title: Spinal reflexes in ankle flexor and extensor muscles after chronic central nervous system lesions and functional electrical stimulation.
abstract: OBJECTIVE
  Spinal reciprocal inhibitory and excitatory reflexes of ankle extensor and flexor muscles were investigated in ambulatory participants with chronic central nervous system (CNS) lesions causing foot drop as a function of time after lesion and stimulator use.
  
  
  METHODS
  Thirty-nine participants with progressive (eg, secondary progressive MS) and 36 with generally nonprogressive (eg, stroke) conditions were studