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PubMed1997

Hyperactive pectoralis reflex as an indicator of upper cervical spinal cord compression. Report of 15 cases.

Myelopathy from cervical spondylosis is often accompanied by hyperreflexia of the upper-extremity deep tendon reflexes (DTRs). Reflexes such as the pectoralis jerk and the deltoid jerk may only be apparent in the context of hyperreflexia. Although the nerve roots involved in the reflex arcs are well described, levels of cervical spinal cord compression that lead to the hyperreflexia are not as clear. This is of particular significance for patients with multilevel cervical spondylosis in determining the levels responsible for their symptoms. The authors examined 15 consecutive patients who presented for treatment of cervical myelopathy. The clinical examination was then correlated with levels of cervical spinal cord compression by cervical magnetic resonance imaging or computerized tomography with intrathecal contrast enhancement. The presence of a prominent pectoralis jerk was seen only in patients with spinal cord compression at the C2-3 and/or C3-4 levels (nine patients). No patient with compression at or below the C4-5 disc space without coexisting compression at a higher level had hyperactive pectoralis reflexes. This association between the C3-4 level and a hyperactive pectoralis reflex was significant (p < 0.004, Fisher's exact test). The deltoid reflex was tested in the last nine consecutive patients. It was present in patients with compression of the upper spinal cord at levels C3-4 and C4-5 (four of five patients) but appeared in only one of four patients with compression below C4-5. This association did not attain statistical significance. The presence of a hyperactive pectoralis reflex is specific for lesions of the upper cervical spinal cord. Examination of upper-extremity DTRs may be helpful in planning the appropriate levels for surgical decompression in patients with multilevel spondylosis and myelopathy.

Humans↗
PubMed2000

Stretch- and H-reflexes of the lower leg during whole body cooling and local warming.

BACKGROUND: This study was undertaken to evaluate if possible changes in stretch- and H-reflexes could be related to the changes in the EMG activity of the cooled lower leg muscles observed during a stretch-shortening cycle exercise. METHODS: Eight subjects wearing shorts and jogging shoes were exposed once to 27 degrees C and twice to 10 degrees C for 60 min each. During the second exposure to 10 degrees C, the subject's lower legs were kept warm (10 degrees Clw) with electrical pillows. After the exposures Achilles tendon reflex (stretch reflex) was induced and the EMG activity of the triceps surae was measured. Immediately after reflex measurements the EMG activity of the triceps surae and tibialis anterior during a drop-jump (stretch-shortening cycle) was measured. After similar thermal exposures electrically induced H-reflex from the calf was measured. RESULTS: During the preactivity and stretch phases the EMG activity of the triceps surae increased after the exposure to 10 degrees C, whereas during the shortening phase it decreased. During the shortening phase cooling, on the contrary, increased the activity of tibialis surae anterior. These changes disappeared at 10 degrees Clw. At 10 degrees C the maximum EMG-amplitude of triceps surae during stretch reflex decreased (p<0.05), reflecting suppressed muscle spindle activity. Suppressed spindle activity causes the agonist to be unfacilitated and the antagonist muscle contraction to be uninhibited, which was seen in the present study as decreased agonist and increased antagonist EMG activity during the shortening phase at 10 degrees C. The Hmax/Mmax-ratio, H-reflex latency and amplitude increased at 10 degrees C (p<0.05), reflecting increased motoneuron pool excitability. This in part may explain the increased EMG activity during the preactivity and stretch phases. CONCLUSION: Cooling-induced increase in the excitability of the motoneuron pool and suppression of muscle spindle activity seem to be responsible of the EMG activity changes during the stretch-shortening cycle, consequently decreasing muscular performance.

Adult↗
PubMed1976

Actions of methoxamine and tryptamine and their interactions with cyproheptadine and phenoxybenzamine on cat spinal cord segmental reflexes.

