Changes in contractile and elastic properties of the triceps surae muscle induced by neuromuscular electrical stimulation training.

PURPOSE: Neuromuscular electrical stimulation (NMES) training is known to induce improvement in force production capacities and fibre-type transition. The aim of this study was to determine whether NMES training also leads to changes in the mechanical properties of the human triceps surae (TS) muscle. METHODS: Fifteen young male subjects performed a training protocol (4 weeks, 18 sessions, 4-5 sessions per week) based on a high-frequency isometric NMES programme of TS muscle. Quick-release test was used to evaluate Musculo-Tendinous (MT) stiffness index (SIMT) as the slope of the linear MT stiffness-torque relationships under submaximal contraction. Sinusoidal perturbations allowed the assessment of musculo-articular stiffness index (SIMA) as well as the calculation of the maximal angular velocity ([Formula: see text]) of TS muscle using an adaptation of Hill's equation. RESULTS: After NMES training, Maximal Voluntary Contraction under isometric conditions and [Formula: see text] increased significantly by 17.5 and 20.6 %, respectively, while SIMT and SIMA decreased significantly (-12.7 and -9.3 %, respectively). CONCLUSIONS: These changes in contractile and elastic properties may lead to functional changes of particular interest in sport-related activities as well as in the elderly.

Benefits of repetitive transcranial magnetic stimulation (rTMS) for spastic subjects: clinical, functional, and biomechanical parameters for lower limb and walking in five hemiparetic patients.

Introduction. Spasticity is a disabling symptom resulting from reorganization of spinal reflexes no longer inhibited by supraspinal control. Several studies have demonstrated interest in repetitive transcranial magnetic stimulation in spastic patients. We conducted a prospective, randomized, double-blind crossover study on five spastic hemiparetic patients to determine whether this type of stimulation of the premotor cortex can provide a clinical benefit. Material and Methods. Two stimulation frequencies (1 Hz and 10 Hz) were tested versus placebo. Patients were assessed clinically, by quantitative analysis of walking and measurement of neuromechanical parameters (H and T reflexes, musculoarticular stiffness of the ankle). Results. No change was observed after placebo and 10 Hz protocols. Clinical parameters were not significantly modified after 1 Hz stimulation, apart from a tendency towards improved recruitment of antagonist muscles on the Fügl-Meyer scale. Only cadence and recurvatum were significantly modified on quantitative analysis of walking. Neuromechanical parameters were modified with significant decreases in H max⁡ /M max⁡ and T/M max⁡ ratios and stiffness indices 9 days or 31 days after initiation of TMS. Conclusion. This preliminary study supports the efficacy of low-frequency TMS to reduce reflex excitability and stiffness of ankle plantar flexors, while clinical signs of spasticity were not significantly modified.

Ipsi- and contralateral H-reflexes and V-waves after unilateral chronic Achilles tendon vibration.

Chronic Achilles tendon vibration has previously shown its effectiveness in improving plantar flexor's strength and activation capacities. The present study investigated the related neural mechanisms by analyzing H-reflexes and V-waves of the soleus (SOL) and gastrocnemii (GM gastrocnemius medialis; GL gastrocnemius lateralis) muscles under maximal isometric plantar flexion. Moreover, recordings were conducted bilaterally to address potential crossed effects. 11 subjects were engaged in this study. Maximal voluntary contraction and superimposed H-reflexes and V-waves were quantified in both legs at baseline (PRE) and 2 weeks later to verify repeatability of data (CON). Then, subjects were retested after 14 days of daily unilateral Achilles tendon vibration (VIB; 1 h per day; frequency: 50 Hz). No changes were reported between PRE and CON data. In the VIB condition, there was an increase in MVC for both the vibrated (+9.1 %; p = 0.016) and non-vibrated (+10.2 %; p = 0.009) legs. The H-reflex increased by a mean 25 % in the vibrated SOL (p < 0.001), while it remained unchanged for the contralateral side (p = 0.531). The SOL V-wave also increased in the vibrated limb (+43.3 %; p < 0.001), as well as in the non-vibrated one (+41.9 %; p = 0.006). Furthermore, the GM V-wave increased by 37.8 % (p = 0.081) in the vibrated side and by 39.4 % (p = 0.03) in the non-vibrated side. However, no changes were reported for the GL muscles. While the present study confirmed the strength gains induced by chronic Achilles tendon vibration, the results indicated a cross-education phenomenon with differences in neural adaptations between the vibrated leg and non-vibrated leg.

Long-term neuromechanical results of selective tibial neurotomy in patients with spastic equinus foot.

BACKGROUND: The neuromechanical consequences of tibial neurotomy have not been extensively studied. METHODS: Fifteen patients were evaluated before and after selective tibial neurotomy (after 2 months and after 15 months) by means of clinical, neurophysiological [tendon (T) reflexes, Hoffmann (H) reflexes and maximum motor response, Mmax] and mechanical parameters (passive stiffness of plantar flexors at the ankle). The neurotomy concerned the soleus (100 % of cases), gastrocnemius (20 % of cases), posterior tibial (60 % of cases) and flexor digitorum longus (47 % of cases) nerves. RESULTS: Neurotomy provided more than 90 % improvement of clinical spasticity scores, 20 % improvement of walking scores and the angle of passive dorsiflexion (APDF) of the ankle (mean angle: 7°), temporary reduction of the soleus Mmax (18 % at 2 months with return to the preoperative value at 15 months), and lasting reduction of the soleus Hmax/Mmax (68 % at 2 months, 78 % at 15 months) and T/Mmax (84 % at 2 months, 80 % at 15 months). M and H responses of the gastrocnemius (whether or not they were included in the neurotomy) were not modified, while T/Mmax decreased to the same degree as for soleus. Passive stiffness was lastingly decreased from 64.0 Nm/rad to 49.0 Nm/rad (2 months) and 49.5 Nm/rad (15 months). CONCLUSION: Selective tibial neurotomy of the soleus nerve induces long-term reduction of reflex hyperexcitability and passive stiffness of plantar flexors in spastic patients, with no lasting impairment of motor efferents. In parallel, it modifies the tendon reflexes of synergistic muscles (gastrocnemius) not concerned by the neurotomy.

Time course of the soleus M response and H reflex after lidocaine tibial nerve block in the rat.

AIMS: In spastic subjects, lidocaine is often used to induce a block predictive of the result provided by subsequent surgery. Lidocaine has been demonstrated to inhibit the Hoffmann (H) reflex to a greater extent than the direct motor (M) response induced by electrical stimulation, but the timecourse of these responses has not been investigated. METHODS: An animal (rat) model of the effects of lidocaine on M and H responses was therefore developed to assess this time course. M and H responses were recorded in 18 adult rats before and after application of lidocaine to the sciatic nerve. RESULTS: Two to five minutes after lidocaine injection, M responses were markedly reduced (mean reduction of 44%) and H reflexes were completely abolished. Changes were observed more rapidly for the H reflex. The effects of lidocaine then persisted for 100 minutes. The effect of lidocaine was therefore more prolonged on the H reflex than on the M response. CONCLUSION: This study confirms that lidocaine blocks not only alpha motoneurons but also Ia afferent fibres responsible for the H reflex. The authors describe, for the first time, the detailed time course of the effect of lidocaine on direct or reflex activation of motoneurons in the rat.

Stunting delays maturation of triceps surae mechanical properties and motor performance in prepubertal children.

Malnutrition can lead to possible irreversible consequences in the development of muscle function and some of them are yet poorly characterized. The present study evaluated the mechanical properties of the triceps surae and motor performance in stunted (S) and eutrophic (E) prepubertal children (9 years ± 6 months). Height-for-age ratio was used as indicator of stunting due to early malnutrition, according to the World Health Organization. Torque was determined by maximal voluntary contractions (MVC) and musculotendinous (MT) stiffness was achieved through quick-release tests to obtain MT stiffness index (SI(MT)) and passive stiffness (K (p)) from linear MT stiffness-torque relationships. Percutaneous supramaximal electrically elicited contractions determined twitch torque (Pt) and electromechanical delay (EMD). Motor performance was evaluated by balance test. S group presented significantly lower MVC and a trend of lower Pt values indicating lower capacities to develop force under voluntary or induced conditions. Significantly higher SI(MT) and EMD values were observed, while K (p) and motor performance in balance were significantly lower. Higher SI(MT) values have been reported previously in youngest prepubertal children, indicating that immature activation capacities can mask MT stiffness assessment during voluntary contractions, taking into consideration the higher EMD values as a measure of muscle stiffness contribution. Lower K (p) may indicate a delay in the maturation of tendinous tissue in S group, influencing motor performance in balance. The present study shows that malnutrition leads to adaptation of intrinsic MT elastic properties, but depends on the level of the observed structure.

