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Suppression of the rat micturition reflex by imipramine.

1. This study investigates possible mechanisms through which imipramine (IMI) exerts its antienuretic effect. The micturition reflex in response to bladder distension produced by saline infusion was examined in anaesthetized rats. 2. The amplitude and frequency of micturition reflex contractions were reduced by peripheral administration of IMI, but the micturition reflex was abolished after its intracerebroventricular (i.c.v.) administration. A muscarinic antagonist, atropine, displayed an inhibitory effect similar to that of IMI. A muscarinic agonist, carbachol, produced a dose-related rightward shift of the dose-response curve to IMI. Both IMI i.c.v. and the muscarinic antagonist l-methylscopolamine i.c.v. elevated the threshold of volume and pressure for micturition initiation, indicating that IMI and muscarinic antagonists mainly exert a central inhibitory effect on the micturition reflex. 3. In addition, to evaluate the role of central monoaminergic neurotransmission on micturition, the acetylcholine depletor hemicholinium-3 (HC-3), the catecholamines depletor alpha-methyl-p-tyrosine (AMPT), and the serotonin depletor p-chlorophenylalanine (PCPA) were examined alone or in combination with IMI. The micturition threshold was increased by treatment with HC-3, but not by AMPT or PCPA. In HC-3 treated rats, the inhibitory effect of IMI on the micturition reflex was more prolonged than in normal rats. After administration of IMI, the recovery from the cessation of micturition reflex contractions was facilitated by carbachol in normal rats, but not in HC-3 treated rats. This indicates that acetylcholine plays a facilitatory role in initiating micturition reflex contractions. 4. Acute treatment with IMI decreased the frequency and increased the volume threshold of micturition reflex contraction. Acute and chronic treatment with IMI prolonged the cessation period of micturition by IMI. 5. These results suggest that IMI exerts an inhibitory action on the micturition reflex by a central cholinergic mechanism. Muscarinic receptors located at the supraspinal level are tonically stimulated during distension-induced micturition reflex.

Adrenergic Uptake Inhibitors↗

Cardiac sympathetic afferent stimulation augments the arterial chemoreceptor reflex in anesthetized rats.

Chronic heart failure (CHF) is well known to be associated with both an enhanced chemoreceptor reflex and an augmented cardiac "sympathetic afferent reflex" (CSAR). The augmentation of the CSAR may play an important role in the enhanced chemoreceptor reflex in the CHF state because the same central areas are involved in the sympathetic outputs of both reflexes. We determined whether chemical and electrical stimulation of the CSAR augments chemoreceptor reflex function in normal rats. Under anesthesia, renal sympathetic nerve activity (RSNA) and mean arterial pressure (MAP) were recorded. The chemoreceptor reflex was tested by unilateral intra-carotid artery bolus injection of potassium cyanide (KCN) and nicotine. We found that 1) left ventricular epicardial application of capsaicin increased the pressor responses and the RSNA responses to chemoreflex activation induced by both KCN and nicotine; 2) when the central end of the left cardiac sympathetic nerve was electrically stimulated, both the pressor and the RSNA responses to chemoreflex activation induced by KCN were increased; 3) pretreatment with intracerebroventricular injection of losartan (500 nmol) completely prevented the enhanced chemoreceptor reflex induced by electrical stimulation of the cardiac sympathetic nerve; and 4) bilateral microinjection of losartan (250 pmol) into the nucleus tractus solitarii (NTS) completely abolished the enhanced chemoreceptor reflex by epicardial application of capsaicin. These results suggest that both the chemical and electrical stimulation of the CSAR augments chemoreceptor reflex and that central ANG II, specially located in the NTS, plays a major role in these reflex interactions.

Analgesics, Non-Narcotic↗

The hoffmann reflex: methodologic considerations and applications for use in sports medicine and athletic training research.

OBJECTIVE: To discuss the proper methods used to elicit the Hoffmann reflex (H-reflex) and to present different situations in which this tool can be used in sports medicine research. DATA SOURCES: We searched MEDLINE and SPORT Discus from 1960 to 2004 using the key words Hoffmann reflex, H-reflex, and methodology. The remaining citations were collected from references of similar papers. DATA SYNTHESIS: Numerous authors have used the H-reflex as a tool to examine neurologic conditions. However, few have used the H-reflex to examine neuromuscular impairments after sport injuries. Several studies were available describing the appropriate methods to elicit the H-reflex and examining the reliability of this measurement in different muscles. CONCLUSIONS/RECOMMENDATIONS: The H-reflex is a valuable tool to evaluate neurologic function in various populations. However, because of the sensitivity of this measurement to extraneous factors, care must be taken when eliciting the H-reflex. We discuss recommendations on how to elicit the H-reflex and how to appropriately present methods in a manuscript.

