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Stretch Reflex Latencies in Spastic Hemiparetic Subjects are Prolonged After Transcutaneous Electrical Nerve Stimulation

Published online by Cambridge University Press:  18 September 2015

Christina W.Y. Hui-Chan*
Affiliation:
School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal
Mindy F. Levin
Affiliation:
School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal
*
School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3654 Drummond Street, Montreal, Quebec, Canada H3G IY5
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Abstract:

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Low-intensity repetitive electrical stimulation such as dorsal column and transcutaneous electrical nerve stimulation (TENS) reportedly decreases spasticity and improves voluntary motor control. However, the mechanisms mediating these effects are unclear. Recent findings suggest that spasticity may be characterized more appropriately by a decrease in the stretch reflex threshold than by an increase in gain. Our objectives were: (1) to examine possible changes in stretch reflex excitability following 45 min of TENS, (2) to map out the time course of possible post-stimulation effects via both latency and magnitude (amplitude or area) measurements, and (3) to determine the role of segmental versus non-segmental mechanisms involved in mediating these changes. The effects of 45 min of segmentally and heterosegmentally applied TENS on lower limb reflexes in ten spastic hemiparetic subjects were contrasted with those resulting from placebo stimulation. We found that both segmentally and heterosegmentally applied TENS caused an immediate increase in soleus H reflex latencies that was evident for up to 60 minutes post-stimulation in over 75% of the subjects. Similar increases for up to 60 and 40 minutes post-stimulation was noted for the stretch reflex latencies in 50% and 67% of the subjects respectively for segmental and heterosegmental stimulation. These results suggested that manipulation of segmental and heterosegmental afférents for 45 min may lead to a decrease of the otherwise augmented stretch reflex excitability accompanying hemiparetic spasticity.

Type
Research Article
Copyright
Copyright © Canadian Neurological Sciences Federation 1993

