Modulation of cutaneous reflexes during sidestepping in adult humans.

A common neural control mechanism coordinates various types of rhythmic locomotion performed in the sagittal plane, but it is unclear whether frontal plane movements show similar neural patterning in adult humans. The purpose of this study was to compare cutaneous reflex modulation patterns evoked during sagittal and frontal plane rhythmic movements. Eight healthy, neurologically intact adults (three males, five females) walked and sidestepped on a treadmill at approximately 1 Hz. The sural nerve of the dominant (and lead) limb was stimulated randomly every 3-7 steps at eight phases of each gait cycle. Ipsilateral electromyographic recordings from four lower leg muscles and kinematic data from the ankle were collected continuously throughout both tasks. Data from unstimulated gait cycles were used as control trials to calculate middle-latency reflex responses (80-120 ms) and kinematic changes (140-220 ms) following electrical stimulation. Results show that the cutaneous reflex modulation patterns were similar across both tasks despite significant differences in background EMG activity. However, increased reflex amplitudes were observed during the late swing and early stance phases of sidestepping, which directly altered ankle kinematics. These results suggest that the neural control mechanisms responsible for coordinating sagittal locomotion are flexibly modified to coordinate frontal plane activities even with very different foot landing mechanics.

Effects of chronic ankle instability on cutaneous reflex modulation during walking.

Chronic ankle instability (CAI) is characterized by persistent giving way at the ankle following an acute lateral ankle sprain and is associated with an early onset of osteoarthritis. Researchers have reported that the cutaneous afferent pathway from certain leg muscles is modified in people with CAI while in a seated position. However, we do not know if these reflex modulations persist during functional activities. The purpose of this study was to further explore sensorimotor function in patients with CAI by analyzing cutaneous reflex modulation during gait. CAI (n = 11) and uninjured control (n = 11) subjects walked on a treadmill at 4 km/h and received non-noxious sural nerve stimulations at eight different time points during the gait cycle. Net electromyographic responses from four lower leg muscles were quantified 80-120 ms after stimulation for each phase of the gait cycle and compared between groups. We found that cutaneous reflex responses between groups were largely similar from the late stance to late swing phases, but uninjured control subjects, and not CAI subjects, experienced significant suppression in the medial gastrocnemius and lateral gastrocnemius muscles during the early stance phase of the gait cycle. Our results indicate that people with CAI lack a protective unloading response in the triceps surae following high-intensity sural nerve stimulation during the early stance phase of the gait cycle. Evaluating cutaneous reflex modulations may help to identify neural alterations in the reflex pathways that contribute to functional deficits in those with CAI.

Contralateral conditioning to the soleus H-reflex as a function of age and physical activity.

Coordination between ipsilateral and contralateral muscles of the lower limbs has a critical role in movement control. However, the roles that aging and physical activity have in maintaining bilateral coordination are understudied. The aim of this study was to examine the roles of physical activity and age on pathways between the soleus and tibialis anterior muscles. Fourteen young and 14 older subjects (7 active, 7 sedentary) participated. A Hoffmann (H)-reflex was elicited in the ipsilateral soleus following a conditioning stimulus to the contralateral common peroneal nerve at differing intervals (25-300 ms). Significant H-reflex facilitation from the control value was observed for the sedentary group at the 50-ms (28.7 %), 75-ms (24.5 %), and 150-ms (34.0 %) intervals when compared with the physically active group. There were also significant differences between the young and older groups. Results demonstrated differences in soleus H-reflex excitability as a result of contralateral conditioning and highlighted the influence of age and physical activity in maintaining these neural pathways.

Post-activation potentiation: The neural effects of post-activation depression.

INTRODUCTION: Our knowledge of the neurophysiology of post-activation potentiation (PAP) is limited. The purpose of this study was to examine the effect of PAP on twitch torque and H-reflex amplitude after a 10-s maximal voluntary contraction (MVC). METHODS: PAP measurements were assessed with the plantarflexors in a relaxed state and during a tonic contraction at 10% MVC. RESULTS: The H-reflex/maximum M-wave ratio (H/M) decreased significantly (P<0.05) and returned to baseline levels after 1 min. The decrement in H/M was depressed when the plantarflexors were active at 10% MVC, and the depression was more obvious in the lateral gastrocnemius than in the soleus muscle. CONCLUSIONS: The inhibition induced immediately after contraction could be attributed to post-activation depression. We conclude that PAP after a 10-s MVC cannot be attributed to increased motor neuron excitability through the reflex pathway as assessed by the H-reflex technique.

Independent segmental inhibitory modulation of synaptic efficacy of the soleus H-reflex.

Synaptic efficacy associated with muscle spindle feedback is partly regulated via depression at the Ia-motorneuron synapse through paired reflex depression (PRD) and presynaptic inhibition (PI). The purpose of this study was to examine PRD and PI of the soleus H-reflex at rest and with a background voluntary muscle contraction. The experiment was conducted on 10 healthy males with no history of neurological deficits. Soleus H-reflex and M-wave curves were elicited in three conditions: unconditioned, PRD (two consecutive H-reflexes with 100 ms interval), and PI (1.2 × MT to tibialis anterior 100 ms prior to soleus H-reflex). Each condition was tested at rest and with a 10% soleus contraction. PRD and PI both produced a pronounced inhibition to the soleus motor pool at rest, with a significant difference observed between threshold values (78.9, 89.3, and 90.4% for unconditioned, PRD, and PI reflexes, respectively). During the voluntary contraction the threshold for both inhibitory mechanisms was significantly reduced, and were not different from the unconditioned H-reflex (74.5, 78.9, and 77.0% for unconditioned, PRD, and PI reflexes, respectively). The slope of PI and the PI Hmax/Mmax ratio were significantly altered during contraction whereas no differences were observed for PRD. The results suggest these inhibitory mechanisms depend on the interaction between background voluntary activation and stimulus intensity. This behavior of these inhibitory mechanisms underscores the specificity of spinal circuitry in the control of motor behaviors.

The inflow of sensory information for the control of standing is graded and bidirectional.

The control of upright standing is accomplished through the integration of different sources of sensory information and by providing an appropriate motor program to control both expected and unexpected perturbations imposed on the system. However, the dynamic characteristics of postural sway and its interplay with the regulation of Ia sensory information within the spinal cord are largely unknown. Here, using a stochastic technique for analyzing the dynamics of upright standing, we demonstrate that the changes in the dynamics of postural sway were accompanied by modulation of the soleus H-reflex during quiet standing. While the causality of this relation was not established, the results showed that these changes were independent of the sway of the center of pressure and were bidirectional and purposeful. With this novel perspective, the appropriate reflex gain, which is important for balance control, can be predicted from the dynamic characteristics of postural sway. Our current findings provide the first human behavioral evidence to suggest the contribution of the spinal cord in fulfilling the desired motor programming of a complex task. This contribution is, by conventional guess, carried out through interneuronal adjustments, which are under the control of different brain areas.

Temporal depression of the soleus H-reflex during passive stretch.

Synaptic efficacy associated with muscle spindle feedback is regulated via depression at the Ia-motoneurone synapse. The inhibitory effects of repetitive Ia afferent discharge on target motoneurones of different sizes were investigated during a passive stretch of ankle extensors in humans. H-reflex recruitment curves were collected from the soleus muscle for two conditions in ten subjects. H-reflexes were elicited during passive stretch at latencies of 50, 100, 300, and 500 ms after a slow (20°/s) dorsiflexion about the right ankle (from 100 to 90°). Control H-reflexes were recorded at corresponding static (without movement) ankle angles of 99, 98, 94, and 90° of flexion. The slope of the H-reflex recruitment curves (Hslp) was then calculated for both conditions. H-reflex values were similar for the static and passive stretch conditions prior to 50-100 ms, not showing the early facilitation typical of increased muscle spindle discharge rates. However, the H-reflex was significantly depressed by 300 ms and persisted through 500 ms. Furthermore, less than 300 ms into the stretch, there was significantly greater H-reflex depression with a lower stimulus intensity (20 % Mmax) versus a higher stimulus intensity (Hmax), though the effects begin to converge at later latencies (>300 ms). This suggests there is a distinct two-stage temporal process in the depression observed in the Ia afferent pathway for all motoneurones during a passive stretch. Additionally, there is not a single mechanism responsible for the depression, but rather both heterosynaptic presynaptic inhibition and homosynaptic post-activation depression are independently influencing the Ia-motoneurone pathway temporally during movement.

