Crossed reflex reversal during human locomotion

Gait phenotype in Batten disease: A marker of disease progression

BACKGROUND

Gait impairment and its etiologic correlate has not previously been subject of special attention in Batten disease.

METHODS

In the present review, the clinical picture of gait phenotype during Batten disease course accompanied by descriptions of the known concomitant patho-anatomical changes is presented.

RESULTS

In CLN1 a non-rhythmic gait is seen around 1-1½ years of age. Shortly after, postural hypotonia and exaggerated tendon reflexes develop. The disease reaches a burnt-out stage during the third year of age and subsequently the children are almost without voluntary movements. The existing literature indicates that gait phenotype in CLN1 is caused by early involvement of the spinal interneurons followed by impact of the cortex and the cortico-spinal tracts. The earliest walking abnormality in children with CLN2 is a clumsy, ataxic, and spastic gait, which is in accordance with the existing imaging and histologic studies showing early involvement of the cerebellum and the cortico-spinal pathways. In CLN3, a reduction in walking speed is present at the age of 7-8 years. It occurs simultaneously with a reduction in the white matter microstructure and brain connectivity networks. Functional impairment of the basal ganglia contributing to a parkinsonian gait phenotype occurs in the mid-teens. In the late teens and early twenties involvement of the peripheral nerves, neurogenic musculoskeletal atrophy, loss of tendon reflexes and postural control are seen.

CONCLUSION

The progressively impaired gait function in Batten disease is related to timing of damage of distinct areas of the nervous system depending on subtype and is a powerful marker of disease progression.

Relative Contribution of Proprioceptive and Vestibular Sensory Systems to Locomotion: Opportunities for Discovery in the Age of Molecular Science

Locomotion is a fundamental animal behavior required for survival and has been the subject of neuroscience research for centuries. In terrestrial mammals, the rhythmic and coordinated leg movements during locomotion are controlled by a combination of interconnected neurons in the spinal cord, referred as to the central pattern generator, and sensory feedback from the segmental somatosensory system and supraspinal centers such as the vestibular system. How segmental somatosensory and the vestibular systems work in parallel to enable terrestrial mammals to locomote in a natural environment is still relatively obscure. In this review, we first briefly describe what is known about how the two sensory systems control locomotion and use this information to formulate a hypothesis that the weight of the role of segmental feedback is less important at slower speeds but increases at higher speeds, whereas the weight of the role of vestibular system has the opposite relation. The new avenues presented by the latest developments in molecular sciences using the mouse as the model system allow the direct testing of the hypothesis.

Spinal Circuits Mediate a Stretch Reflex Between the Upper Limbs in Humans

Inter-limb reflexes play an important role in coordinating behaviors involving different limbs. Previous studies have demonstrated that human elbow muscles express an inter-limb stretch reflex at long-latency (50-100 ms), a timing consistent with a trans-cortical linkage. Here we probe for inter-limb stretch reflexes in the shoulder muscles of human participants. Unexpected torque pulses displaced one or both shoulders while participants adopted a steady posture against background torques. The results demonstrated inter-limb stretch reflexes occurring at short-latency for both shoulder extensors and flexors; the rapid timing (36-50 ms) must involve a spinal linkage for the two arms. Inter-limb stretch reflexes were also observed at long-latency yet they were opposite to the preceding short-latency; when the short-latency stretch reflex was excitatory then the long-latency stretch reflex was inhibitory and vice versa. Comparing the responses to contralateral arm displacement to those during simultaneous displacement of both arms revealed that inhibitory inter-limb stretch reflexes are independent of within-limb stretch reflexes, but that excitatory inter-limb stretch reflexes are suppressed by within-limb stretch reflexes. Our results provide the first demonstration of short-latency inter-limb stretch reflexes in the upper limb of humans and reveal interacting spinal circuits for within-limb and inter-limb stretch reflexes.

Rapid crossed responses in an intrinsic hand muscle during perturbed bimanual movements

Mechanical perturbations in one upper limb often elicit corrective responses in both the perturbed as well as its contralateral and unperturbed counterpart. These crossed corrective responses have been shown to be sensitive to the bimanual requirements of the perturbation, but crossed responses (CRs) in hand muscles are far less well studied. Here, we investigate corrective CRs in an intrinsic hand muscle, the first dorsal interosseous (1DI), to clockwise and anticlockwise mechanical perturbations to the contralateral index finger while participants performed a bimanual finger abduction task. We found that the CRs in the unperturbed 1DI were sensitive to the direction of the perturbation of the contralateral index finger. However, the size of the CRs was not sensitive to the amplitude of the contralateral perturbation nor its context within the bimanual task. The onset latency of the CRs was too fast to be purely transcortical (<70 ms) in 12/12 participants. This confirms that during isolated bimanual finger movements, sensory feedback from one hand can influence the other, but the pathways mediating the earliest components of this interaction are likely to involve subcortical systems such as the brainstem or spinal cord, which may afford less flexibility to the task demands.NEW & NOTEWORTHY An intrinsic hand muscle shows a crossed response to a perturbation of the contralateral index finger. The crossed response is dependent on the direction of the contralateral perturbation but not on the amplitude or the bimanual requirements of the movement, suggesting a far less flexible control policy than those governing crossed responses in more proximal muscles. The crossed response is too fast to be purely mediated by transcortical pathways, suggesting subcortical contributions.

The mammalian spinal commissural system: properties and functions

Commissural systems are essential components of motor circuits that coordinate left-right activity of the skeletomuscular system. Commissural systems are found at many levels of the neuraxis including the cortex, brainstem, and spinal cord. In this review we will discuss aspects of the mammalian spinal commissural system. We will focus on commissural interneurons, which project from one side of the cord to the other and form axonal terminations that are confined to the cord itself. Commissural interneurons form heterogeneous populations and influence a variety of spinal circuits. They can be defined according to a variety of criteria including, location in the spinal gray matter, axonal projections and targets, neurotransmitter phenotype, activation properties, and embryological origin. At present, we do not have a comprehensive classification of these cells, but it is clear that cells located within different areas of the gray matter have characteristic properties and make particular contributions to motor circuits. The contribution of commissural interneurons to locomotor function and posture is well established and briefly discussed. However, their role in other goal-orientated behaviors such as grasping, reaching, and bimanual tasks is less clear. This is partly because we only have limited information about the organization and functional properties of commissural interneurons in the cervical spinal cord of primates, including humans. In this review we shall discuss these various issues. First, we will consider the properties of commissural interneurons and subsequently examine what is known about their functions. We then discuss how they may contribute to restoration of function following spinal injury and stroke.

Robotic investigation on effect of stretch reflex and crossed inhibitory response on bipedal hopping

To maintain balance during dynamic locomotion, the effects of proprioceptive sensory feedback control (e.g. reflexive control) should not be ignored because of its simple sensation and fast reaction time. Scientists have identified the pathways of reflexes; however, it is difficult to investigate their effects during locomotion because locomotion is controlled by a complex neural system and current technology does not allow us to change the control pathways in living humans. To understand these effects, we construct a musculoskeletal bipedal robot, which has similar body structure and dynamics to those of a human. By conducting experiments on this robot, we investigate the effects of reflexes (stretch reflex and crossed inhibitory response) on posture during hopping, a simple and representative bouncing gait with complex dynamics. Through over 300 hopping trials, we confirm that both the stretch reflex and crossed response can contribute to reducing the lateral inclination during hopping. These reflexive pathways do not use any prior knowledge of the dynamic information of the body such as its inclination. Beyond improving the understanding of the human neural system, this study provides roboticists with biomimetic ideas for robot locomotion control.

Excitatory and inhibitory crossed reflex pathways in mice

Sensory information from one leg has been known to elicit reflex responses in the contralateral leg, known as "crossed reflexes," and these have been investigated extensively in cats and humans. Furthermore, experiments with mice have shown commissural pathways in detail by using in vitro and in vivo physiological approaches combined with genetics. However, the relationship between these commissural pathways discovered in mice and crossed reflex pathways described in cats and humans is not known. In this study, we analyzed the crossed reflex in mice by using in vivo electromyographic recording techniques combined with peripheral nerve stimulation protocols to provide a detailed description of the crossed reflex pathways. We show that excitatory crossed reflexes are mediated by both proprioceptive and cutaneous afferent activation. In addition, we provide evidence for a short-latency inhibitory crossed reflex pathway likely mediated by cutaneous feedback. Furthermore, the short-latency crossed inhibition is downregulated in the knee extensor muscle and the ankle flexor muscle during locomotion. In conclusion, this article provides an analysis of excitatory and inhibitory crossed reflex pathways during resting and locomoting mice in vivo. The data presented in this article pave the way for future research aimed at understanding crossed reflexes using genetics in mice. NEW & NOTEWORTHY We describe for the first time excitatory and inhibitory crossed reflex pathways in mouse spinal cord in vivo and show that the inhibitory pathways are modulated during walking. This is a first step toward an understanding of crossed reflexes and their function during walking using in vivo recording techniques combined with mouse genetics.

