Extensor muscle responses to tibial nerve stimulation are enhanced during dynamic tilts in standing humans

Tendon reflexes for predicting movement recovery after acute spinal cord injury in humans

OBJECTIVE

Use the tendon reflex to examine spinal cord excitability after acute spinal cord injury (SCI), relating excitability findings to prognosis.

METHODS

We conducted repeated measures of reflex responses to mechanical taps at the patellar and Achilles tendons of the lower limbs, and the wrist flexor tendons of the upper limbs in persons with acute SCI, beginning as early as the day of injury. The single largest EMG response (peak-to-peak) for each site was recorded. Subjects were compared based on level of injury and final neurologic status of lower limb motor function (i.e. absence of any voluntary recruitment in a lower limb muscle: motor-complete; voluntary recruitment in 1 or more lower-limb muscles: motor-incomplete).

RESULTS

We studied 229 subjects with acute SCI. Persons with injury to the cervical or thoracic spinal cord and who were (or became) motor-incomplete showed large tendon responses, even at the time of initial evaluation. In combination with larger tendon response amplitudes, the presence of the 'crossed-adductor' response to patellar tendon taps at the acute stage was highly predictive of functional motor recovery following SCI. In marked contrast, tendon responses were small (e.g. < 0.1 mV) or absent in persons with acute, motor-complete injury (and which remained motor-complete), and the crossed-adductor response was never seen. Reflex amplitudes and the incidence of the crossed-adductor response increased somewhat over time in persons with motor-complete SCI, but did not approach the values seen in motor-incomplete subjects.

CONCLUSIONS

Taken together, tendon response amplitude and reflex spread were sensitive and specific indicators of preserved supraspinal control over lower limb musculature in subjects with acute SCI. A simple algorithm using these outcome measures predicted a 'motor-complete' status with 100% accuracy, and a motor-incomplete status with accuracy exceeding 91%.

Responses to whole head-and-body tilts with and without passive ankle dorsiflexion in the absence of visual feedback

OBJECTIVES

We have investigated lower limb responses in seven blindfolded healthy subjects to well controlled tilts in the standing position. Our aims were (1) to determine the effect of head acceleration magnitude on responses evoked by whole head-and-body tilts, and (2) to establish whether tilt-evoked responses are modifiable by passive ankle dorsiflexion. Whole head-and-body tilts evoked responses in the biceps femoris, medial gastrocnemius and tibialis anterior muscles.

METHODS

Seven young healthy subjects stood on a spring-activated tilting apparatus and underwent sudden whole head-and-body tilts of about 15 degrees from the vertical position, with or without passive ankle dorsiflexion. Head acceleration was recorded with a linear accelerometer and ankle angular displacement with a potentiometer. Surface EMG signals were recorded in the right biceps femoris, medial gastrocnemius and tibialis anterior muscles.

RESULTS

As the peak of head acceleration was increased from 0.5 g to 1.8 g, the frequency of occurrence of tilt-evoked responses increased from 7% to 60% of trials in the biceps femoris muscle during whole head-and-body tilts. In general, the more proximal muscle (biceps femoris) was activated before the more distal muscle (medial gastrocnemius) during whole head-and-body tilts, while the opposite pattern was found during tilt with dorsiflexion.

CONCLUSIONS

Our results indicate that the occurrence of tilt-evoked responses increases with an increase in the amplitude of tilting acceleration. This suggests that tilt-evoked responses are dependent, at least in part, on vestibular stimulation. In addition, the spatio-temporal pattern of biceps femoris and medial gastrocnemius muscle activation was opposite during whole head-and-body tilts and tilts with dorsiflexion. This finding suggests that foot/ankle somatosensory inputs can modify tilt-evoked responses.

Static and dynamic changes in body orientation modulate spinal reflex excitability in humans

In the present study, we investigated the modulation pattern of the soleus H reflex in healthy subjects in response to imposed static and dynamic changes in body angle, referenced to the vertical plane. Soleus H reflexes were recorded using conventional methods with subjects either supine or while they were erect. Changes in body angle were initiated with subjects lying supine on a tilt table. Table position was controlled via a motor and could move from the horizontal to the upright position and beyond. Elastic bands around the trunk (upper and lower part) and around the thigh and shank secured subjects' position. In the vertical position, the soleus H reflex exhibited a strong depression in all subjects tested, reaching amplitudes as low as 40+/-8.1% of the control reflex (Ho). With subjects supine, positioning the body at 10 degrees, 20 degrees, 40 degrees, 60 degrees, 90 degrees, -50 degrees and -20 degrees all resulted in a significant facilitation of the soleus H reflex. The reflex magnitude at these angles ranged from 140+/-17.2% to 180+/-10.9% of the Ho. Reflex facilitation was also observed following dynamic tilt of the body in the sagittal plane (at 1.8 degrees /s) with the H reflex reaching amplitudes as high as 300+/-18.3% of Ho. Our findings indicate that changes in body orientation induced a significant facilitation of the H reflex magnitude in soleus motoneurones that were essentially independent of angular change in body orientation or of movement direction. In addition, they highlight the potent modulatory effects that natural stimulation of the vestibular system can have on reflex excitability. The implications of our findings are discussed in relation to the maintenance of body posture.

Reflex Interactions during Whole Head-and-Body Tilts are Modified by Age in Humans

We have demonstrated that lower limb extensor muscle response to tibial nerve stimulation is significantly facilitated by whole head-and-body tilt in the forward direction. Our aim was to examine whether this reflex interaction is influenced by age. Reflexes were elicited in lower limb muscles by electrical stimulation (ES) of the right tibial nerve. We compared reflexes during supported stance (ESalone) and sudden forward tilting of the whole head-and-body (Tilt+ES) between 10 healthy subjects aged 66 ± 4 years and 13 subjects aged 27 ± 3 years. In young subjects the area of response evoked in the ipsilateral vastus lateralis (iVL) was significantly increased by 74% during Tilt+ES as compared with ESalone (p < 0.05). Moreover, the latency of contralateral VL and soleus muscle responses (cVL and/or cSO) was significantly shorter by 61 ms during Tilt+ES than ESalone (p < 0.01). In contrast, older subjects showed no significant increase in the excitability of iVL muscle response and cVL and/or cSO muscle responses during Tilt+ES as compared with ESalone despite the application of similar intensity of ES and head acceleration as in young subjects. Our findings showed that the interaction between ES-evoked and tilt-evoked responses in lower limb extensor muscles is modified with age, which suggests modifications of sensorimotor integration involved in balance control.