Activity-dependent plasticity of spinal circuits in the developing and mature spinal cord.

Part of the development and maturation of the central nervous system (CNS) occurs through interactions with the environment. Through physical activities and interactions with the world, an animal receives considerable sensory information from various sources. These sources can be internally (proprioceptive) or externally (such as touch and pressure) generated senses. Ample evidence exists to demonstrate that the sensory information originating from large diameter afferents (Ia fibers) have an important role in inducing essential functional and morphological changes for the maturation of both the brain and the spinal cord. The Ia fibers transmit sensory information generated by muscle activity and movement. Such use or activity-dependent plastic changes occur throughout life and are one reason for the ability to acquire new skills and learn new movements. However, the extent and particularly the mechanisms of activity-dependent changes are markedly different between a developing nervous system and a mature nervous system. Understanding these mechanisms is an important step to develop strategies for regaining motor function after different injuries to the CNS. Plastic changes induced by activity occur both in the brain and spinal cord. This paper reviews the activity-dependent changes in the spinal cord neural circuits during both the developmental stages of the CNS and in adulthood.

Measuring movement in health and disease.

Evaluating and quantifying the many aspects of movement - from open-field locomotion and stepping patterns in rodent models to stride trajectory and postural sway in human patients - are key to understanding brain function. Various experimental approaches have been used in applying these lines of research to investigate the brain mechanisms underlying neurodegenerative disease. Although valuable, data on movement are often limited by the shortcomings inherent in the data collection process itself. Steve Fowler and his research group have been instrumental in pioneering a technology that both minimizes these pitfalls in studies of rodent behavior and has applications to research on human patients. At the center of this technology is the force-plate actometer, developed by the Fowler group to assess multiple aspects of movement in rodent models. Our review highlights how use of the actometer and related behavioral measurements provides valuable insight into Huntington's disease (HD), an autosomal dominant condition of progressively deteriorating behavioral control. HD typically emerges in mid-life and has been replicated in multiple genetically engineered mouse models. The actometer also can be a valuable addition to cutting-edge neuronal and synaptic technologies that are now increasingly applied to studies of behaving animals. In short, the impact of the Fowler contribution to the neuroscience of movement is both meaningful and ongoing.

Postural displacement induced by electrical stimulation; A new approach to examine postural recovery.

BACKGROUND: Controlling upright posture entails acute adjustments by the neuromuscular system to keep the center of mass (COM) within the limits of a relatively small base of support. Sudden displacement of the COM triggers several strategies and balance recovery mechanisms to prevent excessive COM displacement. NEW METHOD: We have examined and quantified a new approach to induce an internal neuromuscular perturbation in standing posture on 15 healthy individuals to provide an insight into the mechanism of loss of balance (LOB). The method comprises eliciting an H-reflex protocol while subjects are standing which produces a contraction in soleus and gastrocnemius muscles. We have also defined analytical techniques to provide biomarkers of balance control during perturbation. We used M-Max unilaterally or bilaterally and induced a forward or sideway perturbation. The vector analysis and the Equilibrium Point calculations defined here can quantify the amplitude, direction, and evolution of the perturbation. RESULTS: Clear patterns of loss of balance due to stimulation was observed. Compared to quiet standing, the density of the EPs substantially increased in the perturbation phase. Leftward stimulation produced significantly higher number of EPs compared to the bilateral stimulation condition which could be due to the fact that the left leg was the nondominant side in all our subjects. COMPARISON AND CONCLUSION: In this study we provide a proof-of-concept technique for examining recovery from perturbation. The advantage of this technique is that it provides a safe perturbation, is internally induced at the spinal cord level, and is free from other factors that might complicate the recovery analysis (e.g., locomotion and the integration of the spinal pattern generator and cutaneous pathways in mediating changes). We have shown that the perturbation induced by this method can be quantified as vectors. We have also shown that the density of instantaneous equilibrium points (EPs) could be a good biomarker for defining and examining the perturbation phase. Thus, this protocol and analysis provides a unique individual assessment of recovery which can be used to assess interventions. Finally, given that the maximal motor response is used as the perturbation (e.g., M-max) it is highly reliable and reproducible within an individual patient.