The effects of norepinephrine, methoxamine and tryptamine were assessed on the monosynaptic and polysynaptic segmental reflexes in the unanesthetized, decerebrated acute spinal cat. Their selectivity of action was determined by studying the interactions of methoxamine and tryptamine with two antagonists, cyproheptadine and phenoxybenzamine. Potentials were evoked by stimulating either the L7 or S1 dorsal root and were recorded from the corresponding ipsilateral ventral root. Norepinephrine did not affect reflex activity, whereas methoxamine facilitated both the monosynaptic and polysynaptic potentials in a dose-related manner when infused over 20 minutes. Tryptamine facilitated both the monosynaptic and polysynaptic reflex potentials. This increase was dose related for the monosynaptic reflex but not for the polysynaptic reflex. Phenoxybenzamine blocked the facilitatory effects of methoxamine and did not antagonize the effects of tryptamine on the segmental reflex. The facilitatory effects of tryptamine were effectively blocked by cyproheptadine. Cyproheptadine failed to reduce the polysynaptic response to methoxamine, although it partially antagonized the monosynaptic facilitation. These findings demonstrate that methoxamine and tryptamine facilitate the segmental reflex by different modes of action and provide additional evidence for noradrenergic and tryptaminergic systems in the spinal cord.

Animals↗
PubMedDate not supplied

[Effect of stimulation of the spinal cord on phasic and tonic reflexes in patients with central motor neuron damage].

Spinal cord stimulation (SCS) is a method enabling the control of increased muscle tonus to be achieved in various spinal cord injuries. Polyelectromyographic (PEMG) methods were used for neurophysiological assessment of the degree of cord damage and persistent spinal reflexes as well as supramedullary influences. The analysed material comprised 40 PEMG records in 19 patients with spastic paraparesis or paraplegia after cord injury, cord tumour or multiple sclerosis. In 15 cases tentative epidural cord stimulation was done and 11 patients received implantation of a system for long-term stimulation. In most cases the epidural electrodes were implanted below the damaged segment, usually in the thoracic part of the cord. Before and after SCS beginning PEMG was done with a 16-channel Mingograph Siemens Elema with simultaneous recording of the responses from the symmetric muscles: quadriceps, semitendinous, adductor femoris, anterior tibialis and triceps surae. The effect of SCS was analysed on exteroceptive and proprioceptive reactions during testing of knee and ankle reflexes, and on the response of the muscles to vibration. In most patients a reduction was observed of the intensity of tendon reflexes, particularly the spread of the reflex to the contralateral extremity was no longer seen. The vibration reflex had a tonic character persisting in 48% of the studied muscles, even in patients with clinically complete transsection of the cord. The change of the character of monosynaptic reflexes and the presence of the vibration reflex suggest that SCS modifies the proprioceptive segmental spinal reactions.

Adult↗
PubMed1984

Knee joint effusion and quadriceps reflex inhibition in man.

This study was designed to elucidate the role of effusion in producing the reflex inhibition, and subsequent atrophy, of quadriceps musculature following knee trauma. In particular, consideration was given to determining the extent, threshold and linearity of inhibition of the motoneuron pool induced by experimental introduction of small increments of 0.9% physiological saline (up to 60ml) into the joint space of the knee in ten healthy subjects. Inhibition of the quadriceps muscle motoneuron pool was indirectly assessed through recording Hoffmann (H) reflexes evoked from vastus medialis, lateralis and rectus femoris. All ten subjects showed a significant (p less than 0.05) reduction in H-reflex amplitude following the introduction of saline: vastus medialis reduced to 55.7 +/- 4.3% of its control 0ml value, rectus femoris to 69.1 +/- 6.1% and vastus lateralis to 65.3 +/- 4.0%. Post hoc analyses of the H-reflex amplitudes at each increment of simulated effusion revealed the threshold for reflex inhibition of the vastus medialis to be between 20 and 30ml of saline and for rectus femoris and vastus lateralis to be between 50 and 60ml. These procedures were repeated on eight subjects following an injection of the anesthetic lidocaine (1%) to the intra-articular space of their knee joints but there was no significant reduction in H-reflex amplitude. Linear relationships were found to adequately describe the relationships between the volume of effusion and intra-articular pressure; and volume of effusion and reduction in H-reflex amplitude.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Electrostimulation-induced stapedius reflex. Presentation of a standardized procedure and results of clinical studies].

The electro-tactile elicitation of the stapedius muscle reflex is well known but not used in clinical practice. Despite a complex reflex pathway in the brainstem, correlations between reflex parameters and neurological impairments are still possible. We have developed a method for eliciting the electro-tactile stapedius muscle reflex and automatic analysis of different reflex parameters by using an analog-digital converter and a personal computer-integrated signal analysis system. Clinical investigations were carried out with a group of 55 healthy persons (control group), 13 patients with central facial palsies, 51 patients with multiple sclerosis (MS group) and 24 patients with absent acoustic-stapedius muscle reflexes. Findings demonstrated that the latency between stimulus and beginning of the reflex (L1) was significantly longer in the MS group compared with the control group. The best parameter for dividing the MS group into groups with different disability scores was S, which was the parameter for the increase in the L1 growth curve at different stimulus levels. Reproduction of the parameter S in repeated tests with different locations of the stimulus-electrode was excellent.

Brain Damage, Chronic↗
PubMed1991

Tremor in reflex sympathetic dystrophy.

Postural hand tremor was quantitatively investigated on both sides in 21 patients suffering from unilateral reflex sympathetic dystrophy of the upper extremity. On the affected side, enhanced tremor amplitude, with a mean tremor frequency of 7.2 Hz, was found in 57% of the patients. The appearance of tremor did not correlate to the occurrence of a single clinical symptom of reflex sympathetic dystrophy. On loading with increasing weight, the frequency of this pathological tremor shifted toward lower values, as it is found in physiological tremor. However, the peak frequencies of the electromyogram remained more or less stable. On recovery from this condition, the reflex sympathetic dystrophy tremor disappeared. Acute sympatholytic intervention could normalize reflex sympathetic dystrophy tremor. This would suggest that the sympathetic supply of the affected extremity contributes to the tremor in reflex sympathetic dystrophy. In conclusion, it is suggested that reflex sympathetic dystrophy should be included among the causes of tremor. According to our findings, tremor in reflex sympathetic dystrophy should be regarded as an enhanced physiological tremor.

Electromyography↗
PubMed1999

Observations on the variability of the H reflex in human soleus.

H reflexes were evoked in human soleus by stimulating the tibial nerve at a constant intensity. Each trial was then assigned to one of three groups on the basis of the amplitude of its H reflex; all trials in each group were then full-wave rectified and reaveraged. There was a strong positive relationship between the amplitude of the H reflex and the level of electromyographic activity in the muscle at the time of onset of the H reflex, which reflects the activity of the motoneuronal pool when the afferent volley arrived. Thus, much of the variability of the H reflex is due to small changes in the level of activation of the motoneuronal pool during repeated trials. The steady torque preceding the H reflex was a poor predictor of the H-reflex amplitude, presumably because of the delay between the changes in the electrical activity of motoneurons and the mechanical outcome thereof.

Adult↗
PubMed1999

Clinical utility of reflex studies in assessing cervical radiculopathy.

We prospectively studied the diagnostic utility of upper limb segmental reflexes in patients with suspected cervical radiculopathy (CR). Fifty-three patients (29 men and 24 women), referred for electrodiagnostic testing, were positive for at least one of four clinical criteria for CR: abnormal (1) history, (2) motor (myotomal) examination, (3) sensory (dermatomal) examination, and (4) changes in deep tendon reflexes (DTR). All underwent electrodiagnostic assessment, needle electrode examination (NEE), specialized segmental reflexes (heteronymous and Hoffman's reflexes [H reflexes]), and neuroimaging. The clinical diagnosis was supported in all 32 patients who entered the study with two or more clinical signs for CR. Abnormal NEE was found in 90% of subjects with three clinical signs, 59% with two signs, and only 10% of those with one sign. H reflexes demonstrated a sensitivity of 72% and specificity of 85% for detection of CR and were particularly helpful when forming conclusions in the 21 subjects with only one clinical sign for CR. Specialized segmental H-reflex studies of the upper limb were as sensitive and specific as neuroimaging (magnetic resonance imaging).