Delayed muscle onset soreness in the gastrocnemius muscle attenuates the spinal contribution to interlimb communication

PURPOSE

Delayed onset muscle soreness (DOMS) has been shown to induce changes in muscle activity during walking. The aim of this study was to elucidate whether DOMS also affects interlimb communication during walking by investigating its effect on short-latency crossed responses (SLCRs).

METHODS

SLCRs were elicited in two recording sessions by electrically stimulating the tibial nerve of the ipsilateral leg, and quantified in the contralateral gastrocnemius muscle. The second recording session occurred 24-36 h after the participants (n = 11) performed eccentric exercises with the ipsilateral calf.

RESULTS

DOMS caused a decreased magnitude of the spinally mediated component of the SLCR in the contralateral gastrocnemius medialis.

CONCLUSIONS

The results of the current study provide insight on the relationship between pain and motor control. Muscle pain affects the spinal pathway mediating interlimb communication, which might result in a reduced ability to maintain dynamical stability during walking.

Force dynamics and synergist muscle activation in stick insects: the effects of using joint torques as mechanical stimuli

Many sensory systems are tuned to specific parameters of behaviors and have effects that are task-specific. We have studied how force feedback contributes to activation of synergist muscles in serially homologous legs of stick insects. Forces were applied using conventional half-sine or ramp and hold functions. We also utilized waveforms of joint torques calculated from experiments in freely walking animals. In all legs, forces applied to either the tarsus (foot) or proximal leg segment (trochanter) activated synergist muscles that generate substrate grip and support, but coupling of the depressor muscle to tarsal forces was weak in the front legs. Activation of trochanteral receptors using ramp and hold functions generated positive feedback to the depressor muscle in all legs when animals were induced to seek substrate grip. However, discharges of the synergist flexor muscle showed adaptation at moderate force levels. In contrast, application of forces using torque waveforms, which do not have a static hold phase, produced sustained discharges in muscle synergies with little adaptation. Firing frequencies reflected the magnitude of ground reaction forces, were graded to changes in force amplitude, and could also be modulated by transient force perturbations added to the waveforms. Comparison of synergist activation by torques and ramp and hold functions revealed a strong influence of force dynamics (dF/d t). These studies support the idea that force receptors can act to tune muscle synergies synchronously to the range of force magnitudes and dynamics that occur in each leg according to their specific use in behavior. NEW & NOTEWORTHY The effects of force receptors (campaniform sensilla) on leg muscles and synergies were characterized in stick insects using both ramp and hold functions and waveforms of joint torques calculated by inverse dynamics. Motor responses were sustained and showed reduced adaptation to the more "natural" and nonlinear torque stimuli. Calculation of the first derivative (dF/d t) of the torque waveforms demonstrated that this difference was correlated with the dynamic sensitivities of the system.

Evidence for a Supraspinal Contribution to the Human Crossed Reflex Response During Human Walking

In humans, an ipsilateral tibial nerve (iTN) stimulation elicits short-latency-crossed-responses (SLCR) comprised of two bursts in the contralateral gastrocnemius lateralis (cGL) muscle. The average onset latency has been reported to be 57-69 ms with a duration of 30.4 ± 6.6 ms. The aim of this study was to elucidate if a transcortical pathway contributes to the SLCR. In Experiment 1 (n = 9), single pulse supra-threshold transcranial magnetic stimulation (supraTMS) was applied alone or in combination with iTN stimulation (85% of the maximum M-wave) while participants walked on a treadmill (delay between the SLCR and the motor evoked potentials (MEP) varied between -30 and 200 ms). In Experiment 2 (n = 6), single pulse sub-threshold TMS (subTMS) was performed and the interstimulus interval (ISI) varied between 0-30 ms. In Experiment 3, somatosensory evoked potentials (SEPs) were recorded during the iTN stimulation to quantify the latency of the resulting afferent volley at the cortical level. SLCRs and MEPs in cGL occurred at 63 ± 6 ms and 29 ± 2 ms, respectively. The mean SEP latency was 30 ± 3 ms. Thus, a transcortical pathway could contribute no earlier than 62-69 ms (SEP+MEP+central-processing-delay) after iTN stimulation. Combined iTN stimulation and supraTMS resulted in a significant MEP extra-facilitation when supraTMS was timed so that the MEP would coincide with the late component of the SLCR, while subTMS significantly depressed this component. This is the first study that demonstrates the existence of a strong cortical control on spinal pathways mediating the SLCR. This likely serves to enhance flexibility, ensuring that the appropriate output is produced in accord with the functional demand.