Educator perspectives on concussion management in the college classroom: a grounded theory introduction to collegiate return-to-learn.

OBJECTIVES: To gather the perspectives of collegiate instructors regarding how concussion is managed within the college classroom. To introduce the themes surrounding collegiate return-to-learn (RTL) and the classroom management of students with concussion. DESIGN: Qualitative grounded theory. SETTING: Large, public university in the Midwest. PARTICIPANTS: Twenty-three college instructors participated in a private, semistructured, audio-recorded, one-on-one interview. Participants included 12 males and 11 females. Interview recordings were transcribed verbatim, followed by an iterative process of open-coding and axial-coding, performed by two researchers. RESULTS: Three themes emerged from the coded data: (1) awareness-external knowledge of concussion and previous experiences, (2) legitimacy-medical note provided and no note provided and (3) accommodating the student-instructor's role and feasibility of the accommodation. Psychosocial factors such as small class sizes, graduate-level students and an instructor's empathy appeared to influence an instructor's decision making when accommodating a student recovering from concussion. CONCLUSION: These novel data provide foundational evidence regarding how college instructors perceive and subsequently manage concussion within the classroom, while also offering accuracy to aims of subsequent collegiate RTL investigations ARTICLE SUMMARY: RTL is an emerging field within concussion management, yet is grossly underexplored within the college setting. By utilising a grounded theory approach, this article introduces the themes that dictate the landscape of RTL for a college student.

Effect of a 12-week yoga intervention on fear of falling and balance in older adults: a pilot study.

OBJECTIVE: To determine whether fear of falling (FoF) and balance improved after a 12-week yoga intervention among older adults. DESIGN: A 12-week yoga intervention single-armed pilot study. SETTING: A retirement community in a medium-sized university town in the Midwest. PARTICIPANTS: A convenience sample of adults (N=14) over the age of 65 years who all endorsed an FoF. INTERVENTION: Each participant took part in a biweekly 12-week yoga intervention. The yoga sessions included both physical postures and breathing exercises. Postures were completed in sitting and standing positions. MAIN OUTCOME MEASURES: We measured FoF with the Illinois FoF Measure and balance with the Berg Balance Scale. Upper- and lower-body flexibility were measured with the back scratch test and chair sit and reach test, respectively. RESULTS: FoF decreased by 6%, static balance increased by 4% (P=.045), and lower-body flexibility increased by 34%. CONCLUSIONS: The results indicate that yoga may be a promising intervention to manage FoF and improve balance, thereby reducing fall risk for older adults. Rehabilitation therapists may wish to explore yoga as a modality for balance and falls programming; however, future research is needed to confirm the use of yoga in such programming.

Respiratory Muscle Fatigue Alters Cycling Performance and Locomotor Muscle Fatigue.

PURPOSE: This study aimed to determine if preexisting respiratory muscle fatigue (RMF) alters motoneuronal output, locomotor muscle fatigue, and cycling performance. METHODS: Eight trained male cyclists performed 5-km cycling time trials after a resistive breathing task that induced RMF and under control conditions (CON). Motoneuronal output was estimated using vastus lateralis surface electromyography, and locomotor muscle fatigue was quantified as the change in potentiated quadriceps twitch force from preexercise to postexercise. RESULTS: Time to complete the time trial was 1.9% ± 0.9% longer in RMF compared with CON (P < 0.001). Estimated motoneuronal output was lower in RMF compared with CON during 1 km (45% ± 11% vs 53% ± 13%, P = 0.004) and 2 km (45% ± 14% vs 51% ± 14%, P = 0.008), but was not different thereafter. Ventilation was lower in RMF compared with CON during 1 km (114 ± 19 vs 135 ± 24 L·min, P = 0.003) and 2 km (136 ± 23 vs 152 ± 31 L·min, P = 0.009); however, ratings of dyspnea were similar. After the 5-km time trial, locomotor muscle fatigue was attenuated in RMF compared with CON (-22% ± 6%, vs -28% ± 7%, P = 0.02). CONCLUSIONS: Alterations to dyspnea for a given ventilation seem to have constrained power output during cycling exercise, thereby limiting the development of locomotor muscle fatigue. These findings indicate that the respiratory system is an integral component in a global feedback loop that regulates exercise performance and the development of locomotor muscle fatigue.

