Characterization of interlimb interaction via transcutaneous spinal stimulation of cervical and lumbar spinal enlargements

The use of transcutaneous electrical spinal stimulation (TSS) to modulate sensorimotor networks after neurological insult has garnered much attention from both researchers and clinicians in recent years. Although many different stimulation paradigms have been reported, the interlimb effects of these neuromodulation techniques have been little studied. The effects of multisite TSS on interlimb sensorimotor function are of particular interest in the context of neurorehabilitation, as these networks have been shown to be important for functional recovery after neurological insult. The present study utilized a condition-test paradigm to investigate the effects of interenlargement TSS on spinal motor excitability in both cervical and lumbosacral motor pools. Additionally, comparison was made between the conditioning effects of lumbosacral and cervical TSS and peripheral stimulation of the fibular nerve and ulnar nerve, respectively. In 16/16 supine, relaxed participants, facilitation of spinally evoked motor responses (sEMRs) in arm muscles was seen in response to lumbosacral TSS or fibular nerve stimulation, whereas facilitation of sEMRs in leg muscles was seen in response to cervical TSS or ulnar nerve stimulation. The decreased latency between TSS- and peripheral nerve-evoked conditioning implicates interlimb networks in the observed facilitation of motor output. The results demonstrate the ability of multisite TSS to engage interlimb networks, resulting in the bidirectional influence of cervical and lumbosacral motor output. The engagement of interlimb networks via TSS of the cervical and lumbosacral enlargements represents a feasible method for engaging spinal sensorimotor networks in clinical populations with compromised motor function.NEW & NOTEWORTHY Bidirectional interlimb modulation of spinal motor excitability can be evoked by transcutaneous spinal stimulation over the cervical and lumbosacral enlargements. Multisite transcutaneous spinal stimulation engages spinal sensorimotor networks thought to be important in the recovery of function after spinal cord injury.

Sensory enhancement amplifies interlimb cutaneous reflexes in wrist extensor muscles

Interlimb neural connections support motor tasks such as locomotion and cross-education strength training. Somatosensory pathways that can be assessed with cutaneous reflex paradigms assist in subserving these connections. Many studies show that stimulation of cutaneous nerves elicits reflexes in muscles widespread across the body and induces neural plasticity after training. Sensory enhancement, such as long-duration trains of transcutaneous stimulation, facilitates performance during rehabilitation training or fatiguing motor tasks. Performance improvements due to sensory stimulation may be caused by altered spinal and corticospinal excitability. However, how enhanced sensory input regulates the excitability of interlimb cutaneous reflex pathways has not been studied. Our purpose was to investigate the effects of sensory enhancement on interlimb cutaneous reflexes in wrist extensor muscles. Stimulation to provide sensory enhancement (2-s trains at 150 Hz to median or superficial radial nerves) or evoke cutaneous reflexes (15-ms trains at 300 Hz to superficial radial nerve) was applied in different arms while participants (n = 13) performed graded isometric wrist extension. Wrist extensor electromyography and cutaneous reflexes were measured bilaterally. We found amplified inhibitory reflexes in the arm receiving superficial radial and median nerve sensory enhancement with net reflex amplitudes decreased by 709.5% and 695.3% repetitively. This suggests sensory input alters neuronal excitabilities in the interlimb cutaneous pathways. These findings have potential application in facilitating motor function recovery through alterations in spinal cord excitability enhancing sensory input during targeted rehabilitation and sports training.NEW & NOTEWORTHY We show that sensory enhancement increases excitability in interlimb cutaneous pathways and that these effects are not influenced by descending motor drive on the contralateral side. These findings confirm the role of sensory input and cutaneous pathways in regulating interlimb movements. In targeted motor function training or rehabilitation, sensory enhancement may be applied to facilitate outcomes.

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.

Crossed reflex reversal during human locomotion

During human walking, precise coordination between the two legs is required in order to react promptly to any sudden hazard that could threaten stability. The networks involved in this coordination are not yet completely known, but a direct spinal connection between soleus (SOL) muscles has recently been revealed. For this response to be functional, as previously suggested, we hypothesize that it will be accompanied by a reaction in synergistic muscles, such as gastrocnemius lateralis (GL), and that a reversal of the response would occur when an opposite reaction is required. In the present study, surface EMGs of contralateral SOL and GL were analyzed after tibial nerve (TN), sural nerve (SuN), and medial plantar nerve (MpN) stimulation during two tasks in which opposite reactions are functionally expected: normal walking (NW), just before ipsilateral heel strike, and hybrid walking (HW) (legs walking in opposite directions), at ipsilateral push off and contralateral touchdown. Early crossed facilitations were observed in the contralateral GL after TN stimulation during NW, and a reversal of such responses occurred during HW. These results underline the functional significance of short-latency crossed responses and represent the first evidence for short-latency reflex reversal in the contralateral limb for humans. Muscle afferents seem to mediate the response during NW, while during HW cutaneous afferents are likely involved. It is thus possible that different afferents mediate the crossed response during different tasks.