Spinal Control of Locomotion: Individual Neurons, Their Circuits and Functions

Systematic research on the physiological and anatomical characteristics of spinal cord interneurons along with their functional output has evolved for more than one century. Despite significant progress in our understanding of these networks and their role in generating and modulating movement, it has remained a challenge to elucidate the properties of the locomotor rhythm across species. Neurophysiological experimental evidence indicates similarities in the function of interneurons mediating afferent information regarding muscle stretch and loading, being affected by motor axon collaterals and those mediating presynaptic inhibition in animals and humans when their function is assessed at rest. However, significantly different muscle activation profiles are observed during locomotion across species. This difference may potentially be driven by a modified distribution of muscle afferents at multiple segmental levels in humans, resulting in an altered interaction between different classes of spinal interneurons. Further, different classes of spinal interneurons are likely activated or silent to some extent simultaneously in all species. Regardless of these limitations, continuous efforts on the function of spinal interneuronal circuits during mammalian locomotion will assist in delineating the neural mechanisms underlying locomotor control, and help develop novel targeted rehabilitation strategies in cases of impaired bipedal gait in humans. These rehabilitation strategies will include activity-based therapies and targeted neuromodulation of spinal interneuronal circuits via repetitive stimulation delivered to the brain and/or spinal cord.

Sensory Feedback in Interlimb Coordination: Contralateral Afferent Contribution to the Short-Latency Crossed Response during Human Walking

A constant coordination between the left and right leg is required to maintain stability during human locomotion, especially in a variable environment. The neural mechanisms underlying this interlimb coordination are not yet known. In animals, interneurons located within the spinal cord allow direct communication between the two sides without the need for the involvement of higher centers. These may also exist in humans since sensory feedback elicited by tibial nerve stimulation on one side (ipsilateral) can affect the muscles activation in the opposite side (contralateral), provoking short-latency crossed responses (SLCRs). The current study investigated whether contralateral afferent feedback contributes to the mechanism controlling the SLCR in human gastrocnemius muscle. Surface electromyogram, kinematic and kinetic data were recorded from subjects during normal walking and hybrid walking (with the legs moving in opposite directions). An inverse dynamics model was applied to estimate the gastrocnemius muscle proprioceptors’ firing rate. During normal walking, a significant correlation was observed between the magnitude of SLCRs and the estimated muscle spindle secondary afferent activity (P = 0.04). Moreover, estimated spindle secondary afferent and Golgi tendon organ activity were significantly different (P ≤ 0.01) when opposite responses have been observed, that is during normal (facilitation) and hybrid walking (inhibition) conditions. Contralateral sensory feedback, specifically spindle secondary afferents, likely plays a significant role in generating the SLCR. This observation has important implications for our understanding of what future research should be focusing on to optimize locomotor recovery in patient populations.

Supraspinal control of spinal reflex responses to body bending during different behaviours in lampreys

KEY POINTS

Spinal reflexes are substantial components of the motor control system in all vertebrates and centrally driven reflex modifications are essential to many behaviours, but little is known about the neuronal mechanisms underlying these modifications. To study this issue, we took advantage of an in vitro brainstem-spinal cord preparation of the lamprey (a lower vertebrate), in which spinal reflex responses to spinal cord bending (caused by signals from spinal stretch receptor neurons) can be evoked during different types of fictive behaviour. Our results demonstrate that reflexes observed during fast forward swimming are reversed during escape behaviours, with the reflex reversal presumably caused by supraspinal commands transmitted by a population of reticulospinal neurons. NMDA receptors are involved in the formation of these commands, which are addressed primarily to the ipsilateral spinal networks. In the present study the neuronal mechanisms underlying reflex reversal have been characterized for the first time.

ABSTRACT

Spinal reflexes can be modified during different motor behaviours. However, our knowledge about the neuronal mechanisms underlying these modifications in vertebrates is scarce. In the lamprey, a lower vertebrate, body bending causes activation of intraspinal stretch receptor neurons (SRNs) resulting in spinal reflexes: activation of motoneurons (MNs) with bending towards either the contralateral or ipsilateral side (a convex or concave response, respectively). The present study had two main aims: (i) to investigate how these spinal reflexes are modified during different motor behaviours, and (ii) to reveal reticulospinal neurons (RSNs) transmitting commands for the reflex modification. For this purpose in in vitro brainstem-spinal cord preparation, RSNs and reflex responses to bending were recorded during different fictive behaviours evoked by supraspinal commands. We found that during fast forward swimming MNs exhibited convex responses. By contrast, during escape behaviours, MNs exhibited concave responses. We found RSNs that were activated during both stimulation causing reflex reversal without initiation of any specific behaviour, and stimulation causing reflex reversal during escape behaviour. We suggest that these RSNs transmit commands for the reflex modification. Application of the NMDA antagonist (AP-5) to the brainstem significantly decreased the reversed reflex, suggesting involvement of NMDA receptors in the formation of these commands. Longitudinal split of the spinal cord did not abolish the reflex reversal caused by supraspinal commands, suggesting an important role for ipsilateral networks in determining this type of motor response. This is the first study to reveal the neuronal mechanisms underlying supraspinal control of reflex reversal.

Short-latency crossed responses in the human biceps femoris muscle

KEY POINTS

The present study is the first to show short-latency crossed-spinal reflexes in the human upper leg muscles following mechanical rotations to the ipsilateral knee (iKnee) joint. The short-latency reflex in the contralateral biceps femoris (cBF) was inhibitory following iKnee extension perturbations, and facilitatory following iKnee flexion perturbations. The onset latency was 44 ms, indicating that purely spinal pathways mediate the cBF reflexes. The short-latency cBF inhibitory and facilitatory reflexes followed the automatic gain control principle, becoming larger as the level of background contraction in the cBF increased. The short-latency cBF reflexes were observed at the motor unit level using i.m. electromyography recordings, and the same population of cBF motor units that was inhibited following iKnee extensions was facilitated following iKnee flexions. Parallel interneuronal pathways from ipsilateral afferents to common motoneurons in the contralateral leg can therefore probably explain the perturbation direction-dependent reversal in the sign of the short-latency cBF reflex.

ABSTRACT

Interlimb reflexes contribute to the central neural co-ordination between different limbs in both humans and animals. Although commissural interneurons have only been directly identified in animals, spinally-mediated interlimb reflexes have been discovered in a number of human lower limb muscles, indicating their existence in humans. The present study aimed to investigate whether short-latency crossed-spinal reflexes are present in the contralateral biceps femoris (cBF) muscle following ipsilateral knee (iKnee) joint rotations during a sitting task, where participants maintained a slight pre-contraction in the cBF. Following iKnee extension joint rotations, an inhibitory reflex was observed in the surface electromyographic (EMG) activity of the cBF, whereas a facilitatory reflex was observed in the cBF following iKnee flexion joint rotations. The onset latency of both cBF reflexes was 44 ms, which is too fast for a transcortical pathway to contribute. The cBF inhibitory and facilitatory reflexes followed the automatic gain control principle, with the size of the response increasing as the level of background pre-contraction in the cBF muscle increased. In addition to the surface EMG, both short-latency inhibitory and facilitatory cBF reflexes were recorded directly at the motor unit level by i.m. EMG, and the same population of cBF motor units that were inhibited following iKnee extension joint rotations were facilitated following iKnee flexion joint rotations. Therefore, parallel interneuronal pathways (probably involving commissural interneurons) from ipsilateral afferents to common motoneurons in the contralateral leg can probably explain the perturbation direction-dependent reversal in the sign of the short-latency cBF reflex.

Soleus Hoffmann reflex amplitudes are specifically modulated by cutaneous inputs from the arms and opposite leg during walking but not standing

