Impaired stretch reflex and joint torque modulation during spastic gait in multiple sclerosis patients

The modulation of the short latency stretch reflex of the soleus muscle during walking was investigated in seven spastic multiple sclerosis (MS) patients and nine healthy control subjects. Ankle joint stretches were applied by a system which can rotate that ankle joint in any phase of the step cycle during treadmill walking. The torque related to the muscle fibres contracting prior to the stretch and the passive tissues around the ankle joint were measured as the “non-reflex torque”. At the same time the short latency stretch reflex-mediated EMG response was measured. The findings show that the stretch reflex modulation was impaired in spastic patients during walking. The stretch reflex modulation was quantified by a modulation index of on average 50% (range −5 to 100%) in the patients and 93% (78–100%) in the control subjects (P < 0.05). The passive stiffness of the ankle joint was at the same time increased in the patients (P < 0.05). It is proposed that the impaired modulation of the stretch reflex along with increased ankle joint stiffness contribute to the impaired walking ability in spastic MS patients.

[1]  J. Nielsen,et al.  Central control of reciprocal inhibition during fictive dorsiflexion in man , 2004, Experimental Brain Research.

[2]  V. Dietz,et al.  Corrective reactions to stumbling in man: neuronal co‐ordination of bilateral leg muscle activity during gait. , 1984, The Journal of physiology.

[3]  Thomas Sinkjær,et al.  An actuator system for investigating electrophysiological and biomechanical features around the human ankle joint during gait , 1995 .

[4]  T. Sinkjaer,et al.  Soleus stretch reflex modulation during gait in humans. , 1996, Journal of neurophysiology.

[5]  J Quintern,et al.  Electrophysiological studies of gait in spasticity and rigidity. Evidence that altered mechanical properties of muscle contribute to hypertonia. , 1981, Brain : a journal of neurology.

[6]  J. F. Yang,et al.  Contribution of peripheral afferents to the activation of the soleus muscle during walking in humans , 2004, Experimental Brain Research.

[7]  T. Sinkjaer,et al.  Muscle stiffness in human ankle dorsiflexors: intrinsic and reflex components. , 1988, Journal of neurophysiology.

[8]  V. Dietz,et al.  Normal and impaired regulation of muscle stiffness in gait: A new hypothesis about muscle hypertonia , 1983, Experimental Neurology.

[9]  K. Hagbarth,et al.  Muscle spindle responses to stretch in normal and spastic subjects. , 2018, Scandinavian journal of rehabilitation medicine.

[10]  V. Dietz,et al.  Reflex activity and muscle tone during elbow movements in patients with spastic paresis , 1991, Annals of neurology.

[11]  H Barbeau,et al.  Effects of conditioning cutaneomuscular stimulation on the soleus H-reflex in normal and spastic paretic subjects during walking and standing. , 1994, Journal of neurophysiology.

[12]  P. Matthews.  The human stretch reflex and the motor cortex , 1991, Trends in Neurosciences.

[13]  S. Andreassen,et al.  Non–reflex and reflex mediated ankle joint stiffness in multiple sclerosis patients with spasticity , 1993, Muscle & nerve.

[14]  T. Sinkjaer,et al.  Stretch responses to ankle rotation in multiple sclerosis patients with spasticity. , 1993, Electroencephalography and clinical neurophysiology.

[15]  K H Mauritz,et al.  Chronic transformation of muscle in spasticity: a peripheral contribution to increased tone. , 1985, Journal of neurology, neurosurgery, and psychiatry.

[16]  P. Ashby,et al.  Reciprocal inhibition following lesions of the spinal cord in man. , 1989, The Journal of physiology.

[17]  T Sinkjaer,et al.  Mechanical and electromyographic responses to stretch of the human ankle extensors. , 1991, Journal of neurophysiology.

[18]  C Morin,et al.  Mécanisme spinal de l'action antispastique de la TRH chez les malades atteints de sclerose latérale amyotrophique. , 1988 .

[19]  V. Dietz,et al.  Role of peripheral afferents and spinal reflexes in normal and impaired human locomotion. , 1987, Revue neurologique.

[20]  T Sinkjaer,et al.  Passive, intrinsic and reflex-mediated stiffness in the ankle extensors of hemiparetic patients. , 1994, Brain : a journal of neurology.

[21]  D. Silberberg,et al.  New diagnostic criteria for multiple sclerosis: Guidelines for research protocols , 1983, Annals of neurology.

[22]  V. Dietz,et al.  Tension development and muscle activation in the leg during gait in spastic hemiparesis: independence of muscle hypertonia and exaggerated stretch reflexes. , 1984, Journal of neurology, neurosurgery, and psychiatry.

[23]  T Sinkjaer,et al.  Mechanical and electromyographic analysis of reciprocal inhibition at the human ankle joint. , 1995, Journal of neurophysiology.

[24]  A. Vallbo,et al.  Somatosensory, proprioceptive, and sympathetic activity in human peripheral nerves. , 1979, Physiological reviews.

[25]  T. Sinkjær,et al.  H‐reflex modulation during gait in multiple sclerosis patients with spasticity , 1995, Acta neurologica Scandinavica.

[26]  R. Lee,et al.  Long latency reflexes to imposed displacements of the human wrist: Dependence on duration of movement , 2004, Experimental Brain Research.

[27]  H. Barbeau,et al.  Quantitative assessment of the effect of cyproheptadine on spastic paretic gait: a preliminary study , 1986, Journal of Neurology.

[28]  S R Simon,et al.  Stretch reflexes of triceps surae in patients with upper motor neuron syndromes. , 1983, Journal of neurology, neurosurgery, and psychiatry.

[29]  Thomas Sinkjær,et al.  Soleus stretch reflex modulation during gait , 1994 .

[30]  R. Stein,et al.  H-Reflex Modulation During Walking in Spastic Paretic Subjects , 1991, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[31]  K. Akazawa,et al.  Modulation of stretch reflexes during locomotion in the mesencephalic cat , 1982, The Journal of physiology.