Analysis of clinical motor testing for adult patients with diagnosed ulnar neuropathy at the elbow.

OBJECTIVE: To compare the dichotomous results for 7 ulnar nerve clinical motor tests (Froment's sign, Wartenberg's sign, finger flexion sign, Jeanne's sign, crossed finger test, Egawa's sign, presence of clinical fasciculations) with motor nerve conduction velocity findings. DESIGN: A static group comparison design assessed for differences among dichotomous test outcomes with respect to motor nerve conduction velocity. SETTING: Five medical facilities throughout the United States provided data for this study. PARTICIPANTS: Records from participants (N=26) with diagnosed ulnar neuropathy at the elbow were included for data analysis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographic data included age, sex, handedness, duration of symptoms, and the number of days between the clinical and electrodiagnostic exam. Other dependent variables included motor conduction velocity of the ulnar nerve, compound muscle action potential amplitude, and the dichotomous clinical motor test outcomes. RESULTS: Two motor signs, the presence of clinical fasciculations and a positive finger flexion sign, were identified more frequently (each present in 11 patients) than the other motor signs. An analysis of covariance revealed significant differences in motor nerve conduction velocity between positive and negative results for all the clinical motor tests except for the finger flexion sign. Significant chi-square analyses were found for the following comparisons: the presence of clinical fasciculations and Froment's sign, the finger flexion sign and the crossed finger test, Egawa's sign and Froment's sign, Warteberg's sign and Froment's sign, the crossed finger test and Froment's sign, and Egawa's sign and Wartenberg's sign. CONCLUSIONS: Some clinical motor tests are better than others at identifying early motor involvement, providing the rehabilitation professional some insight regarding the relative decrement of motor nerve conduction velocity when a selected test is positive.

Combined Aerobic and Resistance Training Increases Stretch- Shortening Cycle Potentiation and Walking Economy in Postmenopausal Women.

PURPOSE: Secondary analyses were performed to test whether combined aerobic and resistance training altered walking economy (i.e., net oxygen uptake) and/or stretch-shortening cycle potentiation (SSCP). A further objective was to determine if walking economy and SSCP were related before or after training. METHODS: Ninety-two postmenopausal women were enrolled wherein 76 completed 16 weeks of supervised aerobic and resistance training. Participants were randomized to one of three training groups based on frequencies: (a) 1 d⋅wk-1 (n = 23); (b) 2 d⋅wk-1 (n = 30) or; (c) 3 d⋅wk-1 (n = 23). Following assessments were performed at baseline and post-training. Indirect calorimetry was used to measure maximal oxygen uptake () and walking economy (submaximal - resting = net ) during a graded exercise test and steady-state treadmill task, respectively. SSCP was determined by measuring the difference between a concentric (CO) and counter-movement (CM) leg press throw. RESULTS: , walking economy, CO and CM velocity were significantly improved (p < 0.05) for all training groups, however; no time by group interactions were observed. Paired t-tests revealed participants exercise training 2 d⋅wk-1 exhibited a significant time effect for SSCP (+0.04 ± 0.09 ms-1; p = 0.03). At baseline, multiple linear regression showed a negative relationship between walking net and SSCP (r = -0.22; p < 0.04) adjusted for relative proportion of . No such relationship was found post-training. CONCLUSION: Among older postmenopausal women, our results indicate that irrespective of frequency of training, 16 weeks of combined aerobic and resistance exercise training increased ease of walking and economy. Additionally, only participants exercising 2 d⋅wk-1 exhibited significant improvement in SSCP.