References

1.Lance, JW.Symposium synopsis. In: Feldman, RG, Young, RR, Koella, WP eds. Spasticity: Disordered Motor Control. Chicago: Year Book 1980; 485494.Google Scholar
2.Gilman, S, Lieberman, JS, Marco, LA.Spinal mechanisms underlying the effects of unilateral ablation of areas 4 and 6 in monkeys. Brain 1974; 97: 4964.CrossRefGoogle ScholarPubMed
3.Hagbarth, K-E, Wallin, G, Lôfstedt, L.Muscle spindle responses to stretch in normal and spastic subjects. Scand J Rehabil Med 1973; 5: 156159.CrossRefGoogle ScholarPubMed
4.Hagbarth, KE, Wallin, G, Lôfstedt, L, et al.Muscle spindle activity in alternating tremor of parkinsonism and in clonus. J Neurol Neurosurg Psychiatry 1975; 39: 636641.CrossRefGoogle Scholar
5.Feldman, AG.Functional tuning of the nervous system with control of movement or maintenance of a steady posture. II. Controllable parameters of the muscle. Biophysics 1966; II: 565578.Google Scholar
6.Feldman, AG.Once more on the equilibrium-point hypothesis model) of motor control. J Mot Behaviour 1986; 18: 1754.CrossRefGoogle ScholarPubMed
7.Ashby, P, Verrier, M.Neurophysiological changes in hemiplegia. Neurology 1976: 26: 11451151.CrossRefGoogle ScholarPubMed
8.Hale, JL, Chan, CWY.The acute effects of conventional TENS in the management of spasticity. Physiothcr Can 1986; 38: (Suppl 5) 3.Google Scholar
9.Dimitrijevic, MR, Nathan, PW.Studies of spasticity in man. 3. Analysis of reflex activity evoked by noxious cutaneous stimulation. Brain 1968; 91: 349368.Google ScholarPubMed
10.Dimitrijevic, MR, Faganel, J, Lehmkuhl, D.et al.Motor control in man after partial or complete spinal cord injury. In: Desmedt, JE. ed. Motor Control Mechanisms in Health and Disease. New York: Raven Press 1983; 915926.Google Scholar
11.Dimitrijevic, MR, Nathan, PW.Studies of spasticity in man. 1. Some features of spasticity. Brain 1967; 90: 130.Google Scholar
12.Stefanovska, A, Gros, N, Vodovnik, L.Rebersek, S.Acimovic-Janezic, R.Chronic electrical stimulation for the modification of spasticity in hémiplégie patients. Scand J Rehab Med Suppl 1988: 17: 115121.Google Scholar
13.Duchenne, GB.De l'éléctrisation localisée et de son application à la pathologie et à la thérapeutique. Paris: Baillière, 1855.Google Scholar
14.Levine, MG, Knott, M.Kabat, H.Relaxation of spasticity by electrical stimulation of antagonist muscles. Arch Phys Med 1952: II: 668673.Google Scholar
15.Alfieri, V.Electrical treatment of spasticity. Scand J Rehab Med 1982: 14: 177182.Google ScholarPubMed
16.Vodovnik, L, Bowman, BR, Hufford, P.Effects of electrical stimulation on spinal spasticity. Scand J Rehab Med 1984; 16: 2934.CrossRefGoogle ScholarPubMed
17.Nashold, BS, Friedman, H.Dorsal column stimulation for control of pain. Preliminary report on 30 patients. J Neurosurg 1972; 36: 590597.Google ScholarPubMed
18.Cook, AW, Weinstein, SD.Chronic dorsal column stimulation in multiple sclerosis. NY State J Med 1973; 73: 28632872.Google ScholarPubMed
19.Levin, MF, Hui-Chan, CWY.Conventional and acupuncture-like transcutaneous electrical nerve stimulation excite similar afferent fibers. Arch Phys Med Rehabil 1993; 74: 5460.Google ScholarPubMed
20.Fredriksen, TA, Bergmann, S, Hesselberg, JP, et al.Electrical stimulation in multiple sclerosis. Comparison of transcutaneous electrical stimulation and epidural spinal cord stimulation. Appl Neurophysiol 1986; 49: 424.Google ScholarPubMed
21.Levin, MF, Hui-Chan, CWY.Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions. Electroencephalogr Clin Neurophysiol 1992; 85: 131142.CrossRefGoogle ScholarPubMed
22.Chapman, CE, Ruegg, DG.Wiesendanger M. Effects of dorsal cord stimulation on stretch reflexes. Brain Res 1983: 258: 211215.CrossRefGoogle ScholarPubMed
23.Siegfried, J, Krainick, JU, Haas, H, et al.Electrical spinal cord stimulation for spastic movement disorders. Appl Neurophysiol 1978: 41: 134141.Google ScholarPubMed
24.Hui-Chan, CWY.Tsang, H.Inhibition of the human flexion reflex by low intensity, high frequency transcutaneous electrical nerve stimulation (TENS) has a gradual onset and offset. Pain 1987: 28: 239253.CrossRefGoogle Scholar
25.Facchinetti, F, Sandrini, G, Petraglia, F, et al.Concomitant increase in nociceptive flexion reflex threshold and plasma opioids following transcutaneous nerve stimulation. Pain 1984; 19: 295303.CrossRefGoogle ScholarPubMed
26.Lee, WA, Boughton, A, Rymer, WZ.Absence of stretch reflex gain enhancement in voluntarily activated spastic muscle. Exp Neurol 1987; 98:317335.CrossRefGoogle ScholarPubMed
