Latency of changes in spinal motoneuron excitability evoked by transcranial magnetic brain stimulation in spinal cord injured individuals

Objectives: To examine the basis for delay in the excitatory effects of transcranial magnetic stimulation (TMS) of motor cortex on motoneuron pools of muscles left partially-paralyzed by traumatic spinal cord injury (SCI).Methods: The effect of subthreshold transcranial magnetic stimulation (TMS) on just-suprathreshold H-reflex amplitude was examined in subjects (n=10) with incomplete cervical SCI, and in able-bodied (AB) subjects (n=20) for comparison. EMG activity was recorded from the soleus and the abductor hallucis muscles, and H-reflex was elicited by stimulation of the tibial nerve behind the knee. Comparison of the peak-to-peak amplitude of the TMS-conditioned H-reflex to that of the H-reflex alone (i.e. unconditioned H-reflex) was made for different conditioning-test intervals with multivariate analysis of variance and (when called for) t testing.Results: The absolute latencies of motor responses to suprathreshold TMS delivered during a weak voluntary contraction of the soleus and abductor hallucis were significantly prolonged in the SCI group relative to AB subjects. For the TMS-conditioned H-reflex, the time-course effect of TMS on the H-reflex amplitude in different AB subjects included an early effect (typically facilitation, but occasionally inhibition) seen between −5 and 0 ms, followed by a later period (i.e. >5 ms) of H-reflex facilitation. In contrast, the earliest indication of a TMS effect on H-reflex excitability in SCI subjects was between 5 and 10 ms after TMS. This difference between SCI and AB subjects of approximately 10 ms was similar to the prolongation of TMS-evoked response latencies in the soleus and the abductor hallucis muscles of the SCI subjects.Conclusions: The results suggest that motor conduction slowing after traumatic SCI most likely occurs across the population of the descending tract axons mediating the TMS-evoked motor responses.     

EMG for assessing the recovery of voluntary movement after acute spinal cord injury in man.

OBJECTIVE: Multi-channel electromyogram (EMG) was used to examine the pattern and time-course of voluntary contraction recovery in subjects with acute traumatic spinal cord injury (SCI), concentrating on the latest time after injury at which a given muscle would begin to show voluntary recruitment. METHODS: We conducted repeated measures of voluntary contractions of 12 lower limb muscles (for all subjects) and 12 upper-limb muscles (for subjects with cervical injury), beginning within days of the injury and extending for 1 or more years post-injury. The EMG interference pattern was scored in a blinded fashion from tape records. RESULTS: We recruited 229 subjects, including 152 from whom repeated measures were made. Several different patterns of recovery were identified. For persons with motor-incomplete injury to the cervical or thoracic spine, EMG recruitment had not yet occurred by 5 weeks post-injury in roughly 1/2 of all lower limb muscles, and prolonged delays between injury and recruitment onset were sometimes seen. Injury to the thoracolumbar spine was frequently associated with very long delays (i.e. >1 year) between injury and resumption of volitional contraction of distal lower limb muscles. DISCUSSION: The incidence of neurologically incomplete SCI is rising. In such subjects, delays of 1 or more months between injury and the onset of voluntary contraction are common for muscles of the distal upper limbs (for cervical injury) and lower limbs. Given the abbreviated period of in-patient rehabilitation now routine in the United States, these subjects in particular will benefit from frequent follow-up evaluations to assess spontaneous recovery and design appropriate rehabilitation strategies to maximize functional independence. Moreover, the potential for delayed recovery must be considered when designing and implementing novel clinical interventions for treating SCI, to better differentiate between spontaneous and treatment-related improvements in neurologic function.     

Topographical differences in the developmental profile of central motor conduction time.

