Reflex contribution of spindle group Ia and II afferent input to leg muscle spasticity as revealed by tendon vibration in hemiparesis.
OBJECTIVE
Foot dorsiflexion evokes a short- (SLR) and a medium-latency EMG response (MLR) in the soleus of standing subjects. SLR is mediated by spindle group Ia, while group II fibres contribute to MLR through an oligosynaptic circuit. We studied the effects of Achilles' tendon vibration on both responses in spastic patients to disclose any abnormal excitability of these pathways.


METHODS
SLR and MLR were evoked in 11 hemiparetics and 11 normals. The vibration-induced changes in both responses were correlated to the Ashworth score of the affected leg.


RESULTS
There were no differences between normals and patients in the size of control SLR or MLR. Vibration decreased SLR to 70% in normal subjects, but increased it to 110% in patients, in both affected and unaffected leg. Vibration did not affect MLR in normals, but increased it to 165% on the affected and 120% on the unaffected side of patients. Ashworth score was solely correlated with the degree of vibration-induced increase of MLR.


CONCLUSIONS
While the lack of inhibitory effect of vibration on SLR confirms a reduced inhibitibility of the monosynaptic reflex, the increased MLR indicates a disinhibition of group II pathway in patients, connected to the loss of descending control on group II interneurones. Spastic hypertonia depends on release of group II rather than group Ia reflex pathways.


CONCLUSIONS
These findings give a neurophysiological support for the pharmacological treatment of spastic hypertonia and suggest a method for the assessment of its effects.
Nardone
Antonio
A
Division of Physical Therapy and Rehabilitation, Posture and Movement Laboratory, Fondazione Salvatore Maugeri, Scientific Institute of Veruno, Novara, Italy.
Schieppati
Marco
M
D000328:Adult; D004576:Electromyography / Q000379:methods; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009128:Muscle Spasticity / Q000503:physiopathology*; D018482:Muscle, Skeletal / Q000503:physiopathology*; D009412:Nerve Fibers / Q000502:physiology; D009475:Neurons, Afferent / Q000502:physiology; D010291:Paresis / Q000503:physiopathology*; D011930:Reaction Time / Q000502:physiology; D013710:Tendons / Q000503:physiopathology*; D014732:Vibration