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Vargas Luna JL, Brown J, Krenn MJ, McKay B, Mayr W, Rothwell JC, Dimitrijevic MR. Neurophysiology of epidurally evoked spinal cord reflexes in clinically motor-complete posttraumatic spinal cord injury. Exp Brain Res 2021; 239:2605-2620. [PMID: 34213632 PMCID: PMC8354937 DOI: 10.1007/s00221-021-06153-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/13/2021] [Indexed: 11/24/2022]
Abstract
Increased use of epidural Spinal Cord Stimulation (eSCS) for the rehabilitation of spinal cord injury (SCI) has highlighted the need for a greater understanding of the properties of reflex circuits in the isolated spinal cord, particularly in response to repetitive stimulation. Here, we investigate the frequency-dependence of modulation of short- and long-latency EMG responses of lower limb muscles in patients with SCI at rest. Single stimuli could evoke short-latency responses as well as long-latency (likely polysynaptic) responses. The short-latency component was enhanced at low frequencies and declined at higher rates. In all muscles, the effects of eSCS were more complex if polysynaptic activity was elicited, making the motor output become an active process expressed either as suppression, tonic or rhythmical activity. The polysynaptic activity threshold is not constant and might vary with different stimulation frequencies, which speaks for its temporal dependency. Polysynaptic components can be observed as direct responses, neuromodulation of monosynaptic responses or driving the muscle activity by themselves, depending on the frequency level. We suggest that the presence of polysynaptic activity could be a potential predictor for appropriate stimulation conditions. This work studies the complex behaviour of spinal circuits deprived of voluntary motor control from the brain and in the absence of any other inputs. This is done by describing the monosynaptic responses, polysynaptic activity, and its interaction through its input–output interaction with sustain stimulation that, unlike single stimuli used to study the reflex pathway, can strongly influence the interneuron circuitry and reveal a broader spectrum of connectivity.
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Affiliation(s)
- Jose Luis Vargas Luna
- Center of Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20/4L, 1090, Vienna, Austria.
| | - Justin Brown
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Matthias J Krenn
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.,Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson, Jackson, MS, 39216, USA
| | - Barry McKay
- Hulse S.C.I. Research Lab, Shepherd Center, 2020 Peachtree Rd NW, Atlanta, GA, 30309, USA
| | - Winfried Mayr
- Center of Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20/4L, 1090, Vienna, Austria
| | - John C Rothwell
- Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK
| | - Milan R Dimitrijevic
- Department of Rehabilitation and Physical Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.,Foundation for Movement Recovery, Bolette Brygge 1, 0252, Oslo, Norway
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2
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Howells J, Sangari S, Matamala JM, Kiernan MC, Marchand-Pauvert V, Burke D. Interrogating interneurone function using threshold tracking of the H reflex in healthy subjects and patients with motor neurone disease. Clin Neurophysiol 2020; 131:1986-1996. [PMID: 32336595 DOI: 10.1016/j.clinph.2020.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/21/2020] [Accepted: 03/15/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The excitability of the lower motoneurone pool is traditionally tested using the H reflex and a constant-stimulus paradigm, which measures changes in the amplitude of the reflex response. This technique has limitations because reflex responses of different size must involve the recruitment or inhibition of different motoneurones. The threshold-tracking technique ensures that the changes in excitability occur for an identical population of motoneurones. We aimed to assess this technique and then apply it in patients with motor neurone disease (MND). METHODS The threshold-tracking approach was assessed in 17 healthy subjects and 11 patients with MND. The soleus H reflex was conditioned by deep peroneal nerve stimulation producing reciprocal Ia and so-called D1 and D2 inhibitions, which are believed to reflect presynaptic inhibition of soleus Ia afferents. RESULTS Threshold tracking was quicker than the constant-stimulus technique and reliable, properties that may be advantageous for clinical studies. D1 inhibition was significantly reduced in patients with MND. CONCLUSIONS Threshold tracking is useful and may be preferable under some conditions for studying the excitability of the motoneurone pool. The decreased D1 inhibition in the patients suggests that presynaptic inhibition may be reduced in MND. SIGNIFICANCE Reduced presynaptic inhibition could be evidence of an interneuronopathy in MND. It is possible that the hyperreflexia is a spinal pre-motoneuronal disorder, and not definitive evidence of corticospinal involvement in MND.
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Affiliation(s)
- James Howells
- Brain & Mind Centre, The University of Sydney, N.S.W. 2006, Australia
| | - Sina Sangari
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, F-75006 Paris, France
| | - José Manuel Matamala
- Department of Neurological Science and Biomedical Neuroscience Institute, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Matthew C Kiernan
- Brain & Mind Centre, The University of Sydney, N.S.W. 2006, Australia; Department of Neurology, Royal Prince Alfred Hospital and The University of Sydney, N.S.W. 2006, Australia
| | | | - David Burke
- Department of Neurology, Royal Prince Alfred Hospital and The University of Sydney, N.S.W. 2006, Australia.
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3
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Mortaza N, Moussavi Z, Stecina K, Salter JE, Passmore SR, Gardiner PF, Glazebrook CM. Effects of training with a neuro-mechano stimulator rehabilitation bicycle on functional recovery and paired-reflex depression of the soleus in individuals with incomplete paralysis: a proof-of-principle study. Int J Neurosci 2019; 129:1066-1075. [PMID: 31220973 DOI: 10.1080/00207454.2019.1634068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim: The present study describes the training effects of a novel motorized bicycle-like device for individuals with incomplete spinal cord injury. Methods: Participants were five individuals with motor incomplete spinal cord injury (56 ± 7 years). Four of five participants received two 30-min sessions of training: one with, and one without, mechanical stimulation on the plantar surface of the foot; soleus paired H-reflex depression was examined before and after each session. Three of five participants received 24 sessions of 30-min of training (long-training). Following the long-training, balance, walking and spasticity improvements were assessed using validated clinical outcome measures, in addition to the H-reflex assessment. Results: One cycling session with mechanical stimulation yielded 14% and 32% more reflex depression in participants with moderate spasticity (n = 2/4). The same trend was not observed in non-spastic participants (n = 2/4). All participants who participated in the long-training had spasticity and showed reduced spasticity, improved walking speed, endurance and balance. Conclusions: Overall, participants with spasticity showed increased soleus H-reflex suppression after one training session with mechanical stimulation and reduced spasticity scores after long training. We interpret this as evidence that the training influenced both presynaptic and postsynaptic inhibitory mechanisms acting on soleus motoneurons. Therefore, this training has the potential to be a non-invasive complementary therapy to reduce spasticity after incomplete spinal cord injury.
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Affiliation(s)
- Niyousha Mortaza
- Program of Biomedical Engineering, Faculty of Engineering, University of Manitoba , Winnipeg , Manitoba , Canada.,Program of Applied Health Sciences, University of Manitoba , Winnipeg , Manitoba , Canada.,Faculty of Kinesiology and Recreation Management, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Zahra Moussavi
- Program of Biomedical Engineering, Faculty of Engineering, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Katinka Stecina
- Program of Biomedical Engineering, Faculty of Engineering, University of Manitoba , Winnipeg , Manitoba , Canada.,Department of Physiology & Pathophysiology, University of Manitoba , Winnipeg , Manitoba , Canada.,Spinal cord Research Center, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Jennifer E Salter
- Faculty of Medicine, Physical Medicine and Rehabilitation, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Steven R Passmore
- Program of Applied Health Sciences, University of Manitoba , Winnipeg , Manitoba , Canada.,Faculty of Kinesiology and Recreation Management, University of Manitoba , Winnipeg , Manitoba , Canada.,Health, Leisure, and Human Performance Research Institute, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Phillip F Gardiner
- Faculty of Kinesiology and Recreation Management, University of Manitoba , Winnipeg , Manitoba , Canada.,Department of Physiology & Pathophysiology, University of Manitoba , Winnipeg , Manitoba , Canada.,Spinal cord Research Center, University of Manitoba , Winnipeg , Manitoba , Canada.,Health, Leisure, and Human Performance Research Institute, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Cheryl M Glazebrook
- Program of Biomedical Engineering, Faculty of Engineering, University of Manitoba , Winnipeg , Manitoba , Canada.,Program of Applied Health Sciences, University of Manitoba , Winnipeg , Manitoba , Canada.,Faculty of Kinesiology and Recreation Management, University of Manitoba , Winnipeg , Manitoba , Canada.,Health, Leisure, and Human Performance Research Institute, University of Manitoba , Winnipeg , Manitoba , Canada
