attention remained on the target during the intervention. In Experiment 1, RI was measured before, immediately after, and 5, 10, 15, 20, and 30 min after the RPM intervention. In Experiment 2, we evaluated ankle joint movement function at the same time points before and after RPM intervention. The maximum ankle dorsiflexion movement (from 30° plantar flexion to 10° dorsiflexion) was measured, reflecting RI. In Experiment 1, the RI function reciprocal Ia inhibition was enhanced for 10 min after RPM under all attention conditions (excluding the control condition. D1 inhibition was enhanced for 20 min after RPM in the forward and monitor attention conditions and 30 min after RPM in the ankle joint attention condition. In Experiment 2, the joint movement function decreased under the forward and monitor attention conditions but improved under the ankle joint attention condition. This study is the first to demonstrate that the participant's attention target affected the intervention effect of the RI enhancement method, which has implications for improving the intervention effect of rehabilitation.

Effects of patterned electrical sensory nerve stimulation and static stretching on joint range of motion and passive torque

Static stretching and proprioceptive neuromuscular facilitation stretching techniques can modulate specific neural mechanisms to improve the range of motion. However, the effects of modulation of these neural pathways on changes in the range of motion with static stretching remain unclear. Patterned electrical stimulation of the sensory nerve induces plastic changes in reciprocal Ia inhibition. The present study examined the effects of patterned electrical stimulation and static stretching on a range of motion and passive torque in plantarflexion muscles. The subjects were 14 young men (age 20.8 ± 1.3 years). The effects of patterned electrical stimulation (10 pulses at 100 Hz every 1.5 s) or uniform electrical stimulation (one pulse every 150 ms) to the common peroneal nerve for 20 min on reciprocal Ia inhibition of the Hoffman reflex (H-reflex) were examined. Reciprocal Ia inhibition was evaluated as short-latency suppression of the soleus H-reflex by conditioning stimulation of the common peroneal nerve. Then, the effects of transcutaneous electrical nerve stimulation (patterned electrical stimulation or uniform electrical stimulation) or prolonged resting (without electrical stimulation) and static 3-min stretching on the maximal dorsiflexion angle and passive torque were investigated. The passive ankle dorsiflexion test was performed on an isokinetic dynamometer. Stretch tolerance and stiffness of the muscle-tendon unit were evaluated by the peak and slope of passive torques, respectively. Patterned electrical stimulation significantly increased reciprocal Ia inhibition of soleus H-reflex amplitude (9.7 ± 6.1%), but uniform electrical stimulation decreased it significantly (19.5 ± 8.8%). The maximal dorsiflexion angle was significantly changed by patterned electrical stimulation (4.0 ± 1.4°), uniform electrical stimulation (3.8 ± 2.3°), and stretching without electrical stimulation (2.1 ± 3.3°). The increase in stretch tolerance was significantly greater after patterned electrical stimulation and uniform electrical stimulation than after stretching without electrical stimulation. Stiffness of the muscle-tendon unit was significantly decreased by patterned electrical stimulation, uniform electrical stimulation, and stretching without electrical stimulation. Transcutaneous electrical nerve stimulation and static stretching improve stretch tolerance regardless of the degree of reciprocal Ia inhibition.

The history of Danish neuroscience

The history of Danish neuroscience starts with an account of impressive contributions made at the 17th century. Thomas Bartholin was the first Danish neuroscientist, and his disciple Nicolaus Steno became internationally one of the most prominent neuroscientists in this period. From the start, Danish neuroscience was linked to clinical disciplines. This continued in the 19th and first half of the 20th centuries with new initiatives linking basic neuroscience to clinical neurology and psychiatry in the same scientific environment. Subsequently, from the middle of the 20th century, basic neuroscience was developing rapidly within the preclinical university sector. Clinical neuroscience continued and was even reinforced during this period with important translational research and a close co-operation between basic and clinical neuroscience. To distinguish 'history' from 'present time' is not easy, as many historical events continue in present time. Therefore, we decided to consider 'History' as new major scientific developments in Denmark, which were launched before the end of the 20th century. With this aim, scientists mentioned will have been born, with a few exceptions, no later than the early 1960s. However, we often refer to more recent publications in documenting the developments of initiatives launched before the end of the last century. In addition, several scientists have moved to Denmark after the beginning of the present century, and they certainly are contributing to the present status of Danish neuroscience-but, again, this is not the History of Danish neuroscience.

Revisiting the use of Hoffmann reflex in motor control research on humans

Research in movement science aims at unravelling mechanisms and designing methods for restoring and maximizing human functional capacity, and many techniques provide access to neural adjustments (acute changes) or long-term adaptations (chronic changes) underlying changes in movement capabilities. First described by Paul Hoffmann over a century ago, when an electrical stimulus is applied to a peripheral nerve, this causes action potentials in afferent axons, primarily the Ia afferents of the muscle spindles, which recruit homonymous motor neurons, thereby causing an electromyographic response known as the Hoffmann (H) reflex. This technique is a valuable tool in the study of the neuromuscular function in humans and has provided relevant information in the neural control of movement. The large use of the H reflex in motor control research on humans relies in part to its relative simplicity. However, such simplicity masks subtleties that require rigorous experimental protocols and careful data interpretation. After highlighting basic properties and methodological aspects that should be considered for the correct use of the H-reflex technique, this brief narrative review discusses the purpose of the H reflex and emphasizes its use as a tool to assess the effectiveness of Ia afferents in discharging motor neurones. The review also aims to reconsider the link between H-reflex modulation and Ia presynaptic inhibition, the use of the H-reflex technique in motor control studies, and the effects of ageing. These aspects are summarized as recommendations for the use of the H reflex in motor control research on humans.

Disexcitation in the ASH/RIM/ADL negative feedback circuit fine-tunes hyperosmotic sensation and avoidance in Caenorhabditis elegans

Sensations, especially nociception, are tightly controlled and regulated by the central and peripheral nervous systems. Osmotic sensation and related physiological and behavioral reactions are essential for animal well-being and survival. In this study, we find that interaction between secondary nociceptive ADL and primary nociceptive ASH neurons upregulates Caenorhabditis elegans avoidance of the mild and medium hyperosmolality of 0.41 and 0.88 Osm but does not affect avoidance of high osmolality of 1.37 and 2.29 Osm. The interaction between ASH and ADL is actualized through a negative feedback circuit consisting of ASH, ADL, and RIM interneurons. In this circuit, hyperosmolality-sensitive ADL augments the ASH hyperosmotic response and animal hyperosmotic avoidance; RIM inhibits ADL and is excited by ASH; thus, ASH exciting RIM reduces ADL augmenting ASH. The neuronal signal integration modality in the circuit is disexcitation. In addition, ASH promotes hyperosmotic avoidance through ASH/RIC/AIY feedforward circuit. Finally, we find that in addition to ASH and ADL, multiple sensory neurons are involved in hyperosmotic sensation and avoidance behavior.

Combined effect of contraction type and intensity on corticomuscular coherence during isokinetic plantar flexions

During isometric contractions, corticomuscular coherence (CMC) may be modulated along with the contraction intensity. Furthermore, CMC may also vary between contraction types due to the contribution of spinal inhibitory mechanisms. However, the interaction between the effect of the contraction intensity and of the contraction type on CMC remains hitherto unknown. Therefore, CMC and spinal excitability modulations were compared during submaximal isometric, shortening and lengthening contractions of plantar flexor muscles at 25, 50, and 70% of the maximal soleus (SOL) EMG activity. CMC was computed in the time-frequency domain between the Cz EEG electrode signal and the SOL or medial gastrocnemius (MG) EMG signals. The results indicated that beta-band CMC was decreased in the SOL only between 25 and 50-70% contractions for both isometric and anisometric contractions, but remained similar for all contraction intensities in the MG. Spinal excitability was similar for all contraction intensities in both muscles. Meanwhile a divergence of the EEG and the EMG signals mean frequency was observed only in the SOL and only between 25 and 50-70% contractions, independently from the contraction type. Collectively, these findings confirm an effect of the contraction intensity on beta-band CMC, although it was only measured in the SOL, between low-level and high-level contraction intensities. Furthermore, the current findings provide new evidence that the observed modulations of beta-band CMC with the contraction intensity does not depend on the contraction type or on spinal excitability variations.

Priming locomotor training with transspinal stimulation in people with spinal cord injury: study protocol of a randomized clinical trial

BACKGROUND

The seemingly simple tasks of standing and walking require continuous integration of complex spinal reflex circuits between descending motor commands and ascending sensory inputs. Spinal cord injury greatly impairs standing and walking ability, but both improve with locomotor training. However, even after multiple locomotor training sessions, abnormal muscle activity and coordination persist. Thus, locomotor training alone cannot fully optimize the neuronal plasticity required to strengthen the synapses connecting the brain, spinal cord, and local circuits and potentiate neuronal activity based on need. Transcutaneous spinal cord (transspinal) stimulation alters motoneuron excitability over multiple segments by bringing motoneurons closer to threshold, a prerequisite for effectively promoting spinal locomotor network neuromodulation and strengthening neural connectivity of the injured human spinal cord. Importantly, whether concurrent treatment with transspinal stimulation and locomotor training maximizes motor recovery after spinal cord injury is unknown.

METHODS

Forty-five individuals with chronic spinal cord injury are receiving 40 sessions of robotic gait training primed with 30 Hz transspinal stimulation at the Thoracic 10 vertebral level. Participants are randomized to receive 30 min of active or sham transspinal stimulation during standing or active transspinal stimulation while supine followed by 30 min of robotic gait training. Over the course of locomotor training, the body weight support, treadmill speed, and leg guidance force are adjusted as needed for each participant based on absence of knee buckling during the stance phase and toe dragging during the swing phase. At baseline and after completion of all therapeutic sessions, neurophysiological recordings registering corticospinal and spinal neural excitability changes along with clinical assessment measures of standing and walking, and autonomic function via questionnaires regarding bowel, bladder, and sexual function are taken.

DISCUSSION

The results of this mechanistic randomized clinical trial will demonstrate that tonic transspinal stimulation strengthens corticomotoneuronal connectivity and dynamic neuromodulation through posture-dependent corticospinal and spinal neuroplasticity. We anticipate that this mechanistic clinical trial will greatly impact clinical practice because, in real-world clinical settings, noninvasive transspinal stimulation can be more easily and widely implemented than invasive epidural stimulation. Additionally, by applying multiple interventions to accelerate motor recovery, we are employing a treatment regimen that reflects a true clinical approach.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04807764 . Registered on March 19, 2021.

Priming locomotor training with transspinal stimulation in people with spinal cord injury: study protocol of a randomized clinical trial

Background

The seemingly simple tasks of standing and walking require continuous integration of complex spinal reflex circuits between descending motor commands and ascending sensory inputs. Spinal cord injury greatly impairs standing and walking ability, but both improve with locomotor training. However, even after multiple locomotor training sessions, abnormal muscle activity and coordination persist. Thus, locomotor training alone cannot fully optimize the neuronal plasticity required to strengthen the synapses connecting the brain, spinal cord, and local circuits and potentiate neuronal activity based on need. Transcutaneous spinal cord (transspinal) stimulation alters motoneuron excitability over multiple segments by bringing motoneurons closer to threshold, a prerequisite for effectively promoting spinal locomotor network neuromodulation and strengthening neural connectivity of the injured human spinal cord. Importantly, whether concurrent treatment with transspinal stimulation and locomotor training maximizes motor recovery after spinal cord injury is unknown.

Methods

Forty-five individuals with chronic spinal cord injury are receiving 40 sessions of robotic gait training primed with 30 Hz transspinal stimulation at the Thoracic 10 vertebral level. Participants are randomized to receive 30-minutes of active or sham transspinal stimulation during standing or active transspinal stimulation while supine followed by 30-minutes of robotic gait training. Over the course of locomotor training, the body weight support, treadmill speed, and leg guidance force are adjusted as needed for each participant based on absence of knee buckling during the stance phase and toe dragging during the swing phase. At baseline and after completion of all therapeutic sessions, neurophysiological recordings registering corticospinal and spinal neural excitability changes along with clinical assessment measures of standing and walking, and autonomic function via questionnaires regarding bowel, bladder and sexual function are taken.

Discussion

The results of this mechanistic randomized clinical trial will demonstrate that tonic transspinal stimulation strengthens corticomotoneuronal connectivity and dynamic neuromodulation through posture-dependent corticospinal and spinal neuroplasticity. We anticipate that this mechanistic clinical trial will greatly impact clinical practice because in real-world clinical settings, noninvasive transspinal stimulation can be more easily and widely implemented than invasive epidural stimulation. Additionally, by applying multiple interventions to accelerate motor recovery, we are employing a treatment regimen that reflects a true clinical approach.

Trial registration

ClinicalTrials.gov: NCT04807764; Registered on March 19, 2021.

Treatment of spasticity

Spasticity is characterized by an enhanced size and reduced threshold for activation of stretch reflexes and is associated with "positive signs" such as clonus and spasms, as well as "negative features" such as paresis and a loss of automatic postural responses. Spasticity develops over time after a lesion and can be associated with reduced speed of movement, cocontraction, abnormal synergies, and pain. Spasticity is caused by a combination of damage to descending tracts, reductions in inhibitory activity within spinal cord circuits, and adaptive changes within motoneurons. Increased tone, hypertonia, can also be caused by changes in passive stiffness due to, for example, increase in connective tissue and reduction in muscle fascicle length. Understanding the cause of hypertonia is important for determining the management strategy as nonneural, passive causes of stiffness will be more amenable to physical rather than pharmacological interventions. The management of spasticity is determined by the views and goals of the patient, family, and carers, which should be integral to the multidisciplinary assessment. An assessment, and treatment, of trigger factors such as infection and skin breakdown should be made especially in people with a recent change in tone. The choice of management strategies for an individual will vary depending on the severity of spasticity, the distribution of spasticity (i.e., whether it affects multiple muscle groups or is more prominent in one or two groups), the type of lesion, and the potential for recovery. Management options include physical therapy, oral agents; focal therapies such as botulinum injections; and peripheral nerve blocks. Intrathecal baclofen can lead to a reduction in required oral antispasticity medications. When spasticity is severe intrathecal phenol may be an option. Surgical interventions, largely used in the pediatric population, include muscle transfers and lengthening and selective dorsal root rhizotomy.

Responses of stance leg muscles induced by support surface translation during gait

This study determined the presence of the muscle responses to the support surface translation in the stance leg during gait and examined the effect of the direction and time point of the translation and that of the cognitive process on the responses. The rectus femoris (RF), biceps femoris (BF), soleus (SOL), and tibialis anterior (TA) muscles in the stance leg were tested. There was no significant effect of cognitive process on the electromyographic (EMG) activity induced by the translation of the support surface. In all muscles except the SOL, the EMG amplitude increased 0–300 ​ms after the support surface translation at the initial stance (IS) or middle stance (MS) of the tested leg. This means that the EMG activity in the leg muscles other than the SOL occurs after the support surface translation at the IS or MS no matter the direction of the translation. The EMG amplitude was not changed after the translation at the late stance, indicating that the translation does not influence the EMG amplitude at the double limb support phase with the tested leg behind the other. In the SOL, the EMG amplitude increased after the backward translation at the IS and after the forward translation at the MS, but decreased after the forward translation at the IS, indicating that the support surface translation-induced change in the EMG amplitude of the SOL is dependent on its direction. The change in the EMG amplitude of the TA and RF induced by the forward translation was greatest when the translation was given at the IS. In the SOL, the decrease in the EMG amplitude after the forward translation and the increase in the amplitude after the backward translation were greatest at the IS. Taken together, the change in the EMG amplitude induced by the support surface translation is greatest when the translation is given at the IS. The increase in the EMG amplitude in the TA and RF after the forward translation was greater than that after the backward translation at the IS, indicating that the EMG activity of the frontal leg muscles after the forward translation is greater when the translation is given at the IS.

Effects of Clenching Strength on Exercise Performance: Verification Using Spinal Function Assessments

BACKGROUND

This study aimed to determine the relationship between exercise performance and spinal function based on clenching strength.

HYPOTHESIS

Low-intensity clenching contributes to joint movement, whereas high-intensity clenching contributes to joint fixation.

STUDY DESIGN

Randomized crossover trial.

LEVEL OF EVIDENCE

Level 3.

METHODS

Two experiments were conducted using 2 groups of 20 healthy adults. The 4 clenching conditions in experiment 1 were 0%, 12.5%, 25%, and 50% of the maximum voluntary contraction (MVC) of the masseter muscle. Experiment 2 consisted of 3 conditions: no-bite condition, moderate effort, and maximum effort (max condition). In experiment 1, spinal function and ankle dorsiflexion tasks were measured for each clenching condition, and the ankle dorsiflexion task was measured in experiment 2. Regarding spinal function, we measured spinal reciprocal inhibition (RI) and excitability of spinal anterior horn cells. For the ankle dorsiflexion task, ankle dorsiflexion MVC was performed for 3 seconds under each clenching condition. The items analyzed were reaction time, peak ankle dorsiflexion torque, and soleus (Sol)/tibialis anterior (TA) electromyography (EMG) ratio.

RESULTS

The results of experiment 1 illustrated that RI was significantly attenuated or eliminated with increasing clenching strength (>25% MVC). Spinal anterior horn cell excitability increased significantly with increasing clenching strength. The peak torque was significantly higher at 50% MVC than that at 0% MVC. In experiment 2, the peak torque was significantly higher under moderate and max conditions than no-bite condition, and the Sol/TA EMG ratio was significantly higher under max condition than that under moderate condition.

CONCLUSION/CLINICAL RELEVANCE

The results illustrated that during high-strength clenching (≥50% MVC), antagonist muscles are activated simultaneously to increase muscle strength. High-strength clenching improved kinetic performance (joint fixation), whereas low-strength clenching (<50% MVC) enhanced exercise performance (joint movement).

Investigation of neural and biomechanical impairments leading to pathological toe and heel gaits using neuromusculoskeletal modelling

KEY POINTS

Pathological toe and heel gaits are commonly present in various conditions such as spinal cord injury, stroke or cerebral palsy. These conditions present various neural and biomechanical impairments and the cause-effect relationships between these impairments and pathological gaits are hard to establish clinically. Based on neuromechanical simulation, this study focuses on the plantarflexor muscles and builds a new reflex circuit controller to model and evaluate the potential effect of both neural and biomechanical impairments on gait. Our results suggest an important contribution of active reflex mechanisms in pathological toe gait. This "what if" based on neuromechanical modelling is thus deemed of great interest to target potential pathological gait causes.

ABSTRACT

This study investigates the pathological toe and heel gaits in human locomotion using neuromusculoskeletal modelling and simulation. In particular, it aims at investigating potential cause-effect relationships between biomechanical or neural impairments and pathological gaits. Toe and heel gaits are commonly present in spinal cord injury, stroke or cerebral palsy. Toe walking is mainly attributed to spasticity and contracture at plantarflexor muscles, whereas heel walking can be attributed to muscle weakness from biomechanical or neural origin. To investigate the effect of these impairments on gait, this study focuses on the soleus and gastrocnemius muscles as they contribute to ankle plantarflexion. We built a reflex circuit model on top of Geyer and Herr's work (2010) with additional pathways affecting the plantarflexor muscles. The SCONE software, which provides optimisation tools for 2D neuromechanical simulation of human locomotion, is used to optimise the corresponding reflex parameters and simulate healthy gait. We then modelled various bilateral plantarflexors biomechanical and neural impairments, and individually introduced them in the healthy model. We characterised the resulting simulated gaits as pathological or not by comparing ankle kinematics and ankle moment with the healthy optimised gait based on metrics used in clinical studies. Our simulations suggest that toe walking can be generated by hyperreflexia, whereas muscle and neural weaknesses induce partially heel gait. Thus, this "what if" approach is deemed of great interest as it allows the investigation of the effect of various impairments on gait and suggests an important contribution of active reflex mechanisms in pathological toe gait. Abstract figure legend Various biomechanical and neural impairments are individually modelled at the level of the plantarflexor muscles in a musculoskeletal model and a complex reflex circuit-based gait controller. For instance, as shown on the left, the plantarflexors spindle reflex gain (KS) is increased to mimic hyperreflexia. The gait controller is then optimised for each of the impaired condition and the resulting gaits are characterised as pathological gait based on ankle kinematics and ankle moment metrics used in clinical studies. Thus, this "what if" approach allows the investigation of the effect of various impairments on gait presented in the table on the right. This article is protected by copyright. All rights reserved.

Soleus H-reflex modulation during a double-legged drop landing task

Muscle spindle afferent feedback is modulated during different phases of locomotor tasks in a way that facilitates task goals. However, only a few studies have studied H-reflex modulation during landing. This study aimed to characterize soleus (SOL) H-reflex modulation during the flight and early landing period of drop landings. Since landing presumably involves a massive increase in spindle afferent firing due to rapid SOL muscle stretching, we hypothesized H-reflex size would decrease near landing reflecting neural modulation to prevent excessive motoneuron excitation. The soleus H-reflex was recorded during drop landings from a 30 cm height in nine healthy adults. Electromyography (SOL, tibialis anterior (TA), medial gastrocnemius, and vastus lateralis), ankle and knee joint motion and ground reaction force were recorded during landings. Tibial nerve stimulation was timed to elicit H-reflexes during the flight and early ground contact period (five 30 ms Bins from 90 ms before to 60 ms after landing). The H-reflexes recorded after landing (0-30 and 30-60 ms) were significantly smaller (21-36% less) than that recorded during the flight periods (90-0 ms before ground contact; P ≤ 0.004). The decrease in H-reflex size not occurring until after ground contact indicates a time-critical modulation of reflex gain during the last 30 ms of flight (i.e., time of tibial nerve stimulation). H-reflex size reduction after ground contact supports a probable neural strategy to prevent excessive reflex-mediated muscle activation and thereby facilitates appropriate musculotendon and joint stiffness.

Contribution of sensory feedback to Soleus muscle activity during voluntary contraction in humans

Sensory feedback contributes to plantar flexor muscle activity during walking, but it is unknown whether this is also the case during non-locomotor movements. Here, we explored the effect of reduction of sensory feedback to ankle plantar flexors during voluntary isometric contractions. 13 adult volunteers were seated with the right leg attached to a foot plate which could be moved in dorsi- or plantarflexion direction by a computer-controlled motor. During static plantar flexion while the plantar flexors were slowly stretched, a sudden plantar flexion caused a decline in Soleus EMG at stretch reflex latency. This decline in EMG remained when transmission from dorsiflexors was blocked. It disappeared following block of transmission from plantar flexors. Imposed plantarflexion failed to produce a similar decline in EMG during static or ramp-and-hold plantar flexion in the absence of slow stretch. Instead, a decline in EMG was observed 15-20 ms later, which disappeared following block of transmission from dorsiflexors. Imposed plantarflexion in the stance phase during walking caused a decline in SOL EMG which in contrast remained following block of transmission from dorsiflexors. These findings imply that the contribution of spinal interneurons to the neural drive to muscles during gait and voluntary movement differs and supports that a locomotion specific spinal network contributes to plantar flexor muscle activity during human walking.

Intra-limb modulations of posterior root-muscle reflexes evoked from the lower-limb muscles during isometric voluntary contractions

Although voluntary muscle contraction modulates spinal reflex excitability of contracted muscles and other muscles located at other segments within a limb (i.e., intra-limb modulation), to what extent corticospinal pathways are involved in intra-limb modulation of spinal reflex circuits remains unknown. The purpose of the present study was to identify differences in the involvement of corticospinal pathways in intra-limb modulation of spinal reflex circuits among lower-limb muscles during voluntary contractions. Ten young males performed isometric plantar-flexion, dorsi-flexion, knee extension, and knee flexion at 10% of each maximal torque. Electromyographic activity was recorded from soleus, tibialis anterior, vastus lateralis, and biceps femoris muscles. Motor evoked potentials and posterior root-muscle reflexes during rest and isometric contractions were elicited from the lower-limb muscles using transcranial magnetic stimulation and transcutaneous spinal cord stimulation, respectively. Motor evoked potential and posterior root-muscle reflex amplitudes of soleus during knee extension were significantly increased compared to rest. The motor evoked potential amplitude of biceps femoris during dorsi-flexion was significantly increased, whereas the posterior root-muscle reflex amplitude of biceps femoris during dorsi-flexion was significantly decreased compared to rest. These results suggest that corticospinal and spinal reflex excitabilities of soleus are facilitated during knee extension, whereas intra-limb modulation of biceps femoris during dorsi-flexion appeared to be inverse between corticospinal and spinal reflex circuits.

Inhibition and Facilitation of the Spinal Locomotor Central Pattern Generator and Reflex Circuits by Somatosensory Feedback From the Lumbar and Perineal Regions After Spinal Cord Injury

Somatosensory feedback from peripheral receptors dynamically interacts with networks located in the spinal cord and brain to control mammalian locomotion. Although somatosensory feedback from the limbs plays a major role in regulating locomotor output, those from other regions, such as lumbar and perineal areas also shape locomotor activity. In mammals with a complete spinal cord injury, inputs from the lumbar region powerfully inhibit hindlimb locomotion, while those from the perineal region facilitate it. Our recent work in cats with a complete spinal cord injury shows that they also have opposite effects on cutaneous reflexes from the foot. Lumbar inputs increase the gain of reflexes while those from the perineal region decrease it. The purpose of this review is to discuss how somatosensory feedback from the lumbar and perineal regions modulate the spinal locomotor central pattern generator and reflex circuits after spinal cord injury and the possible mechanisms involved. We also discuss how spinal cord injury can lead to a loss of functional specificity through the abnormal activation of functions by somatosensory feedback, such as the concurrent activation of locomotion and micturition. Lastly, we discuss the potential functions of somatosensory feedback from the lumbar and perineal regions and their potential for promoting motor recovery after spinal cord injury.

Age-Related Changes in Presynaptic Inhibition During Gait Initiation

Age-related changes in presynaptic inhibition (PSI) have not been observed during gait initiation, which requires anticipatory postural adjustment (APA). As APA is centrally modulated and is impaired in older compared to young adults, here we aimed to study the presynaptic control and co-contraction levels in the ankle muscles during gait initiation in older compared to young adults. Fifteen older (age range 65-80 years) and 15 young adults (age range 19-30 years) performed a gait initiation task on a force platform under 3 conditions: (i) without electrical stimulation; (ii) test Hoffman reflex (H-reflex); and (iii) conditioned H-reflex. H-reflexes were evoked on the soleus muscle when the APA amplitude exceeded 10%-20% of the average baseline mediolateral force. Participants also performed quiet stance as a control task. Results showed that both age groups presented similar PSI levels during quiet stance (p = .941), while in the gait initiation older adults presented higher PSI levels, longer duration, and lower amplitude of APA than young adults (p < .05). Older adults presented higher co-contraction ratio in both tasks than young adults (p < .05). Correlations between the PSI levels and the APA amplitude (r = -0.61, p = .008), and between the PSI levels and the co-contraction ratio during gait initiation (r = -0.64, p = .005) were found for older adults only. APA amplitude explained 49% of the variance of the PSI levels (p = .003). Our findings suggest that older compared to young adults have increased presynaptic control to compensate for the decreased supraspinal modulation on impaired APAs during gait initiation.

Specific modulation of corticomuscular coherence during submaximal voluntary isometric, shortening and lengthening contractions

During voluntary contractions, corticomuscular coherence (CMC) is thought to reflect a mutual interaction between cortical and muscle oscillatory activities, respectively measured by electroencephalography (EEG) and electromyography (EMG). However, it remains unclear whether CMC modulation would depend on the contribution of neural mechanisms acting at the spinal level. To this purpose, modulations of CMC were compared during submaximal isometric, shortening and lengthening contractions of the soleus (SOL) and the medial gastrocnemius (MG) with a concurrent analysis of changes in spinal excitability that may be reduced during lengthening contractions. Submaximal contractions intensity was set at 50% of the maximal SOL EMG activity. CMC was computed in the time-frequency domain between the Cz EEG electrode signal and the unrectified SOL or MG EMG signal. Spinal excitability was quantified through normalized Hoffmann (H) reflex amplitude. The results indicate that beta-band CMC and normalized H-reflex were significantly lower in SOL during lengthening compared with isometric contractions, but were similar in MG for all three muscle contraction types. Collectively, these results highlight an effect of contraction type on beta-band CMC, although it may differ between agonist synergist muscles. These novel findings also provide new evidence that beta-band CMC modulation may involve spinal regulatory mechanisms.

Cutaneous inputs from perineal region facilitate spinal locomotor activity and modulate cutaneous reflexes from the foot in spinal cats

It is well known that mechanically stimulating the perineal region potently facilitates hindlimb locomotion and weight support in mammals with a spinal transection (spinal mammals). However, how perineal stimulation mediates this excitatory effect is poorly understood. We evaluated the effect of mechanically stimulating (vibration or pinch) the perineal region on ipsilateral (9-14 ms onset) and contralateral (14-18 ms onset) short-latency cutaneous reflex responses evoked by electrically stimulating the superficial peroneal or distal tibial nerve in seven adult spinal cats where hindlimb movement was restrained. Cutaneous reflexes were evoked before, during, and after mechanical stimulation of the perineal region. We found that vibration or pinch of the perineal region effectively triggered rhythmic activity, ipsilateral and contralateral to nerve stimulation. When electrically stimulating nerves, adding perineal stimulation modulated rhythmic activity by decreasing cycle and burst durations and by increasing the amplitude of flexors and extensors. Perineal stimulation also disrupted the timing of the ipsilateral rhythm, which had been entrained by nerve stimulation. Mechanically stimulating the perineal region decreased ipsilateral and contralateral short-latency reflex responses evoked by cutaneous inputs, a phenomenon we observed in muscles crossing different joints and located in different limbs. The results suggest that the excitatory effect of perineal stimulation on locomotion and weight support is mediated by increasing the excitability of central pattern-generating circuitry and not by increasing excitatory inputs from cutaneous afferents of the foot. Our results are consistent with a state-dependent modulation of reflexes by spinal interneuronal circuits.

The changes in spinal reciprocal inhibition during motor imagery in lower extremity

Motor imagery (MI) is known to improve motor function through enhancement of motor cortex activity. Spinal reciprocal inhibition (RI) is modulated by motor cortex activity, and, therefore, MI may change RI. The aim of this study was to examine the changes in RI during MI involving the lower extremity. Spinal RI was measured from the tibialis anterior (TA) to the soleus (SOL). Eleven healthy adults participated in experiment 1. All participants performed the following three conditions, and RI was assessed during each condition: (1) resting condition; (2) MI of ankle dorsiflexion condition (MI-DF); and (3) MI of ankle plantarflexion condition (MI-PF). Twelve healthy adults participated in experiment 2. All participants performed the following two conditions, and RI was assessed before and after MI practice for 10 min: (1) resting condition and (2) MI-DF. The interval between the conditioning and test stimulus (inter-stimulus interval; ISI) was set at 0, 1, 2, or 3 ms and 20 ms. In experiment 1, RI during MI-PF was significantly decreased compared with that during resting with both stimulus intervals. RI during MI-DF showed no significant change compared with that during resting with both ISIs. In experiment 2, the difference between the rest condition and the MI-DF condition after the MI task with ISI of 20 ms was significantly higher than before the MI task. Our findings suggest that real-time changes in RI during MI involving the lower extremity may vary depending on the direction of motion and MI practice.

Inter-muscle differences in modulation of motor evoked potentials and posterior root-muscle reflexes evoked from lower-limb muscles during agonist and antagonist muscle contractions

Voluntary contraction facilitates corticospinal and spinal reflex circuit excitabilities of the contracted muscle and inhibits spinal reflex circuit excitability of the antagonist. It has been suggested that modulation of spinal reflex circuit excitability in agonist and antagonist muscles during voluntary contraction differs among lower-limb muscles. However, whether the effects of voluntary contraction on the excitabilities of corticospinal and spinal reflex circuits depend on the tested muscles remains unknown. The purpose of this study was to examine inter-muscle differences in modulation of the corticospinal and spinal reflex circuit excitabilities of multiple lower-limb muscles during voluntary contraction. Eleven young males performed isometric plantar-flexion, dorsi-flexion, knee extension, and flexion at low torque levels. Motor evoked potentials (MEPs) and posterior root-muscle reflexes from seven lower-leg and thigh muscles were evoked by transcranial magnetic stimulation and transcutaneous spinal cord stimulation, respectively, at rest and during weak voluntary contractions. MEP and posterior root-muscle reflex amplitudes of agonists were significantly increased as agonist torque level increased, except for the reflex of the tibialis anterior. MEP amplitudes of antagonists were significantly increased in relation to the agonist torque level, but those of the rectus femoris were slightly depressed during knee flexion. Regarding the posterior root-muscle reflex of the antagonists, the amplitudes of triceps surae and the hamstrings were significantly decreased, but those of the quadriceps femoris were significantly increased as the agonist torque level increased. These results demonstrate that modulation of corticospinal and spinal reflex circuit excitabilities during agonist and antagonist muscle contractions differed among lower-limb muscles.

Toe walking in children with cerebral palsy: a possible functional role for the plantar flexors

Equinus and toe walking are common locomotor disorders in children with cerebral palsy (CP) walking barefoot or with normal shoes. We hypothesized that, regardless of the type of footwear, the plantar flexors do not cause early equinus upon initial foot contact but decelerate ankle dorsiflexion during weight acceptance (WA). This latter action promoted by early flat-foot contact is hypothesized to be functional. Hence, we performed an instrumented gait analysis of 12 children with CP (Gross Motor Function Classification System class: I or II; mean age: 7.2 yr) and 11 age-matched typically developing children. The participants walked either barefoot, with unmodified footwear (4° positive-heel shoes), or with 10° negative-heel shoes (NHSs). In both groups, wearing NHSs was associated with greater ankle dorsiflexion upon initial foot contact, and greater tibialis anterior activity (but no difference in soleus activity) during the swing phase. However, the footwear condition did not influence the direction and amplitude of the first ankle movement during WA and the associated peak negative ankle power. Regardless of the footwear condition, the CP group displayed 1) early flattening of the foot and ample dorsiflexion (decelerated by the plantar flexors) during WA and 2) low tibialis anterior and soleus activities during the second half of the swing phase (contributing to passive equinus upon foot strike). In children with CP, the early action of plantar flexors (which typically decelerate the forward progression of the center of mass) may be a compensatory mechanism that contributes to the WA's role in controlling balance during gait.NEW & NOTEWORTHY Adaptation to walking in negative-heel shoes was similar in typically developing children and children with cerebral palsy: it featured ankle dorsiflexion upon initial contact, even though (in the latter group) the soleus was always spastic in a clinical examination. Hence, in children with cerebral palsy, the early deceleration of ankle dorsiflexion by the plantar flexors (promoted by early flattening of the foot, and regardless of the type of footwear) may have a functional role.

Motor point stimulation primarily activates motor nerve

Electrical stimulation for inducing muscle contraction can be divided into peripheral nerve stimulation (PNS) and motor point stimulation (MPS). Although the neural pathways activated by PNS have been well studied, those by MPS are still unclear. Here we investigated whether MPS activates Ia-sensory nerves and induces antidromic firing of motor nerves. Ten able-bodied males and females participated in this study. We confirmed that soleus MPS did not induce the H-reflex while soleus PNS did. Furthermore, MPS of the tibialis anterior muscle did not induce the reciprocal inhibition of soleus muscle while PNS did. For testing the effect of MPS on motor neuron excitability, we examined the H-reflex modulation by soleus MPS. When the conditioning and test interval was under 100-ms and the conditioning stimulus intensity was above 30-mA, soleus MPS induced the H-reflex inhibition. This suggests that soleus MPS produces antidromic firing that can induce after-hyperpolarization. These results suggest that MPS predominantly activates the motor nerve without depolarizing the Ia-sensory nerve. Since MPS is applicable to larger number of muscles compared to PNS, utilizing MPS can lead to more versatile neuromodulation of the spinal cord.

Sex differences in soleus muscle H-reflex and V-wave excitability

NEW FINDINGS

 What is the central question of this study? How do H-reflex and V-wave excitability compare between men and women engaging in similar levels of physical activity?  What is the main finding and its importance? H-reflex excitability is lower in women than in men because of their greater level of antagonist co-activation during sustained plantar flexion isometric exercise. In addition, supraspinal drive is similar between men and women independently of their differences in H-reflex excitability and antagonist muscle co-activation.

ABSTRACT

We compared H-reflex and V-wave excitability between men and women engaging in similar levels of physical activity. We also explored whether differences in antagonist muscle co-activation between sexes might partially explain sexual dimorphism in the excitability of the H-reflex and V-wave. Fifty-seven young participants were included (29 men: 21.7 ± 2.3 years; 28 women: 22.4 ± 3.3 years). Soleus M- and H-recruitment curves were constructed on a tonic background muscle activation. V-waves were elicited during maximal voluntary contraction (MVC). Besides being stronger than women, men achieved greater H_max /M_max values and presented a steeper slope of the ascending limb of the H-reflex recruitment curve (P < 0.05). The current intensity required to elicit H_max was lower for men (P < 0.05). The co-activation of the tibialis anterior muscle during the sustained plantar flexions was greater in women (ratio between tibialis and soleus normalized EMG: 20.5 vs. 8.3%, P < 0.05). Covariance analysis showed that sexual dimorphism in H-reflex excitability was dissipated when controlling for antagonist co-activation. V-wave normalized amplitude was similar between sexes even after controlling for the effects of H_max /M_max and antagonist co-activation as covariates. Thus, women exhibit lower H-reflex excitability than men and this is dependent on their higher level of antagonist muscle co-activation. While sex differences in antagonist co-activation persist during MVCs, this is not the case for V-wave normalized amplitude. Thus, although the efficacy of the transmission between Ia afferent fibres to α-motoneurons is lower in women because of a greater level of antagonist co-activation, our findings are consistent with similar supraspinal drive between sexes.

Activation of the Supplementary Motor Areas Enhances Spinal Reciprocal Inhibition in Healthy Individuals

The supplementary motor area (SMA) may modulate spinal reciprocal inhibition (RI) because the descending input from the SMA is coupled to interneurons in the spinal cord via the reticulospinal tract. Our study aimed to verify whether the anodal transcranial direct current stimulation (anodal-tDCS) of the SMA enhances RI. Two tDCS conditions were used: the anodal stimulation (anodal-tDCS) and sham stimulation (sham-tDCS) conditions. To measure RI, there were two conditions: one with the test stimulus (alone) and the other with the conditioning-test stimulation intervals (CTIs), including 2 ms and 20 ms. RI was calculated at multiple time points: before the tDCS intervention (Pre); at 5 (Int 5) and 10 min; and immediately after (Post 0); and at 5, 10 (Post 10), 15, and 20 min after the intervention. In anodal-tDCS, the amplitude values of H-reflex were significantly reduced for a CTI of 2 ms at Int 5 to Post 0, and a CTI of 20 ms at Int 5 to Pot 10 compared with Pre. Stimulation of the SMA with anodal-tDCS for 15 min activated inhibitory interneurons in RIs by descending input from the reticulospinal tract via cortico–reticulospinal projections. The results showed that 15 min of anodal-tDCS in the SMA enhanced and sustained RI in healthy individuals.

Understanding hyper-reflexia in acute motor axonal neuropathy (AMAN)

Hyper-reflexia is occasionally seen in acute motor axonal neuropathy (AMAN), but its pathophysiology is unclear. We report a patient with AMAN following Campylobacter jejuni enteritis, who showed generalized hyper-reflexia, bilateral Hoffmann sign and right Babinski sign. MRI and transcranial magnetic stimulation of the motor cortex disclosed no corticospinal tract involvement. An extensive electrophysiological investigation documented α-motoneuron hyperexcitability and dysfunction of the interneuronal inhibitory circuits in the spinal anterior horn. We propose an immune-mediated damage of the spinal inhibitory interneuronal network as possible mechanism inducing hyper-reflexia in AMAN.

Vibration attenuates spasm-like activity in humans with spinal cord injury

KEY POINTS

Cutaneous reflexes were tested to examine the neuronal mechanisms contributing to muscle spasms in humans with chronic spinal cord injury (SCI). Specifically, we tested the effect of Achilles and tibialis anterior tendon vibration on the early and late components of the cutaneous reflex and reciprocal Ia inhibition in the soleus and tibialis anterior muscles in humans with chronic SCI. We found that tendon vibration reduced the amplitude of later but not earlier cutaneous reflex in the antagonist but not in the agonist muscle relative to the location of the vibration. In addition, reciprocal Ia inhibition between antagonist ankle muscles increased with tendon vibration and participants with a larger suppression of the later component of the cutaneous reflex had stronger reciprocal Ia inhibition from the antagonistic muscle. Our study is the first to provide evidence that tendon vibration attenuates late cutaneous spasm-like reflex activity, likely via reciprocal inhibitory mechanisms, and may represent a method, when properly targeted, for controlling spasms in humans with SCI.

