Expansion of nociceptive withdrawal reflex receptive fields in spinal cord injured humans.
OBJECTIVE
In spinal cord injured (SCI) subjects, exaggerated withdrawal reflexes associated with a dominant flexor pattern irrespective of stimulation site have been reported. In the present study, withdrawal reflex receptive field (RRF) was determined in complete SCI subjects (N=9).


METHODS
Distributed electrical stimulation was applied to the sole of the foot, and reflexes in tibialis anterior, soleus, biceps femoris, and vastus lateralis muscles were recorded together with knee and ankle movement trajectories. A group of spinally intact subjects (N=10) were included as controls. With the subjects in supine position, stimulation was applied to 10 different sites on the foot sole. Based on the tibialis anterior reflex threshold for stimulation on the mid foot sole, two stimulus intensities (1.1 times the reflex threshold and 1.4 times the reflex threshold) were used for all 10 sites.


RESULTS
In SCI subjects, dorsi-flexion dominated independent of stimulus site and the tibialis anterior RRF covered the entire foot sole in contrast to a well-defined tibialis anterior receptive field at the medial, distal foot sole in the spinally intact subjects. Further, the soleus RRF also covered the entire sole in the SCI subjects. The reflexes in biceps femoris and vastus lateralis muscles were small and associated with weak knee flexion at all 10 sites in the SCI subjects and in the controls.


CONCLUSIONS
The RRF of the ankle flexor and the ankle extensor muscles both covered the entire sole of the foot indicating an expansion of the RRFs following spinal cord injury. The expansion is most likely due to lack of descending inhibitory control and/or increased sensitivity of the spinal reflex loop in the SCI subjects.


CONCLUSIONS
The study improves the understanding of spinal reflex control in spinal intact and spinal cord injured subjects.
Andersen
Ole K
OK
Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, D3, Aalborg DK-9220, Denmark. oka@hst.aau.dk
Finnerup
Nanna B
NB
Spaich
Erika G
EG
Jensen
Troels S
TS
Arendt-Nielsen
Lars
L
D000328:Adult; D004558:Electric Stimulation; D004576:Electromyography; D005260:Female; D005528:Foot; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology; D009619:Nociceptors / Q000502:physiology*; D017288:Pain Threshold / Q000502:physiology; D012021:Reflex, Abnormal / Q000502:physiology*; D013116:Spinal Cord / Q000502:physiology / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000503:physiopathology*