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4
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Oza PD, Dudley-Javoroski S, Shields RK. Sustained submaximal contraction yields biphasic modulation of soleus Post-activation depression in healthy humans. Scand J Med Sci Sports 2019; 29:944-951. [PMID: 30892718 DOI: 10.1111/sms.13421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 02/01/2019] [Accepted: 03/14/2019] [Indexed: 12/23/2022]
Abstract
The amplitude of the H-reflex during the development and progression of fatigue reflects a complex interplay between central and peripheral factors. The purpose of this study is to characterize H-reflex homosynaptic post-activation depression (PAD) in an online fashion during a sustained submaximal fatigue task. The task required a high motor output in order to increase the likelihood of creating partial muscle ischemia with accumulation of fatigue metabolites, an important potential inhibitory influence upon the H-reflex during the progression of fatigue. Eleven subjects without neurologic impairment maintained volitional, isometric plantar flexion at 60% of maximal voluntary contraction until exhaustion. A paired-pulse stimulus (2 Hz) was delivered to the tibial nerve to elicit paired H-reflexes before, during, and after the fatigue protocol. The normalized amplitude of the second H-reflex (depression ratio) served as an estimate of PAD. Depression ratio increased during the first half of the fatigue protocol (P < 0.001), indicating a diminution of PAD, and then returned as exhaustion approached. The biphasic behavior of homosynaptic H-reflex depression during fatigue to exhaustion suggests a role for metabolic mediators of post-activation depression during fatigue.
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Affiliation(s)
- Preeti D Oza
- Department of Physical Therapy, University of the Pacific, Stockton, California
| | - Shauna Dudley-Javoroski
- Department of Physical Therapy Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Richard K Shields
- Department of Physical Therapy Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa
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5
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Jimenez S, Mordillo-Mateos L, Dileone M, Campolo M, Carrasco-Lopez C, Moitinho-Ferreira F, Gallego-Izquierdo T, Siebner HR, Valls-Solé J, Aguilar J, Oliviero A. Effects of patterned peripheral nerve stimulation on soleus spinal motor neuron excitability. PLoS One 2018; 13:e0192471. [PMID: 29451889 PMCID: PMC5815584 DOI: 10.1371/journal.pone.0192471] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 01/03/2018] [Indexed: 11/24/2022] Open
Abstract
Spinal plasticity is thought to contribute to sensorimotor recovery of limb function in several neurological disorders and can be experimentally induced in animals and humans using different stimulation protocols. In healthy individuals, electrical continuous Theta Burst Stimulation (TBS) of the median nerve has been shown to change spinal motoneuron excitability in the cervical spinal cord as indexed by a change in mean H-reflex amplitude in the flexor carpi radialis muscle. It is unknown whether continuous TBS of a peripheral nerve can also shift motoneuron excitability in the lower limb. In 26 healthy subjects, we examined the effects of electrical TBS given to the tibial nerve in the popliteal fossa on the excitability of lumbar spinal motoneurons as measured by H-reflex amplitude of the soleus muscle evoked by tibial nerve stimulation. Continuous TBS was given at 110% of H-reflex threshold intensity and compared to non-patterned regular electrical stimulation at 15 Hz. To disclose any pain-induced effects, we also tested the effects of TBS at individual sensory threshold. Moreover, in a subgroup of subjects we evaluated paired-pulse inhibition of H-reflex. Continuous TBS at 110% of H-reflex threshold intensity induced a short-term reduction of H-reflex amplitude. The other stimulation conditions produced no after effects. Paired-pulse H-reflex inhibition was not modulated by continuous TBS or non-patterned repetitive stimulation at 15 Hz. An effect of pain on the results obtained was discarded, since non-patterned 15 Hz stimulation at 110% HT led to pain scores similar to those induced by EcTBS at 110% HT, but was not able to induce any modulation of the H reflex amplitude. Together, the results provide first time evidence that peripheral continuous TBS induces a short-lasting change in the excitability of spinal motoneurons in lower limb circuitries. Future studies need to investigate how the TBS protocol can be optimized to produce a larger and longer effect on spinal cord physiology and whether this might be a useful intervention in patients with excessive excitability of the spinal motorneurons.