OBJECTIVES: To study the topographical difference in the developmental profile of the central motor conduction time (CMCT) in upper extremity muscles, electromyographic (EMG) responses to transcranical magnetic stimulation (TMS) were examined in the first dorsal interosseous, extensor carpi radialis (ECR), biceps (BCP), and deltoid (DT) muscles of 25 neurologically normal subjects aged from 2 to 26 years. METHODS: The motor cortex and cervical spinal roots were magnetically stimulated, and CMCT was measured as the onset latency difference between these EMG responses. RESULTS: CMCT in children was shorter in the more proximal muscle of each adjacent muscle pair, despite the tendency of a higher threshold intensity for TMS of the more proximal muscle. This topographical difference tended to be more distinct in younger children, whereas CMCT in adults did not show such a topographical difference. Consequently, the linear decrease in CMCT during maturation was less pronounced in the proximal muscles. CONCLUSIONS: We speculate that direct activation of corticospinal neurons to the more proximal muscles was preferentially produced by TMS in younger children, depending on the relationship between the spatial direction of axons, head circumference, and stimulating coil diameter.     

Effect of antagonistic voluntary contraction on motor responses in the forearm.

OBJECTIVE: We investigated the effects of voluntary contraction of agonist and antagonist muscles on motor evoked potentials (MEP) and on myoelectric activities in the target (agonist) muscle following transcranial magnetic stimulation (TMS). METHODS: The left extensor carpi radialis (ECR) and flexor carpi radialis (FCR) muscles were studied in 16 healthy subjects. H reflexes, MEP induced by TMS, and background electromyographic (EMG) activity were recorded using surface electrodes at rest and during voluntary contraction of either agonist or antagonist muscles. RESULTS: Voluntary contraction of antagonist muscles (at 10% of maximum contraction) enhanced the amplitudes of MEP for both muscles. The H reflex of the FCR muscle was inhibited by contraction (10% of maximum) of the ECR muscle. Background EMG activity did not differ between H-reflex trials and TMS trials. Enhancement of MEP amplitudes and background EMG activity during voluntary antagonist contraction was comparable in the two muscles. Appearance rate of MEP recorded by needle electrodes in response to subthreshold TMS was increased by antagonistic voluntary contraction. CONCLUSION: Facilitation occurs during voluntary contraction of antagonist muscles. Differences between the effects of voluntary contraction of the ECR muscle for the MEP and the H reflex of the FCR suggest that cortical facilitatory spread occurs between agonist and antagonist muscles.     

Neurophysiological assessment of the motor and sensory spinal pathways in chronic spinal cord injury

Introduction of transcranial magnetic stimulation (TMS) has provided means to study non-invasively corticospinal functions in humans. The purpose of the present study was to obtain an objective evaluation of spinal cord functions in spinal cord injury (SCI) subjects using TMS, multichannel surface EMG and somatosensory-evoked potentials (SSEP). Multichannel surface EMG recording was performed during reinforcement manoeuvres and during vibratory tonic reflex. Twenty-five post-traumatic clinically incomplete (ambulatory, AMB, and non-ambulatory, nAMB) SCI subjects were studied and compared to a control group of seven subjects. After preliminary analysis of neurophysiological studies they were divided into four groups according to presence or absence of motor-evoked potentials (MEP) in response to TMS in muscles below the level of the lesion and according to their ability to ambulate. TMS was delivered at vertex at 100% intensity and recorded from the large muscles of the upper and lower limbs. Surface EMG was recorded during reinforcement manoeuvres (RM) in the leg muscles and EMG activity was scored. SSEP were recorded at T12, L2, L4 and SI spinous processes and at Cz' on the scalp following tibial nerve stimulation at popliteal fossa. The prevalence of EMG responses during RM was higher in group with present MEPs (AMB/MEP+ and nAMB/MEP+) than in the group without MEPs. The group with present MEPs also showed better preserved functions of the ascending tracts compared to subjects without MEPs. Groups with present MEPs had 5/10 normal, 2/10 abnormal and 3/10 absent cortical SSEPs, whereas groups without MEPs showed 1/11 normal, 4/11 abnormal and 6/11 absent cortical SSEPs. Sustained function of ascending tracts was also positively correlated with preserved ability to ambulate. It was concluded that TMS in combination with multichannel surface EMG monitoring and sensory evoked potentials may prove feasible in assessing the functional capacity of the spinal cord after spinal cord lesion.     