Effect of carbohydrate ingestion on central fatigue during prolonged running exercise in moderate hypoxia.

To determine whether acute exposure to moderate hypoxia alters central and peripheral fatigue and to test whether carbohydrate ingestion impacts fatigue characteristics, 12 trained runners completed three running trials lasting 1 h each at 65% of normoxic maximum oxygen uptake. The first trial was performed in normoxia [inspired O2 fraction ( FiO2 ) = 0.21], and the last two trials were completed in hypoxia ( FiO2 = 0.15). Participants ingested a placebo drink in normoxia (NORM-PLA), a placebo drink in hypoxia (HYP-PLA), or a carbohydrate solution in hypoxia (HYP-CHO). HYP conditions were randomized. Peripheral [change in potentiated quadriceps twitch force (ΔQtw,pot)] and central [change in voluntary activation (ΔVA)] fatigue were assessed via preexercise-to-postexercise changes in magnetically evoked quadriceps twitch. In HYP, blood was drawn to determine the ratio of free-tryptophan (f-TRP) to branched-chain amino acids (BCAA). After exercise, peripheral fatigue was reduced to a similar degree in normoxia and hypoxia (ΔQtw,pot = -4.5 ± 1.3% and -4.0 ± 1.5% in NORM-PLA and HYP-PLA, respectively; P = 0.61). Central fatigue was present after normoxic and hypoxic exercise but to a greater degree in HYP-PLA compared with NORM-PLA (ΔVA: -4.7 ± 0.9% vs. -1.9 ± 0.7%; P < 0.01). Carbohydrate ingestion did not influence central fatigue (ΔVA in HYP-CHO: -5.7 ± 1.2%; P = 0.51 vs. HYP-PLA). After exercise, no differences were observed in the ratio of f-TRP to BCAA between HYP-PLA and HYP-CHO ( P = 0.67). Central fatigue increased during prolonged running exercise in moderate hypoxia although the ratio of f-TRP to BCAA remained unchanged. Ingesting carbohydrates while running in hypoxia did not influence fatigue development. NEW & NOTEWORTHY Hypoxic exposure influences the origin of exercise-induced fatigue and the rate of fatigue development depending on the severity of hypoxia. Our data suggest that moderate hypoxia increases central, but not peripheral, fatigue in trained runners exercising at 65% of normoxic maximum oxygen uptake. The increase in central fatigue was unaffected by carbohydrate intake and occurred although the ratio of free tryptophan to branched-chain amino acids remained unchanged.

Segmental spinal reflex adaptations associated with chronic ankle instability.

OBJECTIVE: To further understanding of the role that segmental spinal reflexes play in chronic ankle instability (CAI). DESIGN: A 2 x 2 repeated-measures case-control factorial design. The independent variables were ankle group with 2 levels (healthy, CAI) and stance with 2 levels (single, double legged). SETTING: University research laboratory. PARTICIPANTS: Twenty-two participants with CAI and 21 matched healthy controls volunteered. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The dependent variables were 2 measures of motoneuron pool excitability: paired reflex depression (PRD) and recurrent inhibition. RESULTS: A 2 x 2 repeated-measures multivariate analysis of variance revealed a significant interaction between group and stance on the linear combination of PRD and recurrent inhibition variables (Wilks lambda=.808, F(2,40)=4.77, P=.014). Follow-up univariate F tests revealed an interaction between group and stance on the PRD (F(1,41)=9.74, P=.003). Follow-up dependent t tests revealed a significant difference between single- and double-legged PRD in the healthy participants (t(20)=-3.76, P=.001) with no difference in CAI participants (t(21)=-0.44, P=.67). Finally, there was a significant difference in recurrent inhibition between healthy (mean, 83.66) and CAI (mean, 90.27) (P=.004). CONCLUSIONS: This study revealed that, compared with healthy participants, CAI participants were less able to modulate PRD when going from a double- to a single-legged stance. Additionally, CAI participants showed higher overall levels of recurrent inhibition when compared with healthy matched controls.