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Affiliation(s)
- Samuel Jimenez
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Physiotherapy Department, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Physiotherapy Department, Alcalá de Henares University, Alcalá de Henares Spain
| | | | - Michele Dileone
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- CINAC, HM Puerta del Sur, Hospitales de Madrid, Móstoles, Spain
| | - Michela Campolo
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- EMG and Motor Control Section, Neurology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Fabricia Moitinho-Ferreira
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Sarah Network of Rehabilitation Hospitals, Salvador de Bahia, Brazil
| | | | - Hartwig R. Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Josep Valls-Solé
- EMG and Motor Control Section, Neurology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Juan Aguilar
- Experimental Neurophysiology Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
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6
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Burke D. Clinical uses of H reflexes of upper and lower limb muscles. Clin Neurophysiol Pract 2016; 1:9-17. [PMID: 30214954 PMCID: PMC6123946 DOI: 10.1016/j.cnp.2016.02.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/10/2016] [Indexed: 10/25/2022] Open
Abstract
H reflexes can be recorded from virtually all muscles that have muscle spindles, but reflex reinforcement may be required for the reflex response to be demonstrable. This can allow conduction across proximal nerve segments and most nerve root segments commonly involved by pathology. Stimulus rate is critical in subjects who are at rest. However the reflex attenuation with higher rates is greatly reduced during a background contraction of the test muscle, with only minor changes in latency if any. In addition the contraction ensures that the reflex response occurs in the desired muscle. Reflex latencies should be corrected for height (or limb length) and age. Because the reflex discharge requires a synchronised volley in group Ia afferents, large increases in reflex latency occur rarely with purely sensory lesions. If the H reflex of soleus, quadriceps femoris or flexor carpi radialis is absent at rest but appears during a voluntary contraction at near-normal latency, there is either low central excitability or a predominantly sensory abnormality. With the former H reflexes will be difficult to elicit throughout the body. If H reflexes can be recorded at rest from muscles for which no reflex can normally be demonstrated, there is good evidence for hyperreflexia. In the context of possible ALS, this is an important finding when there is EMG evidence of chronic partial denervation in that muscle.
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7
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Recording and assessment of evoked potentials with electrode arrays. Med Biol Eng Comput 2015; 53:857-67. [PMID: 25863691 DOI: 10.1007/s11517-015-1292-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
In order to optimize procedure for the assessment of evoked potentials and to provide visualization of the flow of action potentials along the motor systems, we introduced array electrodes for stimulation and recording and developed software for the analysis of the recordings. The system uses a stimulator connected to an electrode array for the generation of evoked potentials, an electrode array connected to the amplifier, A/D converter and computer for the recording of evoked potentials, and a dedicated software application. The method has been tested for the assessment of the H-reflex on the triceps surae muscle in six healthy humans. The electrode array with 16 pads was positioned over the posterior aspect of the thigh, while the recording electrode array with 16 pads was positioned over the triceps surae muscle. The stimulator activated all the pads of the stimulation electrode array asynchronously, while the signals were recorded continuously at all the recording sites. The results are topography maps (spatial distribution of evoked potentials) and matrices (spatial visualization of nerve excitability). The software allows the automatic selection of the lowest stimulation intensity to achieve maximal H-reflex amplitude and selection of the recording/stimulation pads according to predefined criteria. The analysis of results shows that the method provides rich information compared with the conventional recording of the H-reflex with regard the spatial distribution.