Mechanomyographic response to transcranial magnetic stimulation from biceps brachii and during transcutaneous electrical nerve stimulation on extensor carpi radialis

Transcranial magnetic stimulation (TMS) elicits short latency excitatory responses in the target muscles, termed motor evoked potential (MEP). When TMS is delivered during a voluntary contraction, the MEP is followed by a period of silence called silent period (SP). These MEP parameters are in general recordable by electromyography (EMG). Mechanomyography (MMG) on the other hand is the mechanical counterpart of EMG. Thus, this study has been conducted to observe whether the MEP parameters from MMG signals showed similar trait of EMG recordings. Five normal healthy male subjects were included in this study. The subjects were required to perform right biceps brachii muscles contraction at diverse graded of load level at 5, 10, 20, 30, 40, 60, and 100% maximum voluntary contraction (MVC). MEPs by single pulse TMS on left hemisphere were obtained from both EMG electrode and MMG accelerometer at rest and at different levels of predetermined load level. MEP amplitude and area obtained both from EMG and MMG record were increased with the increase of muscle contraction with a maximum of 60% MVC. With increasing the level of contraction there was a shortening of onset latency and decreasing in the length of silent period in both EMG and MMG signals. We also recorded the EMG- and MMG-MEP from the right extensor carpi radialis muscle during transcutaneous electric nerve stimulation in order to observe neural changes in sensory stimulation from both EMG and MMG responses. The EMG-MEP was not visible in electrical artifact whereas it was obvious in MMG responses. In accordance with other study, this study showed that the voluntary contraction of biceps brachii muscle influenced the MEP parameter which are moreover obtainable by MMG even in electrical noise may provide insight for future study.     

Tendon reflexes for predicting movement recovery after acute spinal cord injury in humans.

OBJECTIVE: Use the tendon reflex to examine spinal cord excitability after acute spinal cord injury (SCI), relating excitability findings to prognosis. METHODS: We conducted repeated measures of reflex responses to mechanical taps at the patellar and Achilles tendons of the lower limbs, and the wrist flexor tendons of the upper limbs in persons with acute SCI, beginning as early as the day of injury. The single largest EMG response (peak-to-peak) for each site was recorded. Subjects were compared based on level of injury and final neurologic status of lower limb motor function (i.e. absence of any voluntary recruitment in a lower limb muscle: motor-complete; voluntary recruitment in 1 or more lower-limb muscles: motor-incomplete). RESULTS: We studied 229 subjects with acute SCI. Persons with injury to the cervical or thoracic spinal cord and who were (or became) motor-incomplete showed large tendon responses, even at the time of initial evaluation. In combination with larger tendon response amplitudes, the presence of the 'crossed-adductor' response to patellar tendon taps at the acute stage was highly predictive of functional motor recovery following SCI. In marked contrast, tendon responses were small (e.g. < 0.1 mV) or absent in persons with acute, motor-complete injury (and which remained motor-complete), and the crossed-adductor response was never seen. Reflex amplitudes and the incidence of the crossed-adductor response increased somewhat over time in persons with motor-complete SCI, but did not approach the values seen in motor-incomplete subjects. CONCLUSIONS: Taken together, tendon response amplitude and reflex spread were sensitive and specific indicators of preserved supraspinal control over lower limb musculature in subjects with acute SCI. A simple algorithm using these outcome measures predicted a 'motor-complete' status with 100% accuracy, and a motor-incomplete status with accuracy exceeding 91%.     

A noninvasive technique to assess completeness of spinal cord lesions in humans

The effect of scalp stimulation delivered through electrodes overlying the motor cortex was evaluated in five healthy subjects and six patients with traumatic spinal cord injury. The latency to the onset of the electromyographic response was measured in the biceps brachii and abductor pollicis brevis muscles. In all the patients, latencies to the muscle (biceps brachii) whose innervation originated above the lesion were in the normal range; whereas, latencies to the muscle (abductor pollicis brevis) whose innervation originated below the lesion were prolonged. Electromyographic signals were recorded in muscles which showed no voluntary motor activity. No lateral differences in latencies were found in healthy subjects; however, in the patients, significant differences were obtained between the right and left abductor pollicis brevis muscles. The results of this study demonstrate that the spinal cord of patients with a lesion deemed to be clinically complete, contains nerve fibers which descend through the lesion and are capable of conveying impulses leading to muscle contraction.     

Muscle Weakness, Paralysis, and Atrophy after Human Cervical Spinal Cord Injury

Muscle weakness and failure of central motor drive were assessed in triceps brachii muscles of individuals with chronic cervical spinal cord injury (SCI) and able-bodied controls. Electrical stimuli were applied to the radial nerve during rest and during triceps submaximal and maximal voluntary contractions (MVCs). The mean forces and integrated EMGs generated by SCI subjects during MVCs were significantly less than those produced by controls (P < 0.01), with 74 and 71% of muscles generating <10% control force and EMG, respectively. There was an inverse linear relationship between the evoked and voluntary forces (n = 32 muscles of SCI subjects) which, when extrapolated to zero evoked force, also showed significant whole muscle weakness for SCI compared to control subjects (P < 0.01). Severe muscle atrophy was revealed which might reflect disuse and/or muscle denervation subsequent to motoneuron loss. Many triceps muscles of SCI subjects showed no force occlusion (n = 41) or were impossible to stimulate selectively (n = 61). Force was always evoked when the radial nerve was stimulated during MVCs of SCI subjects. The force elicited by single magnetic shocks applied to the motor cortex at Cz′ during voluntary contractions of SCI subjects was also inversely related to the voluntary triceps force exerted (n = 18), but usually no force could be elicited during MVCs. Thus central motor drive was probably maximal to these muscles, and the force evoked during MVCs by below-lesion stimulation must come from activation of paralyzed muscle. SCI subjects also had significantly longer mean central nervous system (CNS) conduction times to triceps (P < 0.01) suggesting that the measured deficits reflect CNS rather than peripheral nervous system factors. Thus, the weak voluntary strength of these partially paralyzed muscles is not due to submaximal excitation of higher CNS centers, but results mainly from reduction of this input to triceps motoneurons.     

Modulation of single motor unit discharges using magnetic stimulation of the motor cortex in incomplete spinal cord injury

OBJECTIVES: Motor evoked potentials (MEPs) and inhibition of voluntary contraction to transcranial magnetic stimulation (TMS) of the motor cortex have longer latencies than normal in patients with incomplete spinal cord injury (iSCI) when assessed using surface EMG. This study now examines the modulation of single motor unit discharges to TMS with the aim of improving resolution of the excitatory and inhibitory responses seen previously in surface EMG recordings. METHODS: A group of five patients with iSCI (motor level C4-C7) was compared with a group of five healthy control subjects. Single motor unit discharges were recorded with concentric needle electrodes from the first dorsal interosseus muscle during weak voluntary contraction (2%-5% maximum). TMS was applied with a 9 cm circular stimulating coil centred over the vertex. Modulation of single motor unit discharges was assessed using peristimulus time histograms (PSTHs). RESULTS: Mean (SEM) threshold (expressed as percentage of maximum stimulator output (%MSO)) for the excitatory peak (excitation) or inhibitory trough (inhibition) in the PSTHs was higher (p<0.05) in the patients (excitation = 47.1 (5.9) %MSO; inhibition = 44.3 (3.2) %MSO) than in controls (excitation=31.6 (1.2) %MSO; inhibition = 27.4 (1.0) %MSO). Mean latencies of excitation and inhibition were longer (p<0.05) in the patients (excitation=35 (1.8) ms; inhibition = 47.1 (1.8) ms) than in the controls (excitation = 21.1 (1.6) ms; inhibition = 27 (0.4) ms). Furthermore, the latency difference (inhibition-excitation) was longer (p<0.05) in the patients (10.4 (2.1) ms) than in the controls (6.2 (0.6) ms). CONCLUSION: Increased thresholds and latencies of excitation and inhibition may reflect degraded corticospinal transmission in the spinal cord. However, the relatively greater increase in the latency of inhibition compared with excitation in the patients with iSCI may reflect a weak or absent early component of cortical inhibition. Such a change in cortical inhibition may relate to the restoration of useful motor function after iSCI.     