Adult↗
PubMed1999

Modular organization of human leg withdrawal reflexes elicited by electrical stimulation of the foot sole.

Human withdrawal reflex receptive fields were determined for leg muscles by randomized, electrical stimulation at 16 different positions on the foot sole. Tibialis anterior, gastrocnemius medialis, peroneus longus, soleus, rectus femoris, and biceps femoris reflexes, and ankle joint angle changes were recorded from 14 subjects in sitting position. Tibialis anterior reflexes were evoked at the medial, distal foot and correlated well with ankle dorsal flexion. Gastrocnemius medialis reflexes were evoked on the heel and correlated with plantar flexion. Stimulation on the distal, medial sole resulted in inversion (correlated best with tibialis anterior activity), whereas stimulation of the distal, lateral sole evoked eversion. Biceps femoris reflexes were evoked on the entire sole followed by a small reflex in rectus femoris. A detailed withdrawal reflex organization, in which each lower leg muscle has its own receptive field, may explain the ankle joint responses. The thigh activity consisted primarily of flexor activation.

Adult↗
PubMed2000

Characterization of hamstring reflexes during anterior cruciate ligament disruption: in vivo results from a goat model.

The existence of an anterior cruciate ligament-hamstring reflex arc, the extent to which these reflexes can protect the knee, and the extent to which they are affected by rupture of the anterior cruciate ligament remain controversial. We evaluated the temporal components of the anterior cruciate ligament-hamstring synergy by simulating an injury to the ligament in a goat model. Reflexive hamstring activation in anesthetized goats was evaluated when the anterior cruciate ligament was loaded with static subfailure, dynamic subfailure, and dynamic failure loads. Reflexive hamstring activation was not found in response to static subfailure loading but was observed in response to dynamic subfailure and failure loading. The latency of the reflex evoked by dynamic failure loading was shorter than that evoked by dynamic subfailure loading. The findings suggest that the extent to which the hamstring reflexes can protect the knee may be bounded by the ability of these muscles to generate force rapidly and the amplitude and time-course of the loads applied to the knee joint. The present data present a framework for further investigation of the contribution of anterior cruciate ligament-hamstring reflexes to the stability of the knee joint under high loads and loading rates.

Animals↗
PubMed1995

Soleus H-reflex tests in dystonia.

Vibratory inhibition, the homonymous recovery curve and the ratio of the maximal H-reflex to direct muscle potential (H/M ratio) of the soleus H-reflex were assessed in 10 patients with leg dystonia and in six patients with arm or neck dystonia. The results were compared with those obtained in 48 healthy control subjects. H-reflex variables most helpful for the discrimination of patients and healthy subjects were identified. In patients with leg dystonia, vibratory inhibition was less marked than in control subjects, whereas late facilitation of the recovery curve was increased. In patients with leg dystonia, area values of test reflexes in the late facilitatory phase of the recovery curve exceeded peak-peak values, in contrast to findings in control subjects. This finding may be attributable to less synchronization of enhanced test reflexes in dystonia than in the control condition. In differentiating patients with leg dystonia from control subjects, a combination of parameters of vibratory inhibition and the late facilitatory phase of the recovery curve appeared most useful. In patients with arm or neck dystonia and in the unaffected legs of hemidystonic patients, soleus H-reflex test results were in the normal range. Abnormalities in the results of the soleus H-reflex tests we used appear to be related to the presence of clinical signs in the extremity under examination and not to the severity of features.

Adult↗
PubMed2003

Acute leg-cycling exercise attenuates the H-reflex recorded in soleus but not flexor carpi radialis.