Electrical stimulation of cutaneous nerves innervating heteronymous limbs (the arms or contralateral leg) modifies the excitability of soleus Hoffmann (H-) reflexes. The differences in the sensitivities of the H-reflex pathway to cutaneous afferents from different limbs and their modulation during the performance of motor tasks (i.e., standing and walking) are not fully understood. In the present study, we investigated changes in soleus H-reflex amplitudes induced by electrical stimulation of peripheral nerves. Selected targets for conditioning stimulation included the superficial peroneal nerve, which innervates the foot dorsum in the contralateral ankle (cSP), and the superficial radial nerve, which innervates the dorsum of the hand in the ipsilateral (iSR) or contralateral wrist (cSR). Stimulation and subsequent reflex assessment took place during the standing and early-stance phase of treadmill walking in ten healthy subjects. Cutaneous stimulation produced long-latency inhibition (conditioning-test interval of ~100 ms) of the H-reflex during the early-stance phase of walking, and the inhibition was stronger following cSP stimulation compared with iSR or cSR stimulation. In contrast, although similar conditioning stimulation significantly facilitated the H-reflex during standing, this effect remained constant irrespective of the different conditioning sites. These findings suggest that cutaneous inputs from the arms and contralateral leg had reversible effects on the H-reflex amplitudes, including inhibitions with different sensitivities during the early-stance phase of walking and facilitation during standing. Furthermore, the differential sensitivities of the H-reflex modulations were expressed only during walking when the locations of the afferent inputs were functionally relevant.

Estimating reflex responses in large populations of motor units by decomposition of the high-density surface electromyogram

KEY POINTS

Reflex responses of single motor units have been used for the study of spinal circuitries but the methods employed are invasive and limited to the assessment of a relatively small number of motor units. We propose a new approach to investigate reflexes on individual motor units based on high-density surface electromyography (HDsEMG) decomposition. The decomposition of HDsEMG has been previously validated in voluntary isometric contractions but never during reflex activities. The use of HDsEMG decomposition for reflex studies at the individual motor unit level, during constant force contractions, with excitatory and inhibitory stimuli, was validated here by the comparison of results with concurrently recorded intramuscular EMG signals. The validation results showed that HDsEMG decomposition allows an accurate quantification of reflex responses for a large number of individual motor units non-invasively, for both excitatory and inhibitory stimuli.

ABSTRACT

We propose and validate a non-invasive method that enables accurate detection of the discharge times of a relatively large number of motor units during excitatory and inhibitory reflex stimulations. High-density surface electromyography (HDsEMG) and intramuscular EMG (iEMG) were recorded from the tibialis anterior muscle during ankle dorsiflexions performed at 5%, 10% and 20% of the maximum voluntary contraction (MVC) force, in nine healthy subjects. The tibial nerve (inhibitory reflex) and the peroneal nerve (excitatory reflex) were stimulated with constant current stimuli. In total, 416 motor units were identified from the automatic decomposition of the HDsEMG. The iEMG was decomposed using a state-of-the-art decomposition tool and provided 84 motor units (average of two recording sites). The reflex responses of the detected motor units were analysed using the peri-stimulus time histogram (PSTH) and the peri-stimulus frequencygram (PSF). The reflex responses of the common motor units identified concurrently from the HDsEMG and the iEMG signals showed an average disagreement (the difference between number of observed spikes in each bin relative to the mean) of 8.2 ± 2.2% (5% MVC), 6.8 ± 1.0% (10% MVC) and 7.5 ± 2.2% (20% MVC), for reflex inhibition, and 6.5 ± 4.1%, 12.0 ± 1.8% and 13.9 ± 2.4%, for reflex excitation. There was no significant difference between the characteristics of the reflex responses, such as latency, amplitude and duration, for the motor units identified by both techniques. Finally, reflex responses could be identified at higher force (4 of the 9 subjects performed contraction up to 50% MVC) using HDsEMG but not iEMG, because of the difficulty in decomposing the iEMG at high forces. In conclusion, single motor unit reflex responses can be estimated accurately and non-invasively in relatively large populations of motor units using HDsEMG. This non-invasive approach may enable a more thorough investigation of the synaptic input distribution on active motor units at various force levels.

The effect of crossed reflex responses on dynamic stability during locomotion

In recent studies, we demonstrated that a neural pathway within the human spinal cord allows direct communication between muscles located in the opposing limb. Short-latency crossed responses (SLCRs) are elicited in the contralateral triceps surae at an onset of 40-69 ms following electrical stimulation of the ipsilateral tibial nerve (iTN). The SLCRs are significantly affected by lesions of the central nervous system where the patients are unable to attain normal walking symmetry. The aim of this study was to elucidate the functionality of SLCRs by investigating their effects on the center of pressure (CoP) and pressure distribution. SLCRs were elicited by iTN stimulation at the end of the ipsilateral swing phase while the participants (n = 8) walked on a treadmill. CoP location and pressure distribution on the sole of the contralateral foot were recorded using instrumented insoles inserted bilaterally in the participant's shoes. The SLCR induced a significant displacement of the CoP toward the medial and anterior direction, associated with a significant increase in pressure at the level of the first metatarsal head. The SLCR contributed to dynamic stability, accelerating the propulsion phase of the contralateral leg and thus preparing for a faster step in the event that the ipsilateral leg is not able to support body weight. The results presented here provide new insight into the functionality of SLCRs, introducing the perspective that training these reflexes, as shown successfully for other reflex pathways, would increase dynamic stability in patients with impaired locomotion.