Nociceptive fingertip stimulation inhibits synergistic motoneuron pools in the human upper limb

BACKGROUND: Activation of distinct muscle groups organized in a stereotyped manner ("muscle synergies") is thought to underlie the production of movement by the vertebrate spinal cord. This results in movement with minimum effort and maximum efficiency. The question of how the vertebrate nervous system inhibits ongoing muscle activity is central to the study of the neural control of movement. OBJECTIVE: To investigate the strategy used by the human spinal cord to rapidly inhibit muscle activation in the upper limb. METHODS: The authors performed a series of experiments in 10 healthy subjects to assess the effect of nociceptive cutaneous stimulation on voluntarily contracting upper limb muscles. They recorded the electromyogram (EMG) with surface electrodes placed over various upper limb muscles. RESULTS: The authors found evidence of a simple inhibitory strategy that 1) was dependent on the intensity of the stimulus, 2) was maximally evoked when stimulation was applied to the fingertips, 3) preceded the earliest onset of voluntary muscle relaxation, and 4) produced inhibition of EMG activity in specific upper limb muscle groups. Nociceptive fingertip stimulation preferentially inhibited contraction of synergistic muscles involved in reaching and grasping (intrinsic hand muscles, forearm flexors, triceps) while having little effect on biceps or deltoid. CONCLUSIONS: Neural circuitry within the human spinal cord is organized to inhibit movement by rapidly deactivating muscles that constitute distinct muscle synergies. This strategy of selective and concurrent deactivation of the same basic elements that produce synergistic movement greatly simplifies motor control.     

Posteroanterior cervical transcutaneous spinal stimulation targets ventral and dorsal nerve roots

ObjectiveWe aim to non-invasively facilitate activation of spared neural circuits after cervical spinal cord injury (SCI) and amyotrophic lateral sclerosis (ALS). We developed and tested a novel configuration for cervical transcutaneous spinal stimulation (cTSS).MethodscTSS was delivered via electrodes placed over the midline at ~T2-T4 levels posteriorly and ~C4-C5 levels anteriorly. Electromyographic responses were measured in arm and hand muscles across a range of stimulus intensities. Double-pulse experiments were performed to assess homosynaptic post-activation depression (PAD). Safety was closely monitored.ResultsMore than 170 cTSS sessions were conducted without major safety or tolerability issues. A cathode-posterior, 2 ms biphasic waveform provided optimal stimulation characteristics. Bilateral upper extremity muscle responses were easily obtained in subjects with SCI and ALS. Resting motor threshold at the abductor pollicis brevis muscle ranged from 5.5 to 51.0 mA. As stimulus intensity increased, response latencies to all muscles decreased. PAD was incomplete at lower stimulus intensities, and decreased at higher stimulus intensities.ConclusionsPosteroanterior cTSS has the capability to target motor neurons both trans-synaptically via large-diameter afferents and non-synaptically via efferent motor axons.SignificancePosteroanterior cTSS is well tolerated and easily activates upper extremity muscles in individuals with SCI and ALS.     