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8
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Simon NG, Lin CSY, Lee M, Howells J, Vucic S, Burke D, Kiernan MC. Segmental motoneuronal dysfunction is a feature of amyotrophic lateral sclerosis. Clin Neurophysiol 2015; 126:828-36. [DOI: 10.1016/j.clinph.2014.07.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 07/17/2014] [Accepted: 07/29/2014] [Indexed: 01/08/2023]
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9
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Miyara K, Matsumoto S, Uema T, Hirokawa T, Noma T, Shimodozono M, Kawahira K. Feasibility of using whole body vibration as a means for controlling spasticity in post-stroke patients: a pilot study. Complement Ther Clin Pract 2013; 20:70-3. [PMID: 24439649 DOI: 10.1016/j.ctcp.2013.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/01/2013] [Indexed: 01/03/2023]
Abstract
To examine the feasibility of adapting whole body vibration (WBV) in the hemiplegic legs of post-stroke patients and to investigate the anti-spastic effects, and the improvement of motor function and walking ability. Twenty-five post-stroke patients with lower-limb spasticity were enrolled in the study. Each subject sat with hip joint angles to approximately 90° of flexion, and with knee joint angles to 0° of extension. WBV was applied at 30 Hz (4-8 mm amplitude) for 5 min on hamstrings, gastrocnemius and soleus muscles. The modified Ashworth scale was significantly decreased, active and passive range of motion (A-ROM, P-ROM) for ankle dorsiflexion and straight leg raising increased, and walking speed and cadence both improved during the 5-min intervention. Our proposed therapeutic approach could therefore be a novel neuro-rehabilitation strategy among patients with various severities.
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Affiliation(s)
- Kodai Miyara
- Department of Rehabilitation, Kirishima Rehabilitation Center of Kagoshima University Hospital, Kagoshima, Japan
| | - Shuji Matsumoto
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | - Tomohiro Uema
- Department of Rehabilitation, Kirishima Rehabilitation Center of Kagoshima University Hospital, Kagoshima, Japan
| | - Takuya Hirokawa
- Department of Rehabilitation, Kirishima Rehabilitation Center of Kagoshima University Hospital, Kagoshima, Japan
| | - Tomokazu Noma
- Department of Rehabilitation, Kirishima Rehabilitation Center of Kagoshima University Hospital, Kagoshima, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kazumi Kawahira
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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10
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Paoloni M, Giovannelli M, Mangone M, Leonardi L, Tavernese E, Di Pangrazio E, Bernetti A, Santilli V, Pozzilli C. Does giving segmental muscle vibration alter the response to botulinum toxin injections in the treatment of spasticity in people with multiple sclerosis? A single-blind randomized controlled trial. Clin Rehabil 2013; 27:803-12. [DOI: 10.1177/0269215513480956] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To determine if segmental muscle vibration and botulinum toxin-A injection, either alone or in combination, reduces spasticity in a sample of patients with multiple sclerosis. Design: Single-blind, randomized controlled trial. Setting: Physical medicine and rehabilitation outpatients service. Subjects: Forty-two patients affected by the secondary progressive form of multiple sclerosis randomized to group A (30 minutes of 120 Hz segmental muscle vibration over the rectus femoris and gastrocnemius medial and lateral, three per week, over a period of four weeks), group B (botulinum toxin in the rectus femoris, gastrocnemius medial and lateral and soleus, and segmental muscle vibration) and group C (botulinum toxin). Main measures: Modified Ashworth Scale at knee and ankle, and Fatigue Severity Scale. All the measurements were performed at baseline (T0), 10 weeks (T1) and 22 weeks (T2) postallocation. Results: Modified Ashworth Scale at knee and ankle significantly decreased over time ( p < 0.001) in all groups. Patients in group C displayed a significant increase of knee and ankle spasticity at T2 when compared with T1 ( p < 0.05). Fatigue Severity Scale values in groups A and C were significantly higher at T0 [A: 53.6 (2.31); C: 48.5 (2.77)] than at either T1 [A: 48.6 (2.21); p = 0.03; C: 43.5 (3.22); p = 0.03] or T2 [A: 46.7 (2.75); p = 0.02; 42.5 (2.17); p = 0.02], while no differences were detected in group B [T0: 43.4 (3.10); T1: 37.3 (3.15); T2: 39.7 (2.97)]. Conclusion: Segmental muscle vibration and botulinum toxin-A reduces spasticity and improves fatigue in the medium-term follow-up in patients with multiple sclerosis.
