The Dominant Role of the Hip in Multijoint Reflex Responses in Human Spinal Cord Injury

Following a spinal cord injury (SCI), people often experience exaggerated reflexes, such that mild provocations can cause prolonged and uncontrolled muscle activity throughout the entire leg. These reflexes can be problematic and are known to interfere with functional tasks, such as transferring to and from a wheelchair, and they may interfere with locomotor function by prolonging muscle activity and/or inappropriately activating muscles during attempts to walk. While these multijoint reflexes have been shown to originate from several afferent cues, hip afferent input is a particularly potent sensory signal that readily triggers multijoint reflexes. The overall objective of this dissertation was to understand the role of hip sensory cues and the potential mechanisms associated with multijoint reflex behavior in human SCI. To evaluate this, a custom -built robot was used to impose movement of the legs about the hip joint. Joint torque and muscle activity were used as quantitative measures of reflex activity in SCI subjects. The findings from this suggest that the mutability of reflexes triggered by hip-mediated sensory signals is reduced. Voluntary effort and stretch-sensitive sensory feedback impart weak signals that do not significantly alter multijoint reflex patterns. Additionally, reflex behaviors presented with a distinct temporal response that has been associated with the disregulation of voltage-dependent depolarizing persistent inward currents (PICs). These results further elucidate the underlying mechanisms associated with hyperexcitable multijoint reflexes to help guide rehabilitation techniques for controlling unwanted muscle activity and for increasing functional gains in human SCI

Motor Output Variability Impairs Driving Ability in Older Adults

Background: The functional declines with aging relate to deficits in motor control and strength. In this study, we determine whether older adults exhibit impaired driving as a consequence of declines in motor control or strength. Methods: Young and older adults performed the following tasks: (i) maximum voluntary contractions of ankle dorsiflexion and plantarflexion; (ii) sinusoidal tracking with isolated ankle dorsiflexion; and (iii) a reactive driving task that required responding to unexpected brake lights of the car ahead. We quantified motor control with ankle force variability, gas position variability, and brake force variability. We quantified reactive driving performance with a combination of gas pedal error, premotor and motor response times, and brake pedal error. Results: Reactive driving performance was ~30% more impaired (t = 3.38; p \u3c .01) in older adults compared with young adults. Older adults exhibited greater motor output variability during both isolated ankle dorsiflexion contractions (t = 2.76; p \u3c .05) and reactive driving (gas pedal variability: t = 1.87; p \u3c .03; brake pedal variability: t = 4.55; p \u3c .01). Deficits in reactive driving were strongly correlated to greater motor output variability (R 2 = .48; p \u3c .01) but not strength (p \u3e .05). Conclusions: This study provides novel evidence that age-related declines in motor control but not strength impair reactive driving. These findings have implications on rehabilitation and suggest that interventions should focus on improving motor control to enhance driving-related function in older adults

Motor Output Variability Impairs Driving Ability in Older Adults: Reply to Stinchcombe, Dickerson, Weaver, and Bedard

Driving is a complex skill, as indicated by Stinchcombe and colleagues in their letter. It requires the integration of sensory inputs, cognitive processing, and motor execution. Although our title is broad, we clearly indicate that our findings only address a single component of driving, namely reactive driving. We also indicate that these findings are based on a simulated task and recommend that future studies should examine the contribution of motor output variability to on-road driving performance (see Considerations in the Discussion section). Thus, we share the consideration of Stinchcombe and colleagues that the current results only address a small portion of the driving complexity

Stroke-related Changes in Neuromuscular Fatigue of the Hip Flexors and Functional Implications

Objective: The aim of this study was to compare stroke-related changes in hip flexor neuromuscular fatigue of the paretic leg during a sustained isometric submaximal contraction with those of the nonparetic leg and controls and to correlate fatigue with clinical measures of function. Design: Hip torques were measured during a fatiguing hip flexion contraction at 20% of the hip flexion maximal voluntary contraction in the paretic and nonparetic legs of 13 people with chronic stroke and 10 age-matched controls. In addition, the participants with stroke performed a fatiguing contraction of the paretic leg at the absolute torque equivalent to 20% maximal voluntary contraction of the nonparetic leg and were tested for self-selected walking speed (10-m Walk Test) and balance (Berg). Results: When matching the nonparetic target torque, the paretic hip flexors had a shorter time to task failure compared with the nonparetic leg and controls (P \u3c 0.05). The time to failure of the paretic leg was inversely correlated with the reduction of hip flexion maximal voluntary contraction torque. Self-selected walking speed was correlated with declines in torque and steadiness. Berg-Balance scores were inversely correlated with the force fluctuation amplitude. Conclusions: Fatigue and precision of contraction are correlated with walking function and balance after stroke

Stroke-related Effects on Maximal Dynamic Hip Flexor Fatigability and Functional Implications