Experience with transcranial magnetic stimulation in evaluation of spinal cord injury

Abstract

Nine subjects (seven male, two female) underwent transcranial magnetic stimulation (TMS) toward the evaluation of spinal cord injury (SCI). The evaluation of SCI with TMS tended to support clinical findings. Those subjects with clinically complete injuries demonstrated no evoked muscle response below the level or injury. Those subjects with clinically incomplete injuries showed trends toward prolonged evoked muscle latencies on the weaker side. Facilitation tended to enhance distal muscle responses. With incomplete spinal injurYI the facilitation maneuver allowed the recording of weak muscle responses as well as those otherwise not present at rest. Maximum anal sphincter contraction also hf;lped facilitate muscle responses and tended to impart less noise in the recordings. Facilitation failed, however to produce a response in those subjects with clinically complete injuries. No subject experienced adverse effects during the study. TMS promises to be an effective tool for the evaluation of SCI. [Neural Res 1997; 19: 497-500]     

Muscle imaging: mapping responses to transcranial magnetic stimulation with high-density surface electromyography

Representations of different body parts or muscles in the human primary motor cortex overlap extensively. At the effector level, most muscles are surrounded by and overlap with several neighbours as well. This hampers the assessment of excitability in individual muscles with transcranial magnetic stimulation (TMS), even if so-called "focal" stimulating coils are used. Here we used a novel mapping paradigm based on high-density surface electromyography (HD-sEMG) to investigate the spatial selectivity of TMS in the forearm musculature. In addition, we tested the hypothesis that selective stimulation can be improved by a voluntary background contraction of the target muscle. We mapped and compared the topographies of motor evoked potential (MEP) amplitudes during rest and during background contractions of two forearm muscles (extensor carpi radialis and extensor digitorum communis). The MEP topographies were also compared to the amplitude topography of voluntary EMG. The results indicate that under many conditions a large proportion of the MEP activity recorded at the surface originated from the target muscle's neighbours. There was a systematic relationship between TMS intensity and the topographic distribution of MEP responses during voluntary contraction. With increasing stimulus intensity, the MEP topography deviated increasingly more from the topography of voluntary EMG. We conclude that when standard EMG montages are used, the recorded MEPs are not necessarily evoked in the target muscle alone. Stimulation during a voluntary background contraction of the target muscle may enhance the selectivity of TMS. It however remains essential to use stimulus intensities as low as possible, to minimize the contribution of surrounding non-target muscles to the MEP.     

Impaired facilitation of motor evoked potentials in incomplete spinal cord injury

Objectives To improve the diagnosis of damaged spinal motor pathways in incomplete spinal cord injury (iSCI) by assessing the facilitation of lower limbs motor evoked potentials (MEP). Methods Control subjects (n = 12) and iSCI patients (n = 21) performed static and dynamic isometric foot dorsiflexions. MEPs induced by transcranial magnetic stimulation and EMG background of tibialis anterior muscle (TA) were analyzed. Static and dynamic muscle activation was performed at comparable levels of maximal voluntary contraction (MVC). The influence of the motor tasks on the excitability and facilitation of MEPs was compared between controls and iSCI patients. Results In the controls an increased facilitation of TA MEP at lower levels of dynamic compared with static activation (10–20% MVC) could be shown. At matched EMG background level the MEP responses were significantly increased. In the iSCI patients at a comparable level of TA activation the MEP responses were significantly reduced and 3 different patterns of MEP responses could be distinguished: i) preserved increment of TA MEP in the dynamic motor task, ii) unchanged MEP size in the dynamic and static motor task, and iii) elicitable MEPs in the dynamic motor task,which were abolished in the static motor task. Conclusions Static and dynamic motor tasks have different effects on TA MEP facilitation. The task–dependent modulation of TA MEPs is comparable to that described for upper limb muscles. Complementary to the MEP delay this approach allows for an estimation of the severity of spinal tract damage. The task–dependent modulation of TA MEPs is an additional diagnostic tool to improve the assessment and monitoring of motor function in iSCI.     