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Affiliation(s)
- Marco Paoloni
- Physical Medicine and Rehabilitation, Sapienza – University of Rome, Rome, Italy
| | | | - Massimiliano Mangone
- Physical Medicine and Rehabilitation, Sapienza – University of Rome, Rome, Italy
| | - Laura Leonardi
- MS Center S.Andrea Hospital, Sapienza University, Rome, Italy
| | - Emanuela Tavernese
- Physical Medicine and Rehabilitation, Sapienza – University of Rome, Rome, Italy
| | | | - Andrea Bernetti
- Physical Medicine and Rehabilitation, Sapienza – University of Rome, Rome, Italy
| | - Valter Santilli
- Physical Medicine and Rehabilitation, Sapienza – University of Rome, Rome, Italy
| | - Carlo Pozzilli
- MS Center S.Andrea Hospital, Sapienza University, Rome, Italy
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11
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Tsuruike M, Kitano K, Koceja DM, Riley ZA. Differential control of H-reflex amplitude in different weight-bearing conditions in young and elderly subjects. Clin Neurophysiol 2012; 123:2018-24. [DOI: 10.1016/j.clinph.2012.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 02/26/2012] [Accepted: 03/10/2012] [Indexed: 10/28/2022]
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12
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McNulty PA, Shiner CT, Thayaparan GK, Burke D. The stability of M(max) and H (max) amplitude over time. Exp Brain Res 2012; 218:601-7. [PMID: 22418783 DOI: 10.1007/s00221-012-3053-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 02/25/2012] [Indexed: 11/30/2022]
Abstract
The stability of the maximal muscle response (M(max)) is critical to H reflex methodology. It has previously been reported that the amplitude of M(max) declines over time. If reproducible, this finding would have implications for all experimental studies that normalise the output of the motoneurone pool against the M wave. We investigated the effect of time on changes in M(max) and the maximal H reflex (H(max)) evoked at 4-s intervals over 60 min. To identify an influence of homosynaptic depression, we extended the interstimulus interval to 10 s and the time to 100 min. Two recording montages over soleus were used to ensure that interelectrode distance was not a critical factor. The soleus M(max) and H reflex were evoked by stimulation of the tibial nerve in the popliteal fossa in 7 subjects who sat with the knee flexed to 30° and the ankle plantar flexed by ~30°. We found no change in the pooled data for M(max), H(max), a reflex 50% of maximal, or the current required to produce it. However, one subject had a statistically significant increase in M(max) and a concurrent decrease in H(max) regardless of the interstimulus interval. On average, there was no change in the H(max)/M(max) ratio over time. While both M(max) and H(max) may change in response to many factors, these results suggest that, typically, time is not one of them.
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Affiliation(s)
- Penelope A McNulty
- Neuroscience Research Australia, University of New South Wales, Barker Street, Randwick, Sydney, NSW 2031, Australia.
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13
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Roche N, Achache V, Lackmy A, Pradat-Diehl P, Lamy JC, Katz R. Effects of afferent stimulation rate on inhibitory spinal pathways in hemiplegic spastic patients. Clin Neurophysiol 2011; 123:1391-402. [PMID: 22172769 DOI: 10.1016/j.clinph.2011.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Revised: 11/10/2011] [Accepted: 11/11/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE It has recently been demonstrated in the cat and in healthy subjects that the effects of repetitive afferent fibre stimulation depends on the target spinal neurones. The purpose of this series of experiments was therefore to determine whether central nervous system lesions modify the behaviour of the inhibitory spinal pathways in response to repetitive activation of afferent fibres. METHODS The H-reflex technique was used to study the effect of increasing the conditioning stimulus rate from 0.16 to 1 Hz on disynaptic inhibition and on presynaptic Ia inhibition on the affected side of 36 hemiplegic patients. RESULTS The major finding was that, similar to results previously obtained in healthy subjects, increasing the conditioning stimulus rate in hemiplegic patients leads to an increase in the synaptic efficiency of inhibitory spinal circuits. Furthermore, a significant correlation was found between the severity of flexor carpi radialis muscle spasticity and the amount of disynaptic inhibition. CONCLUSIONS The reinforcement of inhibitory spinal networks induced by repetitive stimulation of afferent fibres is preserved in spastic patients, whereas the mechanisms underlying this phenomena might be altered. SIGNIFICANCE The results of these experiments open up a number of possibilities for novel spasticity therapies based on non-invasive techniques.
