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.

The cerebellum probably obeys the rules of sensorimotor integration common in the nervous system. One such a rule is formulated: the nervous system organizes spatial frames of reference for the sensorimotor apparatus and produces voluntary movements by shifting their origin points. We give examples of spatial frames of reference for different single- and multi-joint movements including locomotion and also illustrate that the process of motor development and learning may depend critically on the formation of appropriate frames of reference and the organism's ability to manage them. We suggest that a solution to the problem of sensorimotor integration may not be trivial and may actually change the mental and experimental paradigms used in the understanding of the cerebellum and other brain structures, [HOUK et al.; SIMPSON et al.; SMITH; TIIACH]

The motor deficits observed in patients following some lesions of the central nervous system may be viewed as falling at one extreme of the continuum of possible motor behaviours. They are usually associated with an impaired ability to select and control specific movements from the available repertoire. Such movements may not be viewed as abnormal. However, it is unlikely that the primary motor deficits can all be considered adaptive.

A hypothesis about sensorimotor integration (the λ model) is described and applied to movement control and kinesthesia. The central idea is that the nervous system organizes positional frames of reference for the sensorimotor apparatus and produces active movements by shifting the frames in terms of spatial coordinates. Kinematic and electromyographic patterns are not programmed, but emerge from the dynamic interaction among the system s components, including external forces within the designated frame of reference. Motoneuronal threshold properties and proprioceptive inputs to motoneurons may be cardinal components of the physiological mechanism that produces positional frames of reference. The hypothesis that intentional movements are produced by shifting the frame of reference is extended to multi-muscle and multi-degrees-of-freedom systems with a solution of the redundancy problem that allows the control of a joint alone or in combination with other joints to produce any desired limb configuration and movement trajectory. The model also implies that for each motor behavior, the nervous system uses a strategy that minimizes the number of changeable control variables and keeps the parameters of these changes invariant. Examples are provided of simulated kinematic and electromyographic signals from single- and multi-joint arm movements produced by suggested patterns of control variables. Empirical support is provided and additional tests of the model are suggested. The model is contrasted with others based on the ideas of programming of motoneuronal activity, muscle forces, stiffness, or movement kinematics.

Understanding of the λ model has greatly increased in recent years as evidenced by most of the commentaries. Some commentators underscored the potential of the model to integrate aspects of different sensorimotor systems in the production of movement. Other commentators focused on not-yet-fully-developed parts of the model. A few persisted in misunderstanding some of its basic concepts, and on these grounds they reject it. In responding to commentaries we continue to elaborate on some fundamental points of the model, especially control variables, the idea of movement production by shifting the positional frame of reference and the hypothesis of biomechanical correspondence in motor control. We also continue to develop our ideas on the intrinsic generation of the frame of reference associated with external space and utilized for the control of arm movement and locomotion. The dynamic principles underlying the model are discussed in light of the dynamical systems approach.

The tonic stretch reflex threshold in children with cerebral palsy (CP) was measured to determine its test–retest reliability and its concurrent validity as a potential measure of spasticity. Fourteen children with spastic CP aged 6 to 18 years were tested on three separate occasions for clinical spasticity and stretch reflex thresholds of affected elbow flexors. Electromyographic (EMG) recordings were obtained by surface electrodes for elbow flexors and extensors during mechanical displacements of the passive joint towards extension. Displacements were produced by a torque motor at seven velocities which randomly varied from trial to trial. EMG activity was measured in the stretched flexor muscles to determine threshold angles and velocities for each velocity of stretch. These were plotted on a velocity–angle-phase diagram and regression analysis was used to determine the static stretch reflex threshold for each participant. The measure showed good test–retest reliability for the group (ICC 0.73, p<0.001) whereas a significant correlation between the measure and the clinical spasticity scale was not found. This technique is a potential outcome variable for measuring the efficacy of treatments aimed at decreasing spasticity in children with CP.

The basic concepts of motor control formulated in our target article were derived from specific experiments, a fact which is disregarded in Dalenoort's comments. A purely academic approach to motor control may not result in a clearer understanding of control concepts.