Interlimb communication following unexpected changes in treadmill velocity during human walking

Interlimb reflexes play an important role in human walking, particularly when dynamic stability is threatened by external perturbations or changes in the walking surface. Interlimb reflexes have recently been demonstrated in the contralateral biceps femoris (cBF) following knee joint rotations applied to the ipsilateral leg (iKnee) during the late stance phase of human gait (Stevenson AJ, Geertsen SS, Andersen JB, Sinkjær T, Nielsen JB, Mrachacz-Kersting N. J Physiol 591: 4921-4935, 2013). This interlimb reflex likely acts to slow the forward progression of the body to maintain dynamic stability following the perturbations. We examined this hypothesis by unexpectedly increasing or decreasing the velocity of the treadmill before (-100 and -50 ms), at the same time, or following (+50 ms) the onset of iKnee perturbations in 12 healthy volunteers. We quantified the cBF reflex amplitude when the iKnee perturbation was delivered alone, the treadmill velocity change was delivered alone, or when the two perturbations were combined. When the treadmill velocity was suddenly increased (or decreased) 100 or 50 ms before the iKnee perturbations, the combined cBF reflex was significantly larger (or smaller) than the algebraic sum of the two perturbations delivered separately. Furthermore, unexpected changes in treadmill velocity increased the incidence of reflexes in other contralateral leg muscles when the iKnee perturbations were elicited alone. These results suggest a context dependency for interlimb reflexes. They also show that the cBF reflex changed in a predictable manner to slow the forward progression of the body and maintaining dynamic stability during walking, thus signifying a functional role for interlimb reflexes.

Task-related modulation of crossed spinal inhibition between human lower limbs

Crossed reflex action mediated by muscle spindle afferent inputs has recently been revealed in humans. This raised the question of whether a complex spinal network involving commissural interneurons receiving inputs from proprioceptors and suprasegmental structures, as described in cats, persists in humans and contributes to the interlimb coordination during movement. First, we investigated the neurophysiological mechanisms underlying crossed reflex action between ankle plantar flexors and its corticospinal control from primary motor cortex. Second, we studied its modulation during motor tasks. We observed crossed inhibition in contralateral soleus motoneurons occurring with about 3 ms central latency, which is consistent with spinal transmission through oligosynaptic pathway. The early phase of inhibition was evoked with lower stimulus intensity than the late phase, suggesting mediation by group I and group II afferents, respectively. The postsynaptic origin of crossed inhibition is confirmed by the finding that both H-reflex and motor-evoked potential were reduced upon conditioning stimulation. Transcranial magnetic stimulation over ipsilateral and contralateral primary motor cortex reduced crossed inhibition, especially its late group II part. Last, late group II crossed inhibition was particularly depressed during motor tasks, especially when soleus was activated during the walking stance phase. Our results suggest that both group I and group II commissural interneurons participate in crossed reflex actions between ankle plantar flexors. Neural transmission at this level is depressed by descending inputs activated by transcranial magnetic stimulation over the primary motor cortex or during movement. The specific modulation of group II crossed inhibition suggests control from monoaminergic midbrain structures and its role for interlimb coordination during locomotion.

Skin, fascias, and scars: symptoms and systemic connections

Every element or cell in the human body produces substances that communicate and respond in an autocrine or paracrine mode, consequently affecting organs and structures that are seemingly far from each other. The same also applies to the skin. In fact, when the integrity of the skin has been altered, or when its healing process is disturbed, it becomes a source of symptoms that are not merely cutaneous. The skin is an organ, and similar to any other structure, it has different functions in addition to connections with the central and peripheral nervous system. This article examines pathological responses produced by scars, analyzing definitions and differences. At the same time, it considers the subcutaneous fascias, as this connective structure is altered when there is a discontinuous cutaneous surface. The consequence is an ample symptomatology, which is not limited to the body area where the scar is located, such as a postural or trigeminal disorder.