Effect of voluntary contraction of the masseter and other muscles upon the masseteric reflex in man

Experiments were carried out on seven adult subjects in order to establish the relationship between the magnitude of the masseteric reflex and the amount of voluntary activity present in the muscle at the time the reflex was evoked. At the same time, an effort was made to determine whether the magnitude of the reflex could be enhanced by the simultaneous voluntary contraction of muscles other than that being tested (the Jendrassik manoeuvre). The reflex was evoked by applying controlled downward thrusts to the mandible so as to produce a constant displacement in each case, and the response of the masseter muscle was recorded by means of small bipolar surface electrodes attached to the skin over the muscle. These responses were averaged by a computer in the presence of various static loads supported by the mandible. It was found that in all subjects the amplitude of the masseteric reflex appeared to increase as the weight supported by the mandible increased, and that in the majority of subjects it was possible to demonstrate Jendrassik facilitation by simultaneous contraction of the muscles of the upper limbs. The results of the experiments suggest that the enhancement of the masseteric reflex by voluntary contraction of the jaw-closing muscles may be due to autogenetic factors, synergistic factors, or both, and that at least two processes contribute to the amplitude of the masseteric reflex evoked by tooth contact during mastication—namely, the stimulation of muscle spindles by the impact of opposing teeth and facilitation caused by voluntary activity in the jaw-closing muscles before tooth contact.     

Single joint perturbation during gait: preserved compensatory response pattern in spinal cord injured subjects.

OBJECTIVE: Responses to afferent input during locomotion are organized at the spinal level but modulated by supraspinal centers. The study aim was to examine whether supraspinal influences affect the behavior of complex electromyographic (EMG) responses to single limb perturbations during walking. METHODS: Subjects with motor-complete (MCSCI), motor-incomplete spinal cord injury (MISCI), and non-disabled (ND) subjects participated. Hip or knee joint trajectory was briefly arrested by a robotic device at early or late swing phase. EMG responses from muscles of both legs were analyzed. RESULTS: Perturbation-induced EMG responses of spinal cord injured and ND individuals were similar in basic structure, with the exception that tibialis anterior onset times were delayed for SCI subjects. Across all groups, perturbations in late swing (i.e., near the swing-to-stance transition) were associated with shorter muscle onset times and higher EMG amplitudes. Knee perturbations were associated with shorter muscle response onset times, while hip perturbations elicited higher response amplitudes. EMG responses were also evoked in muscles contralateral to the perturbation. CONCLUSIONS: These data indicate that neuronal circuits within the spinal cord deprived of normal supraspinal input respond to swing phase perturbations in a manner that is similar to that of the intact spinal cord. SIGNIFICANCE: The adult human spinal cord is capable of generating complex, phase-appropriate responses much as has been observed in studies of human infants and in spinal animals.     

Motor evoked responses from the thigh muscles to the stimulation of the upper limb nerves in patients with late poliomyelitis.

OBJECTIVES: To demonstrate a clear-cut M response recorded from the severely affected thigh muscles to the stimulation of the upper limb nerves in a serial of patients with late poliomyelitis. METHODS: Fifteen patients with late poliomyelitis, 7 patients with spinal cord disorders and 11 control subjects were included. Evoked muscle responses were investigated in quadriceps femoris and/or thigh adductor muscles to the stimulation of the brachial plexus, median and ulnar nerves. RESULTS: Evoked muscle responses were obtained from the thigh muscles in all 12 late polio patients with proximal lower extremity involvement. The response could not be recorded from the thigh muscles neither in the 3 polio patients with upper extremity involvement nor in the healthy control subjects and in patients with other spinal cord disorders of anterior horn cell. CONCLUSIONS: It is proposed that the electrical stimulation of the arm nerves produce interlimb descending muscle responses in the severely affected atrophic thigh muscles of the patients with late polio. This finding suggests that there might be a focal and/or specific loss of inhibitory interneurons between injured and normal motor neurons and increased facilitatory synaptic action at the end of long propriospinal descending fibers in the case of late poliomyelitis.     

