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PubMed1992

Stretch reflex of quadriceps femoris and its relation to rigidity in Parkinson's disease.

Much evidence suggests that parkinsonian rigidity is due to hyperactivity of a reflex arc. While tendon jerk and H reflex are not modified in Parkinson's disease (PD), the long-latency component of stretch reflex (LLR) shows an increased size in PD. It has been proposed that this modification could account for rigidity. We studied in 14 PD patients and 8 normal subjects the stretch reflex of the quadriceps femoris. The muscle was stretched by a torque motor in two experimental sets: at rest and with voluntary background activity. Latency, duration and size of the reflex were compared in two groups; correlation between size of the reflex and rigidity was investigated. A lower threshold for the reflex was found in PD patients in trials at rest, and LLR showed increased size and duration in trials with background activity. No clear relationships between these data and rigidity were demonstrated.

Adult↗
PubMed1987

Effect of cooling on H- and T-reflexes in normal subjects.

The local application of cold has been used to decrease spasticity and facilitate neuromuscular function, but previous attempts to identify its effect on the stretch reflex have not been entirely successful. We examined the effects of cold on the Hoffmann (H) reflex and on the tendon tap (T) reflex in 16 subjects. A series of H/M recruitment curves and T-reflexes were recorded via surface EMG electrodes before and during cooling of the triceps surae. Skin and intramuscular temperatures were recorded with average decreases of 18.4C and 12.1C, respectively. Peak-to-peak amplitude of the M, H, and T compound action potentials (CAPs) was measured. In all cases, the amplitude of the maximal M-wave decreased (p less than 0.001) in response to cooling. These changes in the recording of CAPs should be considered when cooling experiments result in alterations in H or T waveforms. When using the M-wave as a covariant in our analysis, there were no significant changes in the H-reflex amplitude; the height of CAPs elicited by T decreased (p = 0.025). Our findings do not support earlier claims that simple cooling facilitates the excitatory alpha motoneuron pool as measured by the H-reflex; we do confirm that muscle spindle activity, as measured by the T-reflex, is decreased by muscle cooling.

Adult↗
PubMed1994

A case of interhemispheric subdural hematoma.

The interhemispheric subdural hematoma is a rare condition. We present a case of interhemispheric subdural hematoma in a patient aged 65 years. A day prior to admission he was struck with a water-pipe on the head. He went to sleep the same evening complaining of a slight headache. At about two o'clock in the morning the headache increased in intensity. By the morning he lost consciousness. On examination by a neurosurgeon the patient was found to be comatose. The physical examination revealed blue eyelids of the left eye, paraplegia of the right leg, paresis of the left leg and arms. Bilateral Babinski's reflex was present, the abdominal reflexes were absent, the tendon and periosteal reflexes were hyperactive. The pupils were equal in size and slowly reactive to light. The patient exhibited symptoms of meningoradicular irritation. An emergency CT scan revealed high-density area in the interhemispheric sulcus extending frontally to parietally. The patients was operated on in an emergency. At operation, extensive rupture of the sagittal sinus was identified. Later the patient died. The presented case was interesting with the extensive rupture of the sagittal sinus and the relatively long lucid interval until clear manifestation of the clinical picture becomes evident.

Aged↗
PubMed1983

Reflex responses at the human ankle: the importance of tendon compliance.

Subjects with active stretch reflexes responded to an imposed sinusoidal movement of the ankle joint with a reflex force whose amplitude and timing varied widely with changes in the frequency of movement. At some frequency between 6 and 8 Hz, the reflex force tended to offset the non-reflex component of resistance, and thus to reduce the total resistance to movement. At this frequency the reflex response was particularly vigorous, with a deep modulation of electromyogram (e.m.g.) activity and a displacement of the joint stiffness vectors far from their high frequency values. The total resistance to movement might then be small, or it might be zero, or the reflex might actually assist the movement. As the frequency of movement was decreased through this critical range, the timing of the reflex response to movement changed rapidly with an abrupt advancement of the triceps surae e.m.g. signal, and a wide separation of the joint stiffness vectors as they passed close to the origin. This result was attributed to a changing distribution of the movement between the muscle fibres and an elastic Achilles tendon. It was assumed that at most frequencies the muscle fibres resisted extension, so that a major part of the imposed movement went into stretching the tendon; when, however, at 6-8 Hz, the reflex response was so timed as to reduce or abolish the resistance of the muscle fibres, more of the movement would take place in them. The muscle spindles would 'see' this larger movement of the muscle fibres, and generate correspondingly more reflex activity. A simplified model of the muscle-tendon combination behaves in a way that supports this view, and the available information about the human Achilles tendon indicates that it is sufficiently compliant for such an explanation. Therefore, movements imposed on the ankle joint would not necessarily be 'seen' by the muscle spindles, since they would be modified by transmission through a compliant tendon. By assuming a value for the tendon stiffness, it was possible to calculate the course of movements that actually occurred in the muscle fibres and spindles. Records of these spindle movements indicated how some non-linearities might arise.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1973

Modulation of postural reflexes by voluntary movement. II. Modulation at an inactive joint.

We have observed that there is a brief, 400 msec period of widespread facilitation of both the Hoffmann and the tendon-jerk reflexes associated with the initiation of a variety of local, voluntary, isometric efforts. It is suggested that the site of this facilitation lies within the spinal cord. We have also observed that this period is followed, for the Hoffmann reflex, by a period of spinal inhibition. By contrast, the tendon-jerk is facilitated, at a reduced level, for at least another 500 msec by mechanisms probably working at the muscle spindle. These results are discussed in comparison with experiments involving activation of the reflex agonist and antagonist muscles. It is proposed that voluntary control of the locomotor system is organized through separate mechanisms for muscle recruitment and for regulation of the sensitivity of the myotatic reflex loop.

Ankle Joint↗
PubMed1977

Monosynaptic reflexes in falling man.

We have examined peripheral proprioceptive input during fall in man. The first 80 ms of unexpected free fall, both in a parachute harness and while seated, has been studied using the monosynaptic Hoffman (H) and Achilles tendon (T) reflexes. Facilitation of the H reflex begins about 30 to 40 ms after release, representing the onset of motor neurone facilitation before the electromyographic activity which begins about 80 ms after release. Earlier facilitation of the T reflex may represent spindle excitation due to change in muscle shape as suggested by Matthews and Whiteside (1960), but the T reflex inhibition described by these authors after 50 ms of seated fall is probably a purely mechanical phenomenon.

Achilles Tendon↗
PubMed2004

Re-examination of the possible role of Golgi tendon organ and muscle spindle reflexes in proprioceptive neuromuscular facilitation muscle stretching.

Literature concerning the theoretical role of spinal reflex circuits and their sensorimotor signals in proprioceptive neuromuscular facilitation (PNF) muscle stretching techniques was examined. Reviewed data do not support the assertion commonly made in PNF literature that contraction of a stretched muscle prior to further stretch, or contraction of opposing muscles during muscle stretch, produces relaxation of the stretched muscle. Further, following contraction of a stretched muscle, inhibition of the stretch reflex response lasts only 1 s. Studies examined suggested that decreases in the response amplitude of the Hoffmann and muscle stretch reflexes following a contraction of a stretched muscle are not due to the activation of Golgi tendon organs, as commonly purported, but instead may be due to presynaptic inhibition of the muscle spindle sensory signal. The current view on the complex manner by which the spinal cord processes proprioceptive signals was discussed. The ability of acute PNF stretching procedures to often produce a joint range of motion greater than that observed with static stretching must be explained by mechanisms other than the spinal processing of proprioceptive information. Studies reviewed indicate that changes in the ability to tolerate stretch and/or the viscoelastic properties of the stretched muscle, induced by PNF procedures, are possible mechanisms.

Elasticity↗
PubMed2006

Stretching for prevention of Achilles tendon injuries: a review of the literature.

Professional and recreational athletes commonly perform pre-exercise stretching to prevent musculoskeletal injuries. Little definitive evidence exists that clearly demonstrates the efficacy of stretching in reducing injury. Achilles tendon injuries are among the most common injuries affecting active individuals in the United States today. Clinicians commonly recommend stretching the Achilles tendon without concrete scientific evidence to support such a claim. Few studies have addressed the effect of stretching in Achilles tendon injuries, and it is unclear if the conclusions made for musculoskeletal injuries can be applied to the Achilles tendon. Biomechanical studies of the Achilles tendon and measurements of the tendon's reflex activity have demonstrated possible mechanisms for the potential benefit of stretching, including load-induced hypertrophy and increased tendon tensile strength. Recent prospective studies have contended that reductions in plantarflexor strength and increases in ankle dorsiflexion range of motion from stretching the Achilles tendon may increase the risk of injury. Studies examining stretching in injury prevention, the biomechanical properties of injuries to the Achilles tendon were compiled and reviewed. Although many theories have been published regarding the potential benefits and limitations of stretching, few studies have been able to definitively demonstrate its utility in injury prevention.

Achilles Tendon↗
PubMed1994

Fusimotor activity and the tendon jerk in the anaesthetised cat.