ABSTRACT

The neuronal mechanisms contributing to the generation of involuntary muscle contractions (spasms) in humans with spinal cord injury (SCI) remain poorly understood. To address this question, we examined the effect of Achilles and tibialis anterior tendon vibration at 20, 40, 80 and 120 Hz on the amplitude of the long-polysynaptic (LPR, from reflex onset to 500 ms) and long-lasting (LLR, from 500 ms to reflex offset) cutaneous reflex evoked by medial plantar nerve stimulation in the soleus and tibialis anterior, and reciprocal Ia inhibition between these muscles, in 25 individuals with chronic SCI. We found that Achilles tendon vibration at 40 and 80 Hz, but not other frequencies, reduced the amplitude of the LLR in the tibialis anterior, but not the soleus muscle, without affecting the amplitude of the LPR. Vibratory effects were stronger at 80 than 40 Hz. Similar results were found in the soleus muscle when the tibialis anterior tendon was vibrated. Notably, tendon vibration at 80 Hz increased reciprocal Ia inhibition between antagonistic ankle muscles and vibratory-induced increases in reciprocal Ia inhibition were correlated with decreases in the LLR, suggesting that participants with a larger suppression of later cutaneous reflex activity had stronger reciprocal Ia inhibition from the antagonistic muscle. Our study is the first to provide evidence that tendon vibration suppresses late spasm-like activity in antagonist but not agonist muscles, likely via reciprocal inhibitory mechanisms, in humans with chronic SCI. We argue that targeted vibration of antagonistic tendons might help to control spasms after SCI.

The Functional Role of Spinal Interneurons Following Traumatic Spinal Cord Injury

Traumatic spinal cord injury (SCI) impedes signal transmission by disrupting both the local neurons and their surrounding synaptic connections. Although the majority of SCI patients retain spared neural tissue at the injury site, they predominantly suffer from complete autonomic and sensorimotor dysfunction. While there have been significant advances in the characterization of the spared neural tissue following SCI, the functional role of injury-induced interneuronal plasticity remains elusive. In healthy individuals, spinal interneurons are responsible for relaying signals to coordinate both sympathetic and parasympathetic functions. However, the spontaneous synaptic loss following injury alters these intricate interneuronal networks in the spinal cord. Here, we propose the synaptopathy hypothesis of SCI based on recent findings regarding the maladaptive role of synaptic changes amongst the interneurons. These maladaptive consequences include circuit inactivation, neuropathic pain, spasticity, and autonomic dysreflexia. Recent preclinical advances have uncovered the therapeutic potential of spinal interneurons in activating the dormant relay circuits to restore sensorimotor function. This review will survey the diverse role of spinal interneurons in SCI pathogenesis as well as treatment strategies to target spinal interneurons.

Loss of presynaptic inhibition for step initiation in parkinsonian individuals with freezing of gait

KEY POINTS

Individuals with freezing of gait (FoG) due to Parkinson's disease (PD) have small and long anticipatory postural adjustments (APAs) associated with delayed step initiation. Individuals with FoG ('freezers') may require functional reorganization of spinal mechanisms to perform APAs due to supraspinal dysfunction. As presynaptic inhibition (PSI) is centrally modulated to allow execution of supraspinal motor commands, it may be deficient in freezers during APAs. We show that freezers presented PSI in quiet stance (control task), but they presented loss of PSI (i.e. higher ratio of the conditioned H-reflex relative to the test H-reflex) during APAs before step initiation (functional task), whereas non-freezers and healthy control individuals presented PSI in both the tasks. The loss of PSI in freezers was associated with both small APA amplitudes and FoG severity. We hypothesize that loss of PSI during APAs for step initiation in freezers may be due to FoG.

ABSTRACT

Freezing of gait (FoG) in Parkinson's disease involves deficient anticipatory postural adjustments (APAs), resulting in a cessation of step initiation due to supraspinal dysfunction. Individuals with FoG ('freezers') may require functional reorganization of spinal mechanisms to perform APAs. As presynaptic inhibition (PSI) is centrally modulated to allow execution of supraspinal motor commands, here we hypothesized a loss of PSI in freezers during APA for step initiation, which would be associated with FoG severity. Seventy individuals [27 freezers, 22 non-freezers, and 21 age-matched healthy controls (HC)] performed a 'GO'-commanded step initiation task on a force platform under three conditions: (1) without electrical stimulation, (2) test Hoffman reflex (H-reflex) and (3) conditioned H-reflex. They also performed a control task (quiet stance). In the step initiation task, the H-reflexes were evoked on the soleus muscle when the amplitude of the APA exceeded 10-20% of the mean baseline mediolateral force. PSI was quantified by the ratio of the conditioned H-reflex relative to the test H-reflex in both the tasks. Objective assessment of FoG severity (FoG-ratio) was performed. Freezers presented lower PSI levels during quiet stance than non-freezers and HC (P < 0.05). During step initiation, freezers presented loss of PSI and lower APA amplitudes than non-freezers and HC (P < 0.05). Significant correlations were only found for freezers between loss of PSI and FoG-ratio (r = 0.59, P = 0.0005) and loss of PSI and APA amplitude (r = -0.35, P < 0.036). Our findings suggest that loss of PSI for step initiation in freezers may be due to FoG.

Presynaptic inhibition in restless legs syndrome

Introduction: Restless legs syndrome (RLS) is a condition that particularly urges at night in resting and causes the need to move the legs. Although the pathophysiology has not yet been clarified, dopamine and iron metabolism and spinal cord pathologies are blamed for causing the condition. There are few studies on spinal reflex mechanisms on RLS. In the present study, we aimed to investigate the role of presynaptic inhibition (PreI) in the spinal cord in RLS.Methods: Fourteen patients with RLS and 14 controls with similar demographic characteristics were included in the study. Soleus muscle H-reflex (Ht) investigation was performed for subjects whose electrophysiologic investigation was normal. The Ht response was conditioned to the stimulation of the common peroneal nerve (CPN) (Hc). The test and conditioned stimulation intervals were kept between 10 ms, 20 ms, 30 ms, 40 ms, 50 ms, 75 ms, 100 ms, 150 ms and 200 ms. In each inter-stimulus interval, nonparametric repeat measurement evaluations were conducted with the percentage value of Hc/Ht. The Hc/Ht values of the study and control groups in the same intervals were compared separately.Results: A significant decrease was detected in Hc values in the control group in the repeat measurement values at 20 ms and 100 ms inter-stimulus intervals; however, there was not decrease in any intervals in the patient's group.Conclusion: The absence of any decrease in Hc reflexes for 20-100 ms intervals revealed that discernible PreI was vanished in RLS patients.

Mechanically stimulating the lumbar region inhibits locomotor-like activity and increases the gain of cutaneous reflexes from the paws in spinal cats

Mechanically stimulating the dorsal lumbar region inhibits locomotion and reduces weight support during standing in rabbits and cats. However, how this inhibitory effect from the lumbar skin is mediated is poorly understood. Here we evaluated the effect of mechanically stimulating (vibration or pinch) the dorsal lumbar region on short-latency (8- to 13-ms onset) cutaneous reflex responses, evoked by electrically stimulating the superficial peroneal or distal tibial nerves, in seven adult cats with a low thoracic spinal transection (spinal cats). Cutaneous reflexes were evoked before, during, and after mechanical stimulation of the dorsal lumbar region. We found that mechanically stimulating the lumbar region by vibration or manual pinch abolished alternating bursts of activity between flexors and extensors initiated by nerve stimulation. The activity of extensor muscles was abolished bilaterally, whereas the activity of some ipsilateral flexor muscles was sustained during vibration/pinch. Mechanically stimulating the lumbar region increased ipsilateral and contralateral short-latency excitatory responses evoked by cutaneous inputs, a phenomenon that was generalized to muscles crossing different joints and located in different limbs. Our results indicate that the inhibitory effect on locomotion and weight support is not mediated by reducing cutaneous reflex gain and instead points to an inhibition of central pattern-generating circuitry, particularly the extensor component. The results provide greater insight into interactions between different types of somatosensory inputs within spinal motor circuits.NEW & NOTEWORTHY Vibration or pinch of the lumbar region in spinal-transected cats abolished alternating bursts of activity between flexors and extensors initiated by nerve stimulation. Mechanically stimulating the lumbar region increased ipsilateral and contralateral short-latency excitatory responses evoked by cutaneous inputs in hindlimb muscles. Sensory inputs from mechanoreceptors of the lumbar region do not mediate their inhibitory effect on locomotion and weight support by reducing the gain of short-latency excitatory cutaneous reflexes from the foot.