Journal Article↗

Inhibitory effects on flexor reflexes in patients with a complete spinal cord lesion.

The inhibitory effects on flexors of electrical stimulation of a distal peripheral nerve were investigated in 7 paraplegic patients having a complete spinal cord section. The stimuli (3-50 mA) were applied to the sural nerve. Their effects were investigated on: 1) the ipsi- and contralateral H reflex of the Tibialis Anterior (TA); 2) the continuous EMG activity reflexly elicited in TA by a sustained pinch of the foot and 3) on the reflexes evoked in TA by contralateral sural nerve stimulation. Sural nerve stimulation induced two peaks of facilitation of the ipsilateral TA H reflex that could be replaced by inhibition as the stimulus intensity was increased. The comparison of the effect on H reflexes and the EMG activity suggests presynaptic inhibition of Ia fibres at time intervals longer than 300 ms. The stimulation could depress the sustained EMG reflex activity and induce a period of silence whose duration increased with the intensity of the stimulation. As shown in a previous study, a sural nerve stimulation induced a reflex in TA with a prolonged (more than 130 ms) latency. This late reflex could be selectively inhibited by a contralateral sural nerve stimulation, probably at an interneuronal level. These results confirm that the late reflex in TA is similar to the one observed after Flexor Reflex Afferent (FRA) stimulation in the acute spinal cat with DOPA. In addition, they show that at least some part of the "half centre" organization which has been described in the acute spinal cat with DOPA is also present in the human spinal cord chronically deprived of supraspinal control.

Adolescent↗

Qualitative H-reflex testing in huntington's disease.

The occurrence of H-reflexes over both the anterior tibial muscle and the thenar muscle on both sides was investigated in 15 patients suffering from Huntington's disease, 8 clinically inconspicuous offspring, and 30 healthy normal controls. The following results were obtained: 1. An obvious H-reflex over the anterior tibial muscle was found in 12 of 15 patients; there was no H-reflex in only 3 patients. 2. After stimulation on the median nerve there was an H-reflex in 12 of 13 patients investigated. 3. In 5 of 8 clinically inconspicuous offspring there was an H-reflex after peroneal [4] or median [5] nerve stimulation. In 30 normal controls, 1 displayed a weak H-reflex over the anterior tibial muscle, 9 showed a weak H-reflex after median nerve stimulation. 5. The possibility is discussed that an abnormal H-reflex might be an early sign of central reflex disinhibition in otherwise asymptomatic offspring.

Adult↗

Adaptation of reflexive feedback during arm posture to different environments.

In this study we have examined the ability of the central nervous system (CNS) to use spinal reflexes to minimize displacements during postural control while continuous force perturbations were applied at the hand. The subjects were instructed to minimize the displacements of the hand from a reference position that resulted from the force perturbations. The perturbations were imposed in one direction by means of a hydraulic manipulator of which the virtual mass and damping were varied. Resistance to the perturbations came from intrinsic and reflexive stiffness, and from the virtual environment. It is hypothesized that reflexive feedback during posture maintenance is optimally adjusted such that position deviations are minimal for a given virtual environment. Frequency response functions were estimated, capturing all mechanical properties of the arm at the end point (hand) level. Intrinsic and reflexive parameters were quantified by fitting a linear neuromuscular model to the frequency responses. The reflexive length feedback gain increased strongly with damping and little with the eigenfrequency of the total combined system (i.e. arm plus environment). The reflexive velocity feedback gain decreased slightly with relative damping at the largest eigenfrequency and more markedly at smaller eigenfrequencies. In the case of highest reflex gains, the total system remained stable and sufficiently damped while the responses of only the arm were severely underdamped and sometimes even unstable. To further analyse these results, a model optimization was performed. Intrinsic and reflexive parameters were optimized such that two criterion functions were minimized. The first concerns performance and penalized hand displacements from a reference point. The second one weights afferent control effort to avoid inefficient feedback. The simulations showed good similarities with the estimated values. Length feedback was adequately predicted by the model for all conditions. The predicted velocity feedback gains were larger in all cases, probably indicating a mutual gain limiting relation between length and velocity afferent signals. The results suggest that both reflex gains seem to be adjusted by the CNS, where in particular the length feedback gain was optimal so as to maximize performance at minimum control effort.

Adult↗

Enhanced stretch reflex excitability of the soleus muscle in persons with incomplete rather than complete chronic spinal cord injury.

OBJECTIVE: To compare excitabilities of spinal stretch reflex among clinically complete spinal cord injury (SCI), incomplete SCI, elderly healthy, and young healthy subjects. DESIGN: Case comparison. SETTING: Research laboratory. PARTICIPANTS: Volunteer sample of 12 complete SCI, 10 incomplete SCI, 10 elderly, and 11 young subjects. INTERVENTION: Mechanically induced stretch reflex, H-reflex, and M response in electromyographic activity of the soleus muscle were recorded in all subjects. MAIN OUTCOME MEASURES: Absolute peak-to-peak stretch reflex amplitude and maximum H-reflex (Hmax), and those values relative to the maximum M response (Mmax) amplitude (relative peak-to-peak stretch reflex amplitude) and H/M ratio. RESULTS: Both the absolute and relative peak-to-peak stretch reflex amplitudes showed the greatest values in incomplete SCI among the 4 groups. Although absolute and relative peak-to-peak stretch reflex amplitudes of the incomplete SCI group were greater than those of the complete SCI group, the H/M ratios of both groups were comparable, and were greater than those of the younger and elderly groups. CONCLUSIONS: The results suggest that the greater absolute and relative peak-to-peak stretch reflex amplitudes of incomplete SCI were mostly due to the greater maximum motor potential (Mmax), while the elevated spinal motoneuronal excitability shown by the increased H/M ratio was maintained in the chronic stage after both complete and incomplete SCIs.

Age Factors↗

The impact of cachexia on cardiorespiratory reflex control in chronic heart failure.

BACKGROUND: The mechanism of persistent neurohormonal and cardiorespiratory reflex abnormalities in chronic heart failure remain unclear. Also, why chronic heart failure patients who develop cachexia demonstrate a particularly abnormal neurohormonal profile and have a high risk of death is not known. Impaired reflex control within the cardiac and respiratory systems, and abnormal heart rate variability have both been linked to a poor outcome. Muscle reflexes may contribute to persistent neurohormonal overactivity in wasted patients. Thus, we hypothesized that patients with cardiac cachexia might exhibit particularly profound abnormalities in cardiorespiratory reflexes and heart ratevariability. METHODS AND RESULTS: We investigated 39 chronic heart failure patients: 13 with cardiac cachexia (non-intentional, non-oedematous, documented weight loss of >7.5% of previous normal weight over more than 6 months), and 26 non-cachectic chronic heart failure patients matched according to the severity of chronic heart failure (all men, mean age: 59 vs 60 years, NYHA functional class: 2.6 vs 2.5, peak O(2)consumption: 16.2 vs 16.8 ml. kg(-1). min(-1), left ventricular ejection fraction: 23 vs 24%, all P>0.2 for cachectic vs non-cachectic). In the assessment of the cardiorespiratory reflex control we investigated: cardiac sympathovagal balance (using spectral analysis of heart rate variability to derive low (LF, 0. 04-0.15Hz) and high frequency (HF, 0.15-0.4Hz) components), baroreflex sensitivity (using the phenylephrine method), and peripheral chemosensitivity (using the transient hypoxic method). There was a severely abnormal pattern of cardiorespiratory reflex control in patients with cachexia compared with non-cachectic patients. The former group exhibited severely impaired autonomic reflex control, characterized by an abnormal profile of heart rate variability (reduced LF component), and depressed baroreflex sensitivity (P=0.0001 and P=0.02, respectively, vs non-cachectics). Patients with cachexia also demonstrated an increased peripheral chemosensitivity (0.91 vs0.46 l. min(-1). %SaO(2)(-1), P<0.001, cachectic vs non-cachectic, respectively). In the correlation analyses the degree of impairment in the reflex control was more closely related to wasting, and to the level of neurohormonal activation (as measured by the levels of epinephrine and norepinephrine) than to conventional markers of the severity of heart failure. CONCLUSIONS: Chronic heart failure patients who developed cardiac cachexia demonstrate an abnormal reflex control within the cardiovascular and respiratory systems. The nature of the link between this phenomenon and hormonal changes and the poor prognosis of cachectic chronic heart failure patients warrants further investigation.