Acute hypercapnia does not alter voluntary drive to the diaphragm in healthy humans.

Although systemic hypercapnia is a common outcome of pulmonary disease, the relationship between hypercapnia and voluntary diaphragmatic activation (VAdi) is unclear. To examine whether hypercapnia independent of ventilatory work contributes to reduced central motor drive to the diaphragm in healthy humans, 14 subjects spontaneously breathed room air (NN) or a hypercapnic gas mixture (HH; 7% CO2 with air) while at rest. Thereafter, subjects volitionally hyperventilated room air (NH) matching the minute ventilation recorded during HH while maintained at eucapnic levels. Twitch interpolation with bilateral magnetic stimulation of phrenic nerves at functional residual capacity was used to assess VAdi during the three trials. Although PETCO2 was elevated during HH compared with NN and NH (52 vs 36 mmHg), VAdi was not altered across the trials (HH = 93.3 ±â€¯7.0%, NN = 94.4 ±â€¯5.0%, NH = 94.9 ±â€¯4.6%, p = 0.48). Our findings indicate that the magnitude of hypercapnia acutely imposed may not be effective in inhibiting voluntary neural drives to the diaphragm in normal resting individuals.

H-reflex and motor responses to acute ischemia in apparently healthy individuals.

The authors examined the effect of acute ischemia on peripheral nerve function in healthy subjects. It was hypothesized that acute ischemia would interfere with the ability of sensory and motor nerves to propagate an impulse. Twelve young, apparently healthy adults participated in the study. Soleus H-reflex and motor recruitment curves were determined for subjects during a control condition, after 5 minutes of ischemia by femoral artery occlusion, and after a 5-minute recovery. During ischemia, the stimulus intensity required to evoke an H-reflex or M-wave was reduced by 18.3% and 18.4%, respectively. Hmax/Mmax ratios were significantly reduced with acute ischemia (mean +/- standard error) 66.29% +/- 5.4% and 58.81% +/- 6.7% for control and ischemia, respectively, owing to a decrease in Hmax during acute ischemia with no change in Mmax. After ischemia, the Hmax/Mmax returned to control values, as did the M-threshold. However, although the H-threshold slightly recovered, it failed to return to control threshold after 5 minutes of recovery. The results suggest that acute ischemia decreases motor and H-reflex thresholds in healthy individuals with a longer lasting effect for the H-reflex. In addition, a decrease in Hmax/Mmax ratio was observed, suggesting that acute ischemia has differential effects on sensory nerve propagation and synapse transmission.

Down training of the elderly soleus H reflex with the use of a spinally induced balance perturbation.

The purpose of this study was to determine the ability of the elderly central nervous system to modulate spinal reflex output to functionally decrease a spinally induced balance perturbation. In this case, the soleus H reflex was used as the source of perturbation. Therefore, decreasing (down training) of the soleus H reflex was necessary to counteract this perturbation and to better maintain postural control. In addition to assessing the effect of this perturbation on the H reflex, static postural stability was measured to evaluate possible functional effects. Ten healthy young subjects (age: 27.0 +/- 4.6 yr) and 10 healthy elderly subjects (age: 71.4 +/- 5.1 yr) participated in this study. Subjects underwent balance perturbation on 2 consecutive days. On day 1 of perturbation, significant down training of the soleus H reflex was demonstrated in both young (-20.4%) and elderly (-18.7%) subjects. On day 2 of perturbation, significant down training of the soleus H reflex was again demonstrated in both young (-24.6%) and elderly (-21.0%) subjects. Analysis of static stability after the 2 days of balance perturbation revealed a significant 10.1% decrease in the area of sway in elderly subjects. In conclusion, this study demonstrated that healthy, elderly subjects compared with young subjects were equally capable of down training the soleus H reflex in response to a balance perturbation. Furthermore, the improvement in static stability through balance training may provide further evidence that balance can be retrained and rehabilitated in subjects with decreased reflex function.