Effect of Ankle Angles on the Soleus H-Reflex Excitability During Standing

This study investigated effects of ankle joint angle on the Hoffman's reflex (H-reflex) excitability during loaded (weight borne with both legs) and unloaded (full body weight borne with the contralateral leg) standing in people without neurological injuries. Soleus H-reflex/M-wave recruitment curves were examined during upright standing on three different slopes that imposed plantar flexion (-15°), dorsiflexion (+15°), and neutral (0°) angles at the ankle, with the test leg loaded and unloaded. With the leg loaded and unloaded, maximum H-reflex/maximum M-wave ratio of -15° was significantly larger than those of 0° and +15° conditions. The maximum H-reflex/maximum M-wave ratios were 51%, 43%, and 41% with loaded and 56%, 46%, and 44% with unloaded for -15°, 0°, and +15° slope conditions, respectively. Thus, limb loading/unloading had limited impact on the extent of influence that ankle angles exert on the H-reflex excitability. This suggests that task-dependent central nervous system control of reflex excitability may regulate the influence of sensory input on the spinal reflex during standing.

Robot controlled, continuous passive movement of the ankle reduces spinal cord excitability in participants with spasticity: a pilot study

Spasticity of the ankle reduces quality of life by impeding walking and other activities of daily living. Robot-driven continuous passive movement (CPM) is a strategy for lower limb spasticity management but effects on spasticity, walking ability and spinal cord excitability (SCE) are unknown. The objectives of this experiment were to evaluate (1) acute changes in SCE induced by 30 min of CPM at the ankle joint, in individuals without neurological impairment and those with lower limb spasticity; and, (2) the effects of 6 weeks of CPM training on SCE, spasticity and walking ability in those with lower limb spasticity. SCE was assessed using soleus Hoffmann (H-) reflexes, collected prior to and immediately after CPM for acute assessments, whereas a multiple baseline repeated measures design assessed changes following 18 CPM sessions. Spasticity and walking ability were assessed using the Modified Ashworth Scale, the 10 m Walk test, and the Timed Up and Go test. Twenty-one neurologically intact and nine participants with spasticity (various neurological conditions) were recruited. In the neurologically intact group, CPM caused bi-directional modulation of H-reflexes creating 'facilitation' and 'suppression' groups. In contrast, amongst participants with spasticity, acute CPM facilitated H-reflexes. After CPM training, H-reflex excitability on both the more-affected and less-affected sides was reduced; on the more affected side H@Thres, H@50 and H@100 all significantly decreased following CPM training by 96.5 ± 7.7%, 90.9 ± 9.2%, and 62.9 ± 21.1%, respectively. After training there were modest improvements in walking and clinical measures of spasticity for some participants. We conclude that CPM of the ankle can significantly alter SCE. The use of CPM in those with spasticity can provide a temporary period of improved walking, but efficacy of treatment remains unknown.

Agonist-Antagonist Coactivation Enhances Corticomotor Excitability of Ankle Muscles

Spinal pathways underlying reciprocal flexion-extension contractions have been well characterized, but the extent to which cortically evoked motor-evoked potentials (MEPs) are influenced by antagonist muscle activation remains unclear. A majority of studies using transcranial magnetic stimulation- (TMS-) evoked MEPs to evaluate the excitability of the corticospinal pathway focus on upper extremity muscles. Due to functional and neural control differences between lower and upper limb muscles, there is a need to evaluate methodological factors influencing TMS-evoked MEPs specifically in lower limb musculature. If and to what extent the activation of the nontargeted muscles, such as antagonists, affects TMS-evoked MEPs is poorly understood, and such gaps in our knowledge may limit the rigor and reproducibility of TMS studies. Here, we evaluated the effect of the activation state of the antagonist muscle on TMS-evoked MEPs obtained from the target (agonist) ankle muscle for both tibialis anterior (TA) and soleus muscles. Fourteen able-bodied participants (11 females, age: 26.1 ± 4.1 years) completed one experimental session; data from 12 individuals were included in the analysis. TMS was delivered during 4 conditions: rest, TA activated, soleus activated, and TA and soleus coactivation. Three pairwise comparisons were made for MEP amplitude and coefficient of variability (CV): rest versus coactivation, rest versus antagonist activation, and agonist activation versus coactivation. We demonstrated that agonist-antagonist coactivation enhanced MEP amplitude and reduced MEP CVs for both TA and soleus muscles. Our results provide methodological considerations for future TMS studies and pave the way for future exploration of coactivation-dependent modulation of corticomotor excitability in pathological cohorts such as stroke or spinal cord injury.

Effects of Reciprocal Ia Inhibition on Contraction Intensity of Co-contraction

Introduction: Excessive co-contraction interferes with smooth joint movement. One mechanism is the failure of reciprocal inhibition against antagonists during joint movement. Reciprocal inhibition has been investigated using joint torque as an index of intensity during co-contraction. However, contraction intensity as an index of co-contraction intensity has not been investigated. In this study, we aimed to evaluate the influence of changes in contraction intensity during co-contraction on reciprocal inhibition.

Methods: We established eight stimulus conditions in 20 healthy adult males to investigate the influence of changes in contraction intensity during co-contraction on reciprocal inhibition. These stimulus conditions comprised a conditioning stimulus-test stimulation interval (C–T interval) of -2, 0, 1, 2, 3, 4, or 5 ms plus a test stimulus without a conditioning stimulus (single). Co-contraction of the tibialis anterior and soleus muscles at the same as contraction intensity was examined at rest and at 5, 15, and 30% maximal voluntary contraction (MVC).

Results: At 5 and 15% MVC in the co-contraction task, the H-reflex amplitude was significantly decreased compared with single stimulation at a 2-ms C–T interval. At 30% MVC, there was no significant difference compared with single stimulation at a 2-ms C–T interval. At a 5-ms C–T interval, the H-reflex amplitude at 30% MVC was significantly reduced compared with that at rest.

Discussion: The findings indicated that during co-contraction, reciprocal Ia inhibition worked at 5 and 15% MVC. Contrary inhibition of reciprocal Ia inhibition did not apparently work at 30% MVC, and presynaptic inhibition (D1 inhibition) might work.