Cachexia↗

Modulation of spinal reflexes: arousal, pleasure, action.

The human startle reflex is reliably modulated by the affective valence of foreground pictures, with larger reflexes elicited when viewing unpleasant relative to pleasant scenes. If this modulation is due to priming of the defensive startle reflex by an aversive foreground, a different pattern should occur for a reflex that is not inherently defensive in nature. In the current study, affective modulation was investigated using the spinal tendinous (T) reflex, which is well documented as sensitive to differences in arousal and is involved in actions that are both appetitively defensively motivated. As such, T reflexes elicited during unpleasant pictures were not expected to be augmented relative to those elicited in the context of pleasant pictures. Results showed that T reflexes were facilitated during processing of arousing stimuli-either pleasant or unpleasant relative to low-arousal neutral materials. These effects of emotional stimuli on T-reflex amplitude are consistent with hypothesis that motivational priming underlies affective reflex modulation.

Adult↗

The maturation of cutaneous reflexes studied in the upper limb in man.

Cutaneous reflex responses have been recorded from forearm flexor and extensor muscles following electrical stimulation of the fingers. Recordings have been made from premature infants, term infants and children between the age of 6 weeks and 11 years. In the new-born, stimulation of the fingers elicits such a powerful reflex that, in general, individual stimuli will evoke a reflex synchronous action potential in both forearm flexor and extensor muscles. Individual stimuli delivered to the fingers also elicit reflex synchronous muscle action potentials in forearm flexor and extensor muscles in patients with clinical signs of upper motor neurone lesion affecting the upper limb; this has not been observed in normal adult subjects. The latency of the reflex response in the term infant is about 18 msec. Comparison of this value with the latency of the tendon jerk for these muscles would indicate a central delay for the cutaneous reflex of about 3 msec. The latencies of the cutaneous reflex and tendon jerk remain constant over the first 5 years of life. The size of the short-latency cutaneous reflex response decreases progressively over the first year of life. In the second year of life stimulation of the fingers produces long- as well as short-latency increases in recorded muscle electrical activity. The maturation of the cutaneous reflex response is discussed in terms of the maturation of function of the corticospinal tract.

Action Potentials↗

The effect of percutaneous motor cortex stimulation on H reflexes in muscles of the arm and leg in intact man.

The technique of electrical stimulation of the brain via scalp electrodes has been used to activate corticospinal pathways in intact man. The intensity of stimulation was adjusted to be below the threshold necessary to evoke a direct electromyographic response when the muscles being tested were totally relaxed. Changes in spinal cord excitability were measured using H-reflex (monosynaptic) testing. By this means it was found that subthreshold scalp stimulation can produce a descending corticospinal volley even in the absence of a direct muscle response. The time course of changes in spinal cord excitability was evaluated by evoking test H reflexes at different intervals relative to the scalp stimulus. In wrist and finger flexor muscles of seven subjects, a single subthreshold scalp shock produced an initial peak facilitation of the H reflex which on average lasted for 2.5 ms. The end of the initial facilitation was marked by a return of the H reflex towards basal levels and on one occasion by a frank inhibition. It is suggested that the initial facilitation is produced by arrival at the motoneurones of monosynaptic excitatory post-synaptic potentials (e.p.s.p.s) and is truncated by the subsequent arrival of disynaptic inhibitory post-synaptic potentials (i.p.s.p.s). The initial facilitation was followed by a second phase of facilitation of the H reflex. The second phase was weaker, more variable and longer lasting (from 5 to 20 ms) than the first phase. The threshold of scalp stimulus intensity required to produce an effect on the H reflex was the same for the first and second phases of facilitation. Several possible explanations are discussed for the mechanism responsible for the late and long-lasting facilitation. In two subjects wrist and finger extensor muscles were studied. The time course of H-reflex changes was similar to that of the flexors except that the initial facilitation was followed by a frank inhibition in both subjects. In one subject thenar muscles and tibialis anterior were studied and behaved similarly to wrist and finger flexor muscles. Effects on the soleus H reflex was studied in seven subjects. In five of these subjects, in contrast to the other muscles studied, the initial event was an inhibition of the H reflex. This inhibition also could be seen preceding the usual period of facilitation in averaged rectified surface electromyogram (e.m.g.) records when scalp stimuli were given during weak voluntary activation of soleus.(ABSTRACT TRUNCATED AT 400 WORDS)

Arm↗

Functional relationships between myotatic reflex arcs of the lower limb in man: investigation by excitability curves.