Stumbling reactions in man: influence of corticospinal input

The aim of this study was to evaluate the degree of contribution of supraspinal input to the generation of the compensatory leg muscle activation following stance perturbation. Therefore, evoked motor response (EMR) input–output relations of two different motor tasks were compared at 3 distinct periods: (1) the basic period of muscular activity during standing, i.e. when no additional cortical or spinal activity due to the different tasks is to be expected, (2) the pre-movement period with low background activity, when different spinal and cortical inputs to the motoneuronal pool can be assumed and (3) the period of plateau EMG activity of compensatory and voluntary motor task. Transcranial magnetic stimulation (TMS) just below the motor threshold was applied randomly at 19 different time-intervals before and during the onset of stance perturbation and for comparison during an equivalent voluntary foot-dorsiflexion task. Recordings of electromyographic (EMG) activity from the tibialis anterior (TA) and corresponding ankle-joint movements were made from both legs. Forward-directed displacements were induced by randomly-timed ramp impulses of constant acceleration upon a moveable platform. For comparison, leg muscle EMG was recorded during isometric foot dorsiflexion during stance while leaning back against a support. The stance perturbations were followed by a compensatory response (CR) in the TA with a mean onset time of 81 ms. During the basic period of muscular activity and the period of plateau EMG activity there was no significant difference of the input–output relation between stance perturbation and the voluntary motor task. However, in the voluntary task compared with the CR, there was significantly greater input–output relation (facilitation) of the EMR in the TA following TMS, which may be related to an increased cortical influence. In contrast to this result of the CR following stance perturbation, a facilitation of the EMR was described for hand muscles under corresponding conditions of automatic compensation for muscle stretch, suggesting a transcortical reflex loop. This difference in the results from upper and lower extremity muscles favors the assumption of a predominantly spinal generation of the TA-CR following stance perturbation.     

Measurement of voluntary activation of the back muscles using transcranial magnetic stimulation

ObjectiveTwitch interpolation using transcranial magnetic stimulation (TMS) has recently been used to measure the level of drive from the motor cortex to contracting muscles of the upper and lower limbs, termed voluntary activation. It has yet to be used to assess voluntary activation in trunk muscles. The aim of this study was to assess the feasibility of using TMS to measure voluntary activation in back muscles.MethodsSixteen healthy subjects performed a series of brief maximal and submaximal isometric contractions of the back extensors during which TMS was delivered to the motor cortex. The evoked (superimposed) twitch was measured using dynamometry and simultaneous surface electromyographic (EMG) recordings were taken from the left and right erector spinae at vertebral level T12. Voluntary activation was derived using the expression: (1-superimposed twitch amplitude/resting twitch amplitude) × 100. The resting twitch amplitude was estimated by extrapolation of the linear correlation between voluntary torque and superimposed twitch amplitude to zero torque.ResultsThe relationship between superimposed twitch size and voluntary contraction strength for contraction strengths of 50–100% MVC was linear but regression revealed variability between subjects. When data were included from those subjects with a good linear regression fit a strong linear relationship was found for the group means between voluntary contraction strength and voluntary activation (r² = 1) and superimposed twitch size (r² = 0.99) for contraction strengths of 50–100% MVC. Voluntary activation was found to be less than maximal (67.71 ± 5.22%) during maximal efforts. Time-to-peak amplitude decreased linearly with increasing voluntary torque. The amplitudes of the motor evoked potentials (MEPs) increased with increasing voluntary torque.ConclusionsTwitch interpolation using TMS can be used to quantify voluntary activation in back extensors. The results of this study reveal that neural drive to the back extensors during strong contractions is submaximal.SignificanceThe assessment of voluntary activation of the back muscles may aid our understanding of the mechanisms of alteration in control of these muscles implicated in chronic low back pain.