Introduction: Stroke-related changes in maximal dynamic hip flexor muscle fatigability may be more relevant functionally than isometric hip flexor fatigability. Methods: Ten chronic stroke survivors performed 5 sets of 30 hip flexion maximal dynamic voluntary contractions (MDVC). A maximal isometric voluntary contraction (MIVC) was performed before and after completion of the dynamic contractions. Both the paretic and nonparetic legs were tested. Results: Reduction in hip flexion MDVC torque in the paretic leg (44.7%) was larger than the nonparetic leg (31.7%). The paretic leg had a larger reduction in rectus femoris EMG (28.9%) between the first and last set of MDVCs than the nonparetic leg (7.4%). Reduction in paretic leg MDVC torque was correlated with self-selected walking speed (r2 = 0.43), while reduction in MIVC torque was not (r2 = 0.11). Conclusions: Reductions in maximal dynamic torque of paretic hip flexors may be a better predictor of walking function than reductions in maximal isometric contractions

Reflex Response to Imposed Bilateral Hip Oscillations in Human Spinal Cord Injury

In human spinal cord injury (SCI), hip-triggered reflexes are associated with organized interneuronal spinal networks, and it has been suggested that these spastic reflex pathways incorporate interneuronal circuitry involved with spinal control of locomotion (Schmit and Benz 2002; Steldt and Schmit 2004). To determine if spastic reflex pathways overlap with spinal circuits involved with locomotion, we investigated the effects of afferent input from the contralateral hip on spastic reflex activity in eleven chronic SCI study participants. A novel servomotor drive system was constructed to impose bilateral hip oscillations while the knees and ankles were held in an isometric position using instrumented leg braces. Surface electromyograms (EMGs) and joint torques were recorded during the imposed hip oscillations. Tests were conducted at two different frequencies to test for velocity-dependence of the reflexes and the following four tests were used to examine the effects of contralateral hip afferent feedback on spastic reflexes: (1) bilateral alternating, (2) bilateral synchronous, (3) unilateral leg oscillation with the contralateral leg held stationary in hip extension, and (4) unilateral leg oscillation with the contralateral leg held stationary in hip flexion. The response to bilateral alternating movements resulted in an increase in the reflex magnitude compared to the bilateral synchronous movements. Unilateral leg perturbations yielded reflex patterns that were consistent with the reflex patterns observed during alternating and synchronous hip oscillations. These observations suggest that spastic reflex excitability is modulated through afferent input from the contralateral hip, and further suggest that spastic reflexes in human SCI may be linked with spinal locomotor networks

Bilateral Oscillatory Hip Movements Induce Windup of Multijoint Lower Extremity Spastic Reflexes in Chronic Spinal Cord Injury

After spinal cord injury (SCI), alterations in intrinsic motoneuron properties have been shown to be partly responsible for spastic reflex behaviors in human SCI. In particular, a dysregulation of voltage-dependent depolarizing persistent inward currents (PICs) may permit sustained muscle contraction after the removal of a brief excitatory stimulus. Windup, in which the motor response increases with repeated activation, is an indicator of PICs. Although windup of homonymous stretch reflexes has been shown, multijoint muscle activity is often observed following imposed limb movements and may exhibit a similar windup phenomenon. The purpose of this study was to identify and quantify windup of multijoint reflex responses to repeated imposed hip oscillations. Ten chronic SCI subjects participated in this study. A custom-built servomotor apparatus was used to oscillate the legs about the hip joint bilaterally and unilaterally from 10° of extension to 40° flexion for 10 consecutive cycles. Surface electromyograms (EMGs) and joint torques were recorded from both legs. Consistent with a windup response, hip and knee flexion/extension and ankle plantarflexion torque and EMG responses varied according to movement cycle number. The temporal patterns of windup depended on the muscle groups that were activated, which may suggest a difference in the response of neurons in different spinal pathways. Furthermore, because windup was seen in muscles that were not being stretched, these results imply that changes in interneuronal properties are also likely to be associated with windup of spastic reflexes in human SCI

The Effect of Antagonist Muscle Sensory Input on Force Regulation.

The purpose of this study was to understand how stretch-related sensory feedback from an antagonist muscle affects agonist muscle output at different contraction levels in healthy adults. Ten young (25.3 ± 2.4 years), healthy subjects performed constant isometric knee flexion contractions (agonist) at 6 torque levels: 5%, 10%, 15%, 20%, 30%, and 40% of their maximal voluntary contraction. For half of the trials, subjects received patellar tendon taps (antagonist sensory feedback) during the contraction. We compared error in targeted knee flexion torque and hamstring muscle activity, with and without patellar tendon tapping, across the 6 torque levels. At lower torque levels (5%, 10%, and 15%), subjects produced greater knee torque error following tendon tapping compared with the same torque levels without tendon tapping. In contrast, we did not find any difference in torque output at higher target levels (20%, 30%, and 40%) between trials with and without tendon tapping. We also observed a load-dependent increase in the magnitude of agonist muscle activity after tendon taps, with no associated load-dependent increase in agonist and antagonist co-activation, or reflex inhibition from the antagonist tapping. The findings suggest that at relatively low muscle activity there is a deficiency in the ability to correct motor output after sensory disturbances, and cortical centers (versus sub-cortical) are likely involved