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Affiliation(s)
- N Roche
- UPMC Univ Paris 06 Er 6 Physiologie et Physiopathologie de la Motricité chez l'Homme, Médecine Physique et Réadaptation, Hôpital Pitié Salpêtrière, 75013 Paris, France
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Murillo N, Kumru H, Vidal-Samso J, Benito J, Medina J, Navarro X, Valls-Sole J. Decrease of spasticity with muscle vibration in patients with spinal cord injury. Clin Neurophysiol 2011; 122:1183-9. [DOI: 10.1016/j.clinph.2010.11.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Revised: 10/25/2010] [Accepted: 11/25/2010] [Indexed: 11/28/2022]
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Clair JM, Anderson-Reid JM, Graham CM, Collins DF. Postactivation depression and recovery of reflex transmission during repetitive electrical stimulation of the human tibial nerve. J Neurophysiol 2011; 106:184-92. [PMID: 21511709 DOI: 10.1152/jn.00932.2010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
H-reflexes are progressively depressed, relative to the first response, at stimulation frequencies above 0.1 Hz (postactivation depression; PAD). Presently, we investigated whether H-reflexes "recover" from this depression throughout 10-s trains of stimulation delivered at physiologically relevant frequencies (5-20 Hz) during functionally relevant tasks (sitting and standing) and contraction amplitudes [relaxed to 20% maximum voluntary contraction (MVC)]. When participants held a 10% MVC, reflex amplitudes did not change during 5-Hz stimulation. During stimulation at 10 Hz, reflexes were initially depressed by 43% but recovered completely by the end of the stimulation period. During 20-Hz stimulation, reflexes were depressed to 10% and recovered to 36% of the first response, respectively. This "postactivation depression and recovery" (PAD&R) of reflex amplitude was not different between sitting and standing. In contrast, PAD&R were strongly influenced by contraction amplitude. Reflexes were depressed to 10% of the first response during the relaxed condition (10-Hz stimulation) and showed no depression during a 20% MVC contraction. A partial recovery of reflex amplitude occurred when participants were relaxed and during contractions of 1-5% MVC. Surprisingly, reflexes could recover completely by the third pulse within a stimulation train when participants held a contraction between 5 and 10% MVC during stimulation at 10 Hz, a finding that challenges classical ideas regarding PAD mechanisms. Our results support the idea that there is an ongoing interplay between depression and facilitation when motoneurons receive trains of afferent input. This interplay depends strongly on the frequency of the afferent input and the magnitude of the background contraction but is relatively insensitive to changes in task.
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Affiliation(s)
- Joanna M Clair
- Centre for Neuroscience, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
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Schomburg ED, Steffens H, Zschüntzsch J, Dibaj P, Keller BU. Fatigability of spinal reflex transmission in a mouse model (SOD1(G93A) ) of amyotrophic lateral sclerosis. Muscle Nerve 2011; 43:230-6. [PMID: 21254088 DOI: 10.1002/mus.21835] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive loss of motor neurons. To analyze the progressive motor deficits during the course of this disease, we investigated fatigability and ability of recovery of spinal motor neurons by testing monosynaptic reflex transmission with increasing stimulus frequencies in the lumbar spinal cord of the SOD1(G93A) mouse model for ALS in a comparison with wild-type (WT) mice. Monosynaptic reflexes in WT and SOD1(G93A) mice without behavioral deficits showed no difference with respect to their resistance to increasing stimulus frequencies. During the progression of motor deficits in SOD1(G93A) mice, the vulnerability of monosynaptic reflexes to higher frequencies increased, the required time for reflex recovery was extended, and recovery was often incomplete. Fatigability and demand for recovery of spinal motor neurons in SOD1(G93A) mice rose with increasing motor deficits. This supports the assumption that impairment of the energy supply may contribute to the pathogenesis of ALS.
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Affiliation(s)
- Eike D Schomburg
- Department of Physiology, Georg August University of Göttingen, Waldweg 33, Göttingen, Germany.
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Lewis GN, McNair PJ. Heteronymous Ia-afferent connections in the upper limb following stroke. Muscle Nerve 2010; 41:71-7. [DOI: 10.1002/mus.21444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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