Paired changes in electromechanical delay and musculo-tendinous stiffness after endurance or plyometric training.

When measured in vivo electromechanical delay (EMD) depends mainly on the elastic properties of the muscle-tendon unit. Recent studies have shown changes in stiffness of the triceps surae (TS) following a period of training. To confirm the influence of musculo-tendinous stiffness on EMD, this study investigates paired changes in these two parameters after a training period. Two types of training known to induce opposite changes in stiffness were analysed. EMD and musculo-tendinous stiffness were measured on adult subjects before and after 10 weeks of endurance (n = 21) or plyometric (n = 9) trainings. EMD was defined as the time lag between the TS M-wave latency and the onset of muscle twitch evoked at rest by supramaximal electrical stimulations of the posterior tibial nerve. Quick release tests were used to evaluate the musculo-tendinous stiffness of the ankle plantar flexors. The stiffness index was defined as the slope of the relationship between angular stiffness and external torque values. Endurance training, known to preferentially activate the slow, stiffer muscle fibers, leads to a decrease in EMD and to an increase in stiffness index. Following plyometric training, which specifically recruits fast, more compliant fibers, EMD and the stiffness index exhibited adaptations directionally opposite to those seen with endurance training. When pooling the data for the two subject groups, a correlation was found between changes in EMD and changes in musculo-tendinous stiffness indexes. Thus, changes in EMD values are proposed to indirectly link to changes in musculo-tendinous stiffness for subjects involved in muscle training.

Voluntary activation of the triceps surae in prepubertal children.

The activation capacities and neuromuscular efficiency (NME) of the triceps surae (TS) of prepubescent children (7-11 years) and adults were evaluated during submaximal and maximal (MVC) isometric plantarflexion to determine whether they varied with age. TS-EMG were obtained by summing-up the rectified electromyograms of the soleus and gastrocnemii muscles; these data were quantified using a sliding average method and normalized with reference to the TS maximal compound action potential (TS-M-wave). The maximal EMG increased significantly with age in the children, but less than MVC, what led to a significant increase in NME(Max) (MVC/TS-EMG(max) ratio). The EMG-torque relationship indicated an age-related overactivation of TS at low torque, what led to a lower NME(Sub-max) (inverse of the slope of the EMG-torque relationship) for the youngest children. The overactivation of TS was accompanied by contraction of the TA, which decreased with age. The youngest children were also less able to maintain a target torque and muscle activation. Finally, the twitch interpolated method revealed an age-dependant activation deficit. We conclude that central mechanisms are the main cause of the lower torques developed by children and they appear to vary with age in prepubertal children.

Neuromuscular efficiency of the rectus abdominis differs with gender and sport practice.

The purpose of this investigation was to distinguish the abilities of the rectus abdominis (RA) muscle according to gender and sport training by means of neuromuscular parameters extracted from electromyography (EMG)-torque relationships. Thirty-eight healthy students, divided into 4 groups (i.e., 8 male runners, 10 female gymnasts, 12 male controls, and 8 female controls) were asked to perform 6 seconds of isometric trunk flexions at 20%, 25%, 75%, and 100% of their maximal voluntary contraction. Flexion torque and surface EMG of the RA muscle were recorded simultaneously to construct a EMG-torque relationship. Under maximal and submaximal conditions, an index of neuromuscular efficiency (NME) was determined to characterize the capacity of the RA muscle to develop a torque. At each level of contraction, the area of data scattering (ADS), reflecting torque and EMG fluctuations, was computed to express the capacity to maintain a constant target torque. Flexion torque, NME, and ADS values differed significantly between genders, but when data were related to anthropometric characteristics, no difference was observed. Although runners were not distinguished from male controls, gymnasts had higher flexion torque, higher NME, and lower ADS values than female controls had. These differences should reflect neural and muscular adaptations linked to the specificity of gymnastic training. These findings revealed different functional abilities of the RA muscle, according to gender and sport practices. The indices of neuromuscular capacities used in this study could constitute complementary tools to athletic trainers and professionals in sports medicine for evaluating and following, during sport-specific training programs, the abdominal muscle performance implied in force transfers with a lower cost and lower risks of back pain.