The amplitude of the Hoffman reflex (H-reflex) in the soleus muscle is attenuated after acute bouts of leg-cycling exercise. The attenuation has been interpreted as a "tranquilizing" effect of exercise controlled by the central nervous system and generalized beyond a single spinal segmental level. If so, the postexercise depression of the H-reflex should occur in both the soleus and the flexor carpi radialis (FCR) muscle, which is not actively involved during leg cycling. This experiment examined the effect of moderate-intensity cycling exercise on the H-reflex recorded in soleus and FCR among 16 men. The H-reflex was measured immediately before and 10 min after 30 min of either moderate-intensity leg cycling (60% VO(2peak)) or quiet rest. The acute bout of cycling exercise reduced the H-reflex in the soleus but not in the FCR. Thus, the attenuation of the H-reflex after leg cycling does not generalize beyond the spinal segmental level that modulates the involved locomotory muscles; it is likely the result of segmental processes associated with the repetitive stretching or activation of the soleus muscle.

Adult↗
PubMed2004

Hering-Breuer reflex and sleep state in the preterm infant.

The aim of this study was to determine the effect of sleep state on the Hering-Breuer inflation reflex in the preterm infant. Seventeen nonintubated, premature infants, ranging in birth weight from 980-2,440 g with postconceptual ages of 30-36 weeks, were studied. In each infant, pulmonary function testing, including the Hering-Breuer inflation reflex, was obtained using the SensorMedics 2600 during active and quiet sleep states in supine position. The strength of the Hering-Breuer inflation reflex was quantified by the measurement of the percent prolongation of expiration after an occluded breath. Sleep states were categorized by the criteria of Prechtl. There was a significant difference in Hering-Breuer activity in active (REM) vs. quiet (non-REM) sleep, with a consistently stronger reflex in the active sleep state. The mean percent prolongation of expiration was 419% in active sleep vs. 87% in quiet sleep. Analysis of the data, using a paired t-test, revealed a mean difference of 331 +/- 185% between active and quiet sleep (P = 0.000). In conclusion, significant differences in the strength of the Hering-Breuer inflation reflex occur in relation to sleep state, and may explain the variability of the reflex described in previous studies. Measurement of the Hering-Breuer inflation reflex may be affected by pulmonary stretch receptors as well as chest wall afferents in the preterm infant.

Female↗
PubMed1996

Neural regulation of coronary vascular resistance: role of nitric oxide in reflex cholinergic coronary vasodilation in normal and pathophysiologic states.

A number of reflexes participate in the control of coronary vascular resistance through activation of the sympathetic or parasympathetic nervous system. Classically, activation of vagal efferent fibers to the heart results in vasodilation due to the release of acetylcholine and activation of muscarinic receptors. Recently, we have found that activation of a number of reflexes in conscious dogs, the Bezold-Jarisch reflex and the carotid chemoreflex in particular, results in cholinergic coronary vasodilation which is blocked by an inhibitor of nitric oxide synthesis, nitro-L-arginine. After the development of pacing-induced heart failure, the cholinergic dilation subsequent to activation of the Bezold-Jarisch or carotid chemoreflex is essentially abolished, since coronary blood vessels no longer produce nitric oxide. In contrast, after brief exercise training, there is a potentiation of Bezold-Jarisch reflex-induced coronary vasodilation since exercise upregulates nitric oxide production by coronary blood vessels. Since the Bezold-Jarisch reflex may be important as a compensatory mechanism during acute myocardial infarction, and the carotid chemoreflex is the acute mechanisms responsible for ameliorating systemic hypoxemia, the role of nitric oxide in reflex cholinergic coronary vasodilation may be essential in the compensatory vascular adjustments evoked by these and other reflexes.

Animals↗
PubMed1987

The role of the aural head shake reflex in serotonin-mediated head shaking behavior.

The head shake reflex is a rapid rhythmic shaking of the head in a radial motion and is a prominent part of the behavior of most mammalian species. The administration of agonists at 5-hydroxytryptamine (5-HT) receptors to rats increases apparently-spontaneous head shaking behavior. The present study examined the relationship between the head shake reflex, elicited by stimulation of the aural ampullae with Tween 80, with a similar-appearing behavior, the head shake response caused by the administration of 5-HT agonists to rats. Head shaking was attenuated by the subcutaneous infiltration of the local anesthetic procaine into the posterior border of the external auditory meatus. However, the local anesthetic did not alter head shake behavior produced by administering either the 5-HT agonist quipazine or the 5-HT precursor 5-hydroxy-L-tryptophan (L-5-HTP). The magnitude of the head shake reflex was also diminished after habituation of the reflex by repeatedly applying Tween 80 to the ampullae, yet this treatment had no effect on the head shaking behavior caused by quipazine. In a complementary manner, pretreatment with the 5-HT2 receptor antagonist ketanserin potently blocked shaking behavior caused by quipazine without significantly altering the head shake reflex. Chronic administration of the atypical antidepressant drug iprindole to rats for 7 days reduced quipazine-induced shaking behavior without affecting the head shake reflex. In contrast, chronic administration of the monoamine oxidase inhibitor phenelzine to rats for 7 days reduced head shaking behavior caused by either stimulus, indicating that an attenuation of motor reflex activity could play a role in the reduced response to quipazine.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Operant conditioning of the primate H-reflex: factors affecting the magnitude of change.

Primates can gradually increase or decrease H-reflex amplitude in one leg when reward depends on that amplitude. The magnitude of change varies greatly from animal to animal. This study sought to define the factors that control this magnitude. It evaluated the influence of animal age, muscle size (absolute and relative), background electromyographic activity (EMG) level, M response amplitude, initial H-reflex amplitude, performance intensity, and behavior of the contralateral leg. Fifty-four animals (Macaca nemestrina) underwent operant conditioning of the triceps surae H-reflex in one leg (the trained leg). Twenty-eight were rewarded for larger H-reflexes (HRup animals), and 26 were rewarded for smaller H-reflexes (HRdown animals). In the HRup animals, H-reflex amplitude in the trained leg rose to an average final value of 177% of its initial amplitude. Magnitude of increase varied widely across animals. Nine animals rose to 120-140%, 11 to 160-240%, three to 300% or more, and five remained within 20% of initial amplitude. In the HRdown animals, H-reflex amplitude in the trained leg decreased to an average of 69% of initial amplitude. Magnitude of decrease varied widely. Five animals decreased to 20-40%, seven to 40-60%, six to 60-80%, and eight remained within 20% of initial amplitude. Animal age, as assessed by weight, markedly affected HRdown conditioning, but not HRup conditioning. Heavy HRdown animals (> or = 6 kg) were more successful than light HRdown animals (< 6 kg). Thirteen of 14 heavy animals and only five of 12 light animals decreased to less than 80% of initial amplitude.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1991

Contribution of the maculo-ocular reflex to gaze stability in the rabbit.

The contribution of the maculo-ocular reflex to gaze stability was studied in 10 pigmented rabbits by rolling the animals at various angles of sagittal inclination of the rotation and/or longitudinal animal axes. At low frequencies (0.005-0.01 Hz) of sinusoidal stimulation the vestibulo-ocular reflex (VOR) was due to macular activation, while at intermediate and high frequencies it was mainly due to ampullar activation. The following results were obtained: 1) maculo-ocular reflex gain decreased as a function of the cosine of the angle between the rotation axis and the earth's horizontal plane. No change in gain was observed when longitudinal animal axis alone was inclined. 2) At 0 degrees of rotation axis and with the animal's longitudinal axis inclination also set at 0 degrees, the maculo-ocular reflex was oriented about 20 degrees forward and upward with respect to the earth's vertical axis. This orientation remained constant with sagittal inclinations of the rotation and/or longitudinal animal axes ranging from approximately 5 degrees upward to 30 degrees downward. When the longitudinal animal axis was inclined beyond these limits, the eye trajectory tended to follow the axis inclination. In the upside down position, the maculo-ocular reflex was anticompensatory, oblique and fixed with respect to orbital coordinates. 3) Ampullo-ocular reflex gain did not change with inclinations of the rotation and/or longitudinal animal axes. The ocular responses were consistently oriented to the stimulus plane. At intermediate frequencies the eye movement trajectory was elliptic because of directional differences between the ampullo- and maculo-ocular reflexes.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