Alteration of H-reflex amplitude modulation is a marker of impaired postural responses in individuals with incomplete spinal cord injury.

Individuals with incomplete spinal cord injury (iSCI) show altered postural reactions leading to increased risk of falls. To investigate neural correlates underlying this deficit, we assessed the modulation pattern of the Soleus H-reflex in iSCI individuals following unexpected perturbations of a base of support. Ten men with iSCI (AIS D) and 8 age-matched controls (CTRL) stood on a force-platform randomly tilted forward or backward. The center of pressure (CoP) excursion, 95% confidence ellipse area and electromyographic (EMG) activity of the Soleus (SOL) and Tibialis Anterior (TA) muscles were analyzed. SOL H-reflex amplitude was assessed by stimulating the tibial nerve prior to and at 100, 150 and 200 ms following perturbation onset. Although SOL and TA short-latency EMG responses were comparable in both groups, long-latency EMG responses occurred later in the iSCI group for both directions: during backward tilt, a decrease in H-reflex amplitude was observed at all stimulus timings post-tilt in CTRL, but only at 200 ms in iSCI. The decrease in H-reflex amplitude was smaller in iSCI participants. During forward tilt, an increase in H-reflex amplitude was observed at 150 and 200 ms in the CTRL group, but no increase was observed in the iSCI group. Decreased and delayed SOL H-reflex amplitude modulation in the iSCI group accompanied impaired balance control as assessed clinically with the Berg Balance Scale and biomechanically through CoP displacement. Overall, delayed and reduced spinal reflex processing may contribute to impaired balance control in people with iSCI.

H-reflex modulation preceding changes in soleus EMG activity during balance perturbation.

When balance is compromised, postural strategies are induced to quickly recover from the perturbation. However, neuronal mechanisms underlying these strategies are not fully understood. Here, we assessed the amplitude of the soleus (SOL) H-reflex during forward and backward tilts of the support surface during standing (n = 15 healthy participants). Electrical stimulation of the tibial nerve was applied randomly before platform tilt (control) and 0, 25, 50, 75, 100 or 200 ms after tilt onset. During backward tilt, a significant decrease in H-reflex amplitude was observed at 75, 100 and 200 ms. The onset of the decreased H-reflex amplitude significantly preceded the onset of the SOL EMG decrease (latency: 144 ± 16 ms). During forward tilt, the amplitude of the H-reflex increased at 100 and 200 ms after tilt onset. The onset of H-reflex increase did not occur significantly earlier than the onset of the SOL EMG increase (127 ± 5 ms). An important inter-subject variability was observed for the onset of H-reflex modulation with respect to EMG response for each direction of tilt, but this variability could not be explained by the subject's height. Taken together, the results establish the time course of change in SOL H-reflex excitability and its relation to the increase and decrease in SOL EMG activity during forward and backward tilts. The data presented here also suggest that balance mechanisms may differ between forward and backward tilts.