In 30 normal subjects, the influence of the reflex activation of one myotatic reflex arc on the excitability of other myotatic reflex arcs of the lower limb has been investigated using excitability curves. Soleus, quadriceps, and short biceps tendon reflexes as well as H reflex at two different intensities (liminal and H max/2) were used either as conditioning or as conditioned responses. The reflex activation of the soleus muscle has opposite effects on antagonistic muscle groups of the thigh: facilitation of the quadriceps myotatic arc and inhibition of the short biceps myotatic reflex arc. Conversely, activation of both quadriceps and short biceps muscles leads to a marked and long lasting (+/- 5000 ms) inhibition of the soleus myotatic reflex arc. The differences of functional organization between proximal and distal myotatic reflex arcs are emphasized and the role of the afferent impulses secondary to the conditioning muscular contraction is discussed.

Afferent Pathways↗

Measurement of the Achilles tendon reflex for the diagnosis of lumbosacral root compression syndromes.

The Hoffmann reflex and the Achilles tendon reflex were measured in a group of 194 subjects suspected of having a lumbosacral root compression syndrome. The Achilles tendon reflex was elicited manually with a metal hammer. There was a high correlation between the H-M interval and the Achilles tendon reflex-M interval. The usefulness of the Achilles tendon reflex was evaluated in a selected sub-group of 61 patients with proven L5 or S1 root compression. Neither the H-reflex nor the Achilles tendon reflex appeared to be of any value in detecting L5 root compression. Both the H-reflex and the Achilles tendon reflex proved to be useful for diagnosis of S1 root compression syndromes, the latter being the more sensitive method.

Achilles Tendon↗

Visceral and somatic reflexes produced by J pulmonary receptors in newborn kittens.

The functional efficiency of J pulmonary receptor reflexes was studied in 28 newborn anesthetized kittens. J receptor stimulation was achieved by injecting phenyl diguanide (PDG) solution into the right atrium using a technique established earlier for cats. Control injections of PDG into the aorta were made. Respiration, aortic blood presure, and knee jerk were recorded. The Hering-Breuer reflex was routinely tested in each kitten by inflating the lungs through the tracheal cannula. In the newborn kitten (1-6 days old), it was not possible to elicit any effect on injection of PDG into the right atrium. At 1 wk, the visceral reflexes--apnea, rapid shallow breathing, bradycardia--could be produced by doses much higher (six times) than the adult dose. By the 10th day, the visceral reflexes were fully developed. The motor reflex, i.e., inhibition of EMG and reduction of knee jerk, was elicited after 3 wk. The earliest response was seen in a 3-wk-old kitten. All these reflexes were abolished by bilateral cervical vagotomy. These results suggest that the J receptor reflexes are poorly developed in the newborn kitten and that the motor reflexes develop much later than the visceral reflexes.

Age Factors↗

The H- and T-reflex response parameters of long- and short-distance athletes.

It is well known that the training level of a muscle belongs to the parameters that affect the H-reflex response amplitude. The aim of this study was to investigate the effects of training type on H- and T-reflex response parameters. For this purpose, 20 long-distance athletes (group I, test group), 18 short-distance athletes (group II, test group) and 20 non-trained subjects (group III, control group) were involved in this study in which the H- and T-reflex amplitude and latency values were measured. The H-reflex amplitude and latency values found in groups I, II and III were 3.64 +/- 0.28 mV and 26.88 +/- 1.45 ms, 3.17 +/- 0.26 mV and 26.19 +/- 1.89 ms, and 6.07 +/- 0.34 mV and 26.77 +/- 1.32 ms, respectively. The T-reflex amplitude and latency values of the groups I, II and III were 3.30 +/- 0.18 mV and 32.01 +/- 1.02 ms, 3.11 +/- 0.20 mV and 31.47 +/- 1.16 ms, 4.24 +/- 0.21 mV and 31.47 +/- 1.16 ms, respectively. There was no statistically significant difference between the groups with respect to latencies of H- and T-reflexes (p>0.05). In both test groups, the amplitudes of the H-reflex and T-reflex were significantly smaller than the control group (p<0.05). The results of this study suggest that training of muscles affect the H- and T-reflex response parameters.