This is a study of the tendon jerk reflex elicited by a brief stretch applied to the triceps surae muscle group in the chloralose-anaesthetised cat. The size of the recorded reflex depended on stretch parameters (optimum at 300 microns amplitude at a rate of 100 mm/s) and on how the muscle had been conditioned. A reflex elicited after a conditioning contraction at the test length was often twice as large as after a contraction carried out at a length longer than the test length. This difference was attributed to the amount of slack introduced in the intrafusal fibres of muscle spindles by conditioning. The question was posed, did ongoing fusimotor activity exert any influence on the size of the tendon jerk? Depolarization indices (DPI) were calculated from responses of muscle spindles to stretch and correlated with the level of reflex tension. Values of DPI obtained from afferent responses with and without repetitive stimulation of identified fusimotor fibres suggested that with the stretch parameters used here the main influence of fusimotor activity was that it removed any pre-existing slack in muscle spindles and thereby increased reflex tension. In the absence of intrafusal slack, stimulation of static and dynamic fusimotor fibres had little additional influence on the size of the reflex. It is concluded that much of the variability typically seen with tendon jerks is due to muscle history effects. Since in muscles which have not been deliberately conditioned there is commonly some slack present in spindles, activity in fusimotor fibres is likely to reduce slack and therefore increase reflex size.

Anesthesia↗
PubMed1990

Operant conditioning of H-reflex in freely moving monkeys.

The H-reflex, the electrical analog of the stretch reflex or tendon jerk, is the simplest behavior of the primate CNS. It is subserved by a wholly spinal two-neuron reflex arc. Recent studies show that this reflex can be increased or decreased by operant conditioning, and that such conditioning causes plastic changes in the spinal cord itself. Thus, H-reflex conditioning provides a powerful new model for investigating primate memory traces. The key feature of this model, the conditioning task, originally required animal restraint. This report describes a new tether-based design that allows H-reflex measurement and conditioning without restraint. This design integrates the conditioning task into the life of the freely moving animal.

Animals↗
PubMed1984

The effect of the GABA-agonist, progabide, on stretch and flexor reflexes and on voluntary power in spastic patients.

The action of the GABA-receptor agonist, progabide , was investigated in a double-blind study with cross-over to placebo. The stretch and flexor reflexes and voluntary power were measured in 16 patients with spasticity. 2-week treatment periods were used; the median daily oral dosage of progabide was 24.3 mg/kg. The Achilles tendon (T) reflex was significantly suppressed whereas the Hoffmann (H) reflex remained unchanged: the T/H ratio was thus reduced. Hmax /M (direct motor)max ratio and the vibration-induced suppression of the T- and H-reflexes were unchanged. These findings indicate an effect of progabide on the spindles or on the controlling fusimotor system (probably acting on spinal interneurons), whereas influence on presynaptic inhibition and alpha-motoneuron excitability is unlikely. The flexor reflex threshold was increased during progabide treatment and latency at threshold decreased towards normal latency. This indicates some influence of progabide on flexor reflex activity attributed to reinforcement of action of GABAergic interneurons at the spinal level. Isokinetic measurement of voluntary power of knee extension revealed particularly good progress for the fastest movements during progabide treatment, whereas isometric measurement of sustained handgrip remained unchanged, probably reflecting a reduction of spasticity without reduction of voluntary power in non-spastic muscles.

Achilles Tendon↗
PubMed2000

Reflex innervation of the bulbocavernosus muscle.

OBJECTIVE: To determine the somatic reflex innervation of the bulbocavernosus muscle (BCM) and to illustrate the role of the perineal nerve in BCM contraction, using electrophysiological techniques. Subjects and methods Ten healthy, potent men underwent genital electrophysiological testing. Stimuli were applied to the dorsal nerve of the penis at the base of the penis, glans and anterior urethra, and the perineal nerve branch to the BCM. The electromyographic (EMG) responses of the BCM were recorded and onset latencies measured at baseline, both after anaesthetising the perineal nerve and after recovery from the anaesthetic. RESULTS: A reflex BCM contraction was elicited from all stimulation sites. Anaesthetizing the perineal nerve resulted in alterations of the EMG response. After the anaesthetic effect wore off, the responses returned to baseline values. CONCLUSIONS: Three distinct somatic bulbocavernosus reflexes were detected which are components of normal ejaculation. BCM contraction can be elicited after stimulating the dorsal penile nerve at the glans and the anterior urethra; these are the flexor responses of the bulbocavernosus reflex. BCM contraction can also be induced on stimulating the perineal nerve, which is the pathway through which the stretch and the tendon organ reflexes are carried to mediate muscle tone. The motor innervation of the BCM for all reflexes is carried through a branch of the perineal nerve. The findings may be relevant to the evaluation of ejaculatory disorders.

Adult↗
PubMed1989

Autogenetic inhibition from contraction receptors in the decerebrate cat.