Aging affects passive stiffness and spindle function of the rat soleus muscle.

Aging affects many motor functions, notably the spinal stretch reflexes and muscle spindle sensitivity. Spindle activation also depends on the elastic properties of the structures linked to the proprioceptive receptors. We have calculated a spindle efficacy index, SEI, for old rats. This index relates the spindle sensitivity, deduced from electroneurograms recording (ENG), to the passive stiffness of the muscle. Spindle sensitivity and passive incremental stiffness were calculated during ramp and hold stretches imposed on pseudo-isolated soleus muscles of control rats (aged 4 months, n=12) and old rats (aged 24 months, n=16). SEI were calculated for the dynamic and static phases of ramp (1-80 mm/s) and for hold (0.5-2mm) stretches imposed at two reference lengths: length threshold for spindle afferents discharges, L(n) (neurogram length) and slack length, L(s). The passive incremental stiffness was calculated from the peak and steady values of passive tension, measured under the stretch conditions used for the ENG recordings, and taking into account the muscle cross-sectional area. The pseudo-isolated soleus muscles were also stretched to establish the stress-strain relationship and to calculate muscle stiffness constant. The contralateral muscle was used to count muscle spindles and spindle fibers (ATPase staining) and immunostained to identify MyHC isoforms. L(n) and L(s) lengths were not significantly different in the control group, while L(n) was significantly greater than L(s) in old muscles. Under dynamic conditions, the SEI of old muscles was the same as in controls at L(s), but it was significantly lower than in controls at L(n) due to increased passive incremental stiffness under the stretch conditions used to analyze the ENG. Under static conditions, the SEI of old muscles was significantly lower than control values at all the stretch amplitudes and threshold lengths tested, due to increased passive incremental stiffness and decreased spindle sensitivity at L(s). The muscle stiffness constant values were greater in old muscles than in controls, confirming the changes in elastic properties under passive conditions due to aging. Aging also altered the intrafusal fibers: it increased the mean number of intrafusal fibers and the contents in the slow, neonatal and developmental isoforms intrafusal of MyHC have been modified. These structural modifications do not seem great enough to counteract the loss of the spindle sensitivity or the spindle efficacy under passive conditions and after the nerve was severed. However, they may help to maintain the spindle afferent message under natural conditions and under fusimotor control.

Changes in stretch reflexes and muscle stiffness with age in prepubescent children.

Musculo-articular stiffness of the triceps surae (TS) increases with age in prepubescent children, under both passive and active conditions. This study investigates whether these changes in muscle stiffness influence the amplitude of the reflex response to muscle stretch. TS stiffness and reflex activities were measured in 46 children (7-11 yr old) and in 9 adults. The TS Hoffmann reflex (H reflex) and T reflex (tendon jerk) in response to taping the Achilles tendon were evaluated at rest and normalized to the maximal motor response (Mmax). Sinusoidal perturbations of passive or activated muscles were used to evoke stretch reflexes and to measure passive and active musculoarticular stiffness. The children's Hmax-to-Mmax ratio did not change with age and did not differ from adult values. The T-to-Mmax ratio increased with age but remained significantly lower than in adults. Passive stiffness also increased with age and was correlated with the T-to-Mmax ratio. Similarly, the children's stretch reflex and active musculoarticular stiffness were significantly correlated and increased with age. We conclude that prepubescent children have smaller T reflexes and stretch reflexes than adults, and the lower musculoarticular stiffness is mainly responsible for these smaller reflexes, as indicated by the parallel increases in reflex and stiffness.

An index of spindle efficacy obtained by measuring electroneurographic activity and passive tension in the rat soleus muscle.