Achilles Tendon↗

Segmental H-reflex studies in upper and lower limbs of patients with radiculopathy.

The H-reflex was recorded from the flexor carpi radialis, vastus medialis, and soleus muscles in patients with radiculopathy at C7, L4, and S1 roots. Reflex parameters were compared to normal standards and correlated with other electrophysiologic (eg, electromyography) and clinical evaluations, as well as magnetic resonance imaging scan reports. The H-reflex had significantly smaller peak-to-peak amplitude and longer latency. The stimulus threshold for eliciting the reflexes was substantially higher than normal standards, and the reflex was polyphasic in most patients. A strong correlation was recorded between the pathologic changes in reflex parameters and electrophysiologic and clinical findings of different segmental lesions. Magnetic resonance imaging reports showed moderate correlation with the H-reflex changes. A test of specificity showed that soleus and vastus medialis H-reflexes were 100% specific for lumbosacral segments; flexor carpi radialis was 90% specific for cervical spinal segments. These results indicate that flexor carpi radialis, vastus medialis, and soleus H-reflexes are useful and valid methods for testing C7, L4, and S1 radiculopathy.

Action Potentials↗

Role of peripheral afferents and spinal reflexes in normal and impaired human locomotion.

For many years, electrophysiological investigations of locomotion were restricted to animals, largely the cat. They concentrated on and emphasized the role of spinal interneuronal networks responsible for the generation of the locomotor pattern. Following the introduction of perturbation impulses and electrical nerve stimulation during stance and gait, information became increasingly available concerning the role of the reflex systems involved in the regulation of gait, their afferent pathways and their control by supraspinal motor centres. During gait monosynaptic stretch reflexes are inhibited. From a knowledge of the behaviour of the cerebral potentials evoked during stance and gait, it can be deduced that during gait the signals of group I afferents are blocked at both segmental and supraspinal levels. Polysynaptic reflex responses are mainly responsible for the compensation of perturbations introduced during gait. They are most probably mediated by group II afferents via a spinal pathway closely connected with the spinal locomotor centres. The functioning of these responses depends on an intact supraspinal control. They are suggested to be incorporated in a more complex e.m.g. pattern mainly determined by central mechanisms. In contrast to the gait condition, segmental stretch reflex activity does contribute to activation of extensor muscles of the leg during fast movements, such as running and hopping. In children at an early stage in the development of gait (around 1 to 2 years of age), as well as in patients with spastic paresis, the polysynaptic reflex responses are reduced or absent, and isolated monosynaptic reflex potentials are present. This suggests a reciprocal modulation of mono- and polysynaptic reflex mechanisms, both being dependant on supraspinal control. When this control is either not yet matured (small children) or impaired (spastic paresis), inhibition of monosynaptic stretch reflexes is absent and associated with a reduced facilitation of polysynaptic spinal reflexes. In spastic muscle hypertonia, the tension developed at the Achilles tendon during gait cannot be explained by gastrocnemius activation alone. In patients with spastic hemiparesis gastrocnemius e.m.g. activity is reduced in the spastic leg as compared to the unaffected one. It can be concluded that the paretic muscle undergoes changes in its mechanical properties, secondary to the supraspinal lesion, which results in the development of spastic muscle hypertonia.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

Tendon reflex asymmetry by voluntary mental effort in healthy subjects.

The effect of voluntary mental influences on the tendon reflexes was examined in healthy subjects. The patellar reflexes were evoked by a method comparable with the clinical examination, and the reflexes were recorded by surface electrodes. Eighteen subjects were instructed to increase and then decrease the right patellar reflex by mental effort, without contracting any muscles. Most subjects increased the reflex in both conditions. Subsequently, ten subjects were instructed to increase the right patellar reflex and decrease the left by mental effort. Measurement showed reflex asymmetry in seven subjects consistent with the instruction. The experiment was repeated in another 20 subjects with symmetric reflexes at rest. Ten of these subjects were, after random assignment, instructed to increase either the right or the left knee jerk. All subjects (and an additional 15 asymmetric control subjects) were examined by a neurologist without knowledge of the instruction. Three of the ten instructed subjects were correctly judged to be asymmetric, but the agreement between instruction and neurologic judgment was not statistically significant. Mentally induced reflex asymmetry is possible, and may be clinically relevant in some cases.

Adult↗