27.Powers, RK, Marder-Meyer, J, Rymer, WZ.Quantitative relations between hypertonia and stretch reflex threshold in spastic hemi-paresis. Ann Neurol 1988: 23: 115124.CrossRefGoogle Scholar
28.Levin, MF.Chan, CWY.Stretch reflex latency changes following repetitive reciprocal and hetero-segmental electrical stimulation in spastic hémiplégie subjects. Soc Neurosci Abstr 1989; 15: 916.Google Scholar
29.Ashworth, B.Preliminary trial of carioproddal in multiple sclerosis. The Practitioner 1964; 192: 540542.Google ScholarPubMed
30.Berardelli, A, Sabra, AF, Hallet, M.et al.Stretch reflexes of triceps surae in patients with upper motor neuron syndromes. J Neurol Neurosurg Psychiatry 1983; 46: 5460.CrossRefGoogle ScholarPubMed
31.Hoffmann, P.Uber die Beziehungen der Sehnenreflexe zur willkürlichen Bewegung und zum Tonus. Z Biol 1918; 68: 351370.Google Scholar
32.Schieppati, M.The Hoffmann reflex: a means of assessing spinal reflex excitability and its descending control in man. Prog Neurobiol 1987; 28: 345376.CrossRefGoogle ScholarPubMed
33.Desmedt, JE, Godaux, E.Mechanism of the vibration paradox: excitatory and inhibitory effects of tendon vibration on single soleus muscle motor units in man. J Physiol (Lond) 1978; 285: 197207.CrossRefGoogle ScholarPubMed
34.Robinson, KL, McComas, AJ, Belanger, AY.Control of soleus motoneuron excitability during muscle stretch in man. J Neurol Neurosurg Psychiatry 1982; 45: 698704.CrossRefGoogle ScholarPubMed
35.Inman, VT.The joints of the ankle. Baltimore: Williams and Wilkins 1976.Google Scholar
36.Hugon, M.Methodology of the Hoffmann reflex in man. In: Desmedt, JE, ed. New Developments in Electromyography and Clinical Neurophysiology. Basel: Karger 1973: 3; 277293.Google Scholar
37.Meinck, H-M.Facilitation and inhibition of the human H reflex as a function of the amplitude of the control reflex. Electro-encephlogr Clin Neurophysiol 1980; 48: 203211.CrossRefGoogle Scholar
38.Angel, RW, Hofmann, WW.The H reflex in normal, spastic, and rigid subjects. Arch Neurol 1963; 8: 591596.CrossRefGoogle Scholar
39.Levin, MF, Hui-Chan, CWY.Are H and stretch reflexes in hemiparesis reproducible and correlated with spasticity? J Neurol 1993; 240: 6371.CrossRefGoogle ScholarPubMed
40.Burke, D, Gandevia, SC.McKeon, B.Monosynaptic and oligosynaptic contributions to human ankle jerk and H-reflex. J Neurophysiol 1984: 52:435448.CrossRefGoogle ScholarPubMed
41.Burke, RE.Composite nature of the monosynaptic excitatory post synaptic potential. J Neurophysiol 1967; 30: 11141136.CrossRefGoogle Scholar
42.Feldman, AG.Orlovsky, GN.Activity of interneurons mediating reciprocal la inhibition during locomotion. Brain Res 1975; 81: 181194.CrossRefGoogle Scholar
43.Abbruzzese, M, Reni, L, Favale, E.Changes in central delay of soleus H reflex after facilitatory or inhibitory conditioning in humans. J Neurophysiol 1991; 65: 15981605.CrossRefGoogle ScholarPubMed
44.Verrier, M.Alterations in H reflex magnitude by variations in base-line EMG excitability. Electroencephalogr Clin Neurophysiol 1985; 60: 492499.CrossRefGoogle Scholar
45.Edin, BB, Vallbo, AB.Stretch sensitization of human muscle spindles. J Physiol (Lond) 1988; 400: 101111.CrossRefGoogle ScholarPubMed
46.Walker, JB.Modulation of spasticity: prolonged suppression of a spinal reflex by electrical stimulation. Science 1982; 216: 203204.CrossRefGoogle ScholarPubMed
47.Macdonald, JF, Pearson, JF.Inhibition of spinal interneuronal activity by repeated cutaneous stimulation: a possible substrate of flexor reflex habituation. J Neurobiol 1979; 10: 7992.CrossRefGoogle ScholarPubMed
48.Feldman, AG, Orlovsky, GN.The influence of different descending systems on the tonic stretch reflex in the cat. Exp Neurol 1972; 37: 481494.CrossRefGoogle ScholarPubMed
49.Gillies, JD, Lance, JW.Neilson, PD, et al.Presynaptic inhibition of the monosynaptic reflex by vibration. J Physiol (Lond) 1969; 205: 329339.CrossRefGoogle ScholarPubMed
50.Burke, D, Hagbarth, K-E.Lofstedt, L, et al.The responses of human muscle spindle ending to vibration of non-contracting muscles. J Physiol (Lond) 1976; 261: 673693.CrossRefGoogle ScholarPubMed
51.Baldissera, F, Hultborn, H.liiert, M.Integration in spinal neuronal systems. In: Brooks, VB, ed. Handbook of Physiology. Sect. 1: The Nervous System, Vol II, Part 1. Bethesda: Am Physiol Soc 1981: 509596.Google Scholar
52.Salar, G, Job, I, Mingrino, S, et al.Effect of transcutaneous electrotherapy on CSF: β-endorphin content in patients without pain problems. Pain 1981; 10: 169172.CrossRefGoogle ScholarPubMed