While muscle spindle afferent discharges are known to change with altered muscle use, the way in which the changes in spindle discharge are affected by modifications to the elastic properties of the muscle-tendon unit remains to analyze. This paper describes a methodology to define, in the rat, a spindle efficacy index. This index relates the spindle afferent discharges recorded from electroneurograms (ENG) due to muscle stretch to the passive elastic properties of the muscle-tendon unit quantified during the stretch imposed for the ENGs recordings. The stretches were applied to the rat soleus muscle after the Achilles tendon was severed. The spindle afferent discharges were characterized from the root mean square (RMS) values of electroneurograms (ENGs) recorded from the soleus nerve. The first step of the study was to validate the definition of dynamic and static indices (DI and SI) of spindle discharges from RMS-ENG as classically done when isolated afferents are studied. The slopes of the DI-stretch velocity or SI-stretch amplitude relationships gave the indices of spindle sensitivity under dynamic and static conditions, respectively. Incremental stiffness was calculated to describe the passive elastic properties during the dynamic and static phases of ramp and hold stretches applied at different amplitudes and velocities. The spindle efficacy index (SEI) is the ratio between the indices of spindle sensitivity and incremental stiffness values. Both spindle discharges and incremental stiffness increased with stretch amplitude under dynamic and static conditions. The corresponding SEI values were constant whatever the stretch amplitude. This result validates the relationship between spindle discharges and passive incremental stiffness. This method can be proposed to study, in the rat, the spindle function when the muscles are suspected to present changes in their neuromechanical properties.

Differences in kinematic parameters and plantarflexor reflex responses between manual (Ashworth) and isokinetic mobilisations in spasticity assessment.

OBJECTIVE: The purpose of this study was first to compare the kinematic parameters of imposed ankle mobilizations measured during Ashworth or isokinetic tests and, second, to better understand why the stretch reflex was more or less easily elicited by one method or the other. METHODS: Passive dorsiflexions were applied on eight adult patients with plantarflexor spasticity in two conditions: (i) manually, using the Ashworth test where passive dorsiflexions were performed freely by seven rehabilitation clinicians, and (ii) instrumentally, using an isokinetic device (Cybex Norm) and a dorsiflexion velocity at 300 degrees /s. Mean values of initial ankle position, maximal angular velocity (theta;'(max)), maximal angular acceleration (theta;''(max)) and plantarflexor reflex responses obtained with each method were compared. RESULTS: During the Ashworth test, all the patients presented reflex activities in the triceps surae while, during the isokinetic mobilization, only three out of the eight patients tested shown reflex responses. theta;'(max) values were significantly higher (P<0.05) in the manual test (308+/-80 degrees /s vs 216+/-5.5 degrees /s for the isokinetic test). The most marked difference concerned the theta;''(max) values (5046+/-2181 degrees /s(2) for the Ashworth test vs 819+/-18 degrees /s(2) for the isokinetic test, P<0.001). This parameter was significantly correlated with the mean rms-EMG values of the gastrocnemius lateralis (GL) and the soleus (SOL). CONCLUSIONS: This study indicates that passive dorsiflexions imposed during Ashworth and isokinetic tests largely differ in velocity and acceleration, and the higher dynamic parameters evaluated during the Ashworth test could mainly explain that the stretch reflex was more easily elicited during this manual testing. SIGNIFICANCE: If isokinetic devices offer numerous advantages in the assessment of passive resistance to spastic muscle stretch, they cannot be used to simulate the manual test.

Quantitative assessment of the velocity-dependent increase in resistance to passive stretch in spastic plantarflexors.

BACKGROUND: Although numerous studies revealed that isokinetic dynamometers were valuable tools for assessing spastic hypertonia, no standard methodology using such devices is currently widespread in clinical setting. The aim of this study was to standardize a protocol to assess spastic hypertonia in the triceps surae. METHODS: The passive resistance during dorsiflexions imposed from 10 to 300 degrees /s with an isokinetic dynamometer was measured at the neutral position in 15 patients with spastic hypertonia and 12 healthy subjects. The normalized passive resistance was obtained by expressing raw passive resistance as a percent of the values measured at the lowest velocity (10 degrees /s). EMG signals from plantar and dorsiflexors were also recorded. FINDINGS: While no significant difference between spastic patients and control subjects was observed in raw passive resistance values, the difference was significant for each tested velocity when considering the normalized values. Furthermore, the Ashworth score was significantly correlated with the normalized passive resistance for each velocity whereas no correlation was observed with the raw passive resistance. For the patients, except at the highest velocity, the normalized passive resistance was not affected by the fact that reflex responses in the triceps surae were elicited or not. INTERPRETATION: The normalized passive resistance, expressed with respect to the initial one, i.e., measured at very low velocity, seems a very effective parameter to quantify the velocity-dependent increase in resistance to passive stretch in spastic plantarflexors. However, while the simplicity of the isokinetic tests and the reduced time of data treatment seems to support the clinical use of this methodology, further investigations are required to definitely standardize the protocol.