1. Autogenetic inhibition from contraction receptors was measured by eliciting contractions of the soleus muscle in the decerebrate cat. Inhibitory feedback was detected when the tension increment f, produced by stimulating motor fibres in the presence of a background reflex contraction, was smaller than the tension d elicited by the same stimulus in the absence of reflex action. Tendon vibration was applied throughout to clamp primary spindle afferents at a constant firing rate, thereby preventing spindle unloading from disfacilitating the reflex contraction. 2. The reduction in tension d--f varied roughly linearly with the size of the tension stimulus f. Feedback gain was proportional to d--f/f, i.e. the ratio of inhibited tension to stimulus tension. It was computed by averaging over several measurements obtained with stimuli of different sizes, and ranged between 0 and 0.88 in ten animals. The average gain, 0.39, implies that voluntary muscle force is reduced by approximately 27% through the direct inhibition of alpha-motoneurones from homonymous contraction receptors. 3. Inhibitory feedback gain did not appear to co-vary with the background reflex contraction. When measured without vibration, however, a positive covariance did emerge, suggesting that this is due to unloading of muscle spindles, either by extrafusal muscle shortening or by inhibition of fusimotor neurones. 4. Inhibited tension varied linearly with the estimated increment in Ib afferent firing. On the assumption that group Ib afferents carried the entire inhibitory signal, inhibitory feedback gain measured with vibration was used to predict the size of the gain if vibration had not been applied. Feedback gain calculated in this way was reduced by still did not vary with reflex tension. 5. In one animal with signs of brain stem trauma, feedback gain was increased to around six. It is argued that inhibitory feedback in the intact animal can rise to comparable values, as a result both of convergence of signals from different muscles and of supraspinal facilitation.

Animals↗
PubMed1987

The medial hamstring reflex in the level-diagnosis of a lumbar disc herniation.

Evaluation of the medial hamstring reflex (MHR) was included in the routine neurological examination of 52 hospitalized patients with a suspected lumbar disc protrusion. The MHR was tested in the supine patient with the hip slightly flexed, externally rotated and abducted. The ipsilateral knee was semiflexed and supported by one of the examiner's hands. The reflex muscle contraction was elicited by striking the index finger of the supporting hand placed on the tendons in question with a reflex hammer. The positive predictive value of an abnormal MHR as a sign of herniation from the fourth lumbar disc was found to be 85-89 per cent and the negative predictive value to be 51-61 per cent. The corresponding values when considering an abnormal Achilles tendon reflex as a sign of herniation from the fifth lumbar disc were calculated to be 67-84 per cent and 79-84 per cent, respectively. It is therefore recommended to include the MHR in the neurological examination of patients with a suspected lumbar disc protrusion.

Adult↗
PubMed1989

Electromyographic reflexes evoked in human wrist flexors by tendon extension and by displacement of the wrist joint.

1. The electromyographic (EMG) reflexes evoked in the wrist flexor muscle, flexor carpi radialis (FCR), by percutaneous extension of its tendon and by forcible extension of the wrist joint have been studied. Reflexes were elicited during steadily maintained voluntary flexor contraction of 10% of each subject's maximum. 2. Tendon extension, using 'ramp and hold' displacements, evoked fairly prolonged (ca 50 ms) increases in EMG activity. These responses were usually subdivided into two main excitatory peaks of respectively short (SL, ca 20 ms) and long (LL, ca 45 ms) latency. This pattern contrasted with that observed following brief tendon taps when only a single, SL peak was elicited. 3. 'Stretch' reflexes evoked by 'ramp and hold' wrist extensions, as has been noted by numerous earlier investigators, were also protracted and comprised two main excitatory components. These responses resembled those produced by tendon extension both in their general form and in their behaviour upon altering the velocity of mechanical stimuli. Quantitatively, however, two main differences were evident. The reflexes evoked by wrist extension, including their SL and LL peaks, were generally somewhat larger. Additionally, when parameters of the two modes of stimulation were adjusted to elicit SL responses of equivalent amplitude, the LL responses elicited by tendon extension were regularly smaller and of shorter duration than those elicited by wrist extension. 4. Termination of the two forms of mechanical stimulation, by releasing tendon or wrist extension, each elicited a SL reduction in EMG activity. Such troughs were more pronounced and more consistently observed upon release of wrist extension. 5. Neither local anaesthesia of the skin overlying the flexor tendons at the wrist nor ischaemia of the hand and lower forearm produced any systematic modification of reflex response patterns. 6. It is concluded that intramuscular receptors (presumably muscle spindles) in FCR mediate both the SL and LL reflexes evoked in this muscle by extension of its tendon. Intramuscular receptors also seem certain to be very largely responsible for the EMG responses generated in this muscle by wrist extension.

Action Potentials↗