Influence of long-term spaceflight on neuromechanical properties of muscles in humans.

Reflex and elastic properties of the triceps surae (TS) were measured on 12 male cosmonauts 28-40 days before a 3- to 6-mo spaceflight, 2 or 3 days after return (R+2/+3) and a few days later (R+5/+6). H reflexes to electrical stimulations and T reflexes to tendon taps gave the reflex excitability at rest. Under voluntary contractions, reflex excitability was assessed by the stretch reflex, elicited by sinusoidal length perturbations. Stiffness measurements concerned the musculoarticular system in passive conditions and the musculotendinous complex in active conditions. Results indicated 1) no changes (P > 0.05) in H reflexes, whatever the day of test, and 2) increase in T reflexes (P < 0.05) by 57%, despite a decrease (P < 0.05) in musculoarticular stiffness (11%) on R+2/+3. T reflexes decreased (P < 0.05) between R+2/+3 and R+5/+6 (-21%); 3) increase in stretch reflexes (P < 0.05) on R+2/+3 by 31%, whereas it decreased (P < 0.05) between R+2/+3 and R+5/+6 (-29%). Musculotendinous stiffness was increased (P < 0.05) whatever the day of test (25%). Links between changes in reflex and stiffness were also studied by considering individual data. At R+2/+3, correlated changes between T reflexes and musculoarticular stiffness suggested that, besides central adaptive phenomena, musculoarticular structures took part in the reflex adaptation. This mechanical contribution was confirmed when data collected at R+2/+3 and R+5/+6 were used because correlations between changes in stretch reflexes and musculotendinous stiffness were improved. In conclusion, the present study shows that peripheral influences take part in reflex changes in gravitational unloaded muscles, but can only be revealed when central influences are reduced.

Evaluation of musculotendinous stiffness in prepubertal children and adults, taking into account muscle activity.

Musculotendinous (MT) stiffness of the triceps surae (TS) muscle group was quantified in 28 prepubertal children (7-10 yr) by using quick-release movements at different levels of submaximal contractions. Surface electromyograms (EMG) of each part of the TS and of the tibialis anterior were also recorded. A stiffness index, defined as the slope of the angular stiffness-torque relationship (SIMT-Torque), was used to quantify changes in MT stiffness with age. Results showed a significant decrease in SIMT-Torque with age, ranging from 4.02 +/- 0.29 to 2.88 +/- 0.31 rad-1 for the youngest to the oldest children. Because an increase in stiffness with age was expected due to the maturation of elastic tissues, overactivation of the TS was suspected to contribute to the higher SIMT-Torque values found in the youngest children. TS EMG-torque analyses confirmed that neuromuscular efficiency was significantly lower for the 7- or 8-yr-old children compared with 10-yr-old children, notably due to a higher degree of tibialis anterior coactivation found in the youngest children. Thus the stiffness index originally defined as the slope of the angular stiffness-EMG relationship increased significantly with age toward adult values. The results underlined the necessity to take into account the capacities of muscle activation to quantify changes in elastic properties of muscles, when those capacities are suspected to be altered.

Neuromechanical assessment of lidocaine test block in spastic lower limbs.

The objective of this study was to quantify in spastic lower limbs the changes in reflex EMGs and in ankle stiffness after a lidocaine block of the soleus nerve to better understand physiological effects of lidocaine. Twenty patients were prospectively included and assessed before and after lidocaine block of the soleus nerve. We studied clinical and neuromechanical parameters of the triceps surae, including quantification of the maximum Hoffmann's reflex (Hmax) and tendinous reflex (T) normalized to the maximum direct motor response (Mmax), and passive ankle stiffness assessed by sinusoidal length perturbations. All patients whatever the aetiology of spasticity were improved in clinical parameters of spasticity after the block (62% reduction of the Ashworth score, 85% reduction of stretch reflex scores, increased score on the Physicians' Rating Scale). All patients presented a reduction of the Hmax-Mmax ratio (mean reduction of 67%) and the T-Mmax ratio (82%). Ankle stiffness was decreased by an average of 23%. Measured stiffness was correlated with the Ashworth score and the T-Mmax ratio. Relatively greater change in the T reflex than in the H reflex suggests that lidocaine block reduces hyperreflexia not only by interfering with generation of afferent volleys in the injected nerve, but also probably by altering generation of the volleys at the level of muscle spindles in the affected spastic muscles, presumably by blocking the transmission along gamma-efferent fibers.

Influence of muscle activity on musculotendinous stiffness quantification in stunted, prepubertal children.

The quick-release technique to estimate musculotendinous (MT) stiffness has been extensively used over the last years, in both animals and humans, to gain insights in the adaptive process of the series elastic component (SEC). Recently, MT stiffness quantification, i.e., SEC behavior, has been revisited for subjects not able to fully activate their muscles (effects of long-term spaceflight or non-mature muscles). Such a phenomenon can also be encountered in stunted children. So, the aim of the present study was to analyze the effect of stunting on MT stiffness taking into account possible defect in muscle activation. For this study, 20 eutrophic children (EU) with an average age of 9years±4months were compared to 11age matched stunted children (S) evaluated by the height-to-age index. The MT stiffness index was obtained with regard to stiffness-torque and stiffness-soleus EMG relationships. The children of the S group presented a significantly lower Maximal Voluntary Contraction (MVC) in plantar flexion in comparison with children of the EU group (-37.8%). The significantly lower MT stiffness index for S children (-42.6%) was evidenced only when quantified with regard to the stiffness-soleus EMG relationship (66.5±42.8 vs. 38.2±19.9 Nmrad(-1)%(-1)). Possible delay in fiber type differentiation or tendinous structure maturation can account for the lower MT stiffness index in S children. In conclusion, stunting during early childhood delays the differentiation and maturation processes of musculotendinous structures as shown by the lower MT stiffness quantified with regards to muscle activity, also altered for stunted prepubertal children.

Hoffmann reflex is increased after 14 days of daily repeated Achilles tendon vibration for the soleus but not for the gastrocnemii muscles.

In a previous study, Achilles tendon vibrations were enough to improve the triceps surae (TS) activation capacities and also to slightly increase TS Hoffmann reflex (H-reflex) obtained by summing up soleus (Sol) and gastrocnemii (GM and GL) EMGs. The purpose of the present study was to analyze separately Sol and GM or GL reflexes to account for different effects of the vibrations on the reflex excitability of the slow soleus and of the gastrocnemii muscles. A control group (n = 13) and a vibration group (n = 16) were tested in pre-test and post-test conditions. The Achilles tendon vibration program consisted of 1 h of daily vibration (frequency: 50 Hz) applied during 14 days. Maximal Sol, GM and GL H-reflexes, and M-waves were recorded, and their H(max)/M(max) ratios gave the index of reflex excitability. After the vibration protocol, only Sol H(max)/M(max) was enhanced (p < 0.001). The enhanced Sol reflex excitability after vibration is in favor of a decrease in the pre-synaptic inhibition due to the repeated vibrations and the high solicitation of the reflex pathway. Those results of a short period of vibration applied at rest may be limited to the soleus because of its high density in muscle spindles and slow motor units, both structures being very sensitive to vibrations.

Acute postural modulation of the soleus H-reflex after Achilles tendon vibration.

Alteration of Soleus (SOL) H-reflex has been reported after prolonged vibratory exposure and it was hypothesized that presynaptic inhibition, known to depress the H-reflex during vibration, largely contributed to the H-reflex changes. To confirm this hypothesis, the purpose of the present study was to quantify the SOL H-reflex changes between sitting and standing positions (postural modulation) with or without the after-effects of 1h of Achilles tendon vibration. Indeed, postural modulation of the SOL H-reflex has been reported to inform on the level of presynaptic inhibition exerted on Ia afferents. SOL H-reflex and M waves were measured in healthy voluntary subjects in both sitting and standing positions before and after 1h of Achilles vibration (frequency: 50 Hz) applied in sitting position (vibration group, n=11) or before and after 1h of sitting position only (control group, n=6). SOL H(max)/M(max) ratios were calculated. Furthermore, in order to quantify presynaptic inhibition induced by prolonged vibration, an index of SOL H-reflex postural modulation was calculated as the standing H(max)/M(max) ratio relative to the sitting one. After 1h of Achilles tendon vibration, a significant decrease in the SOL H(max)/M(max) ratio was observed both in sitting and standing positions (p<0.05). However, the decrease was more pronounced in the standing position, leading to a significant decrease of the index of SOL H-reflex postural modulation. Those results suggest that presynaptic inhibition could have largely contributed to the H-reflex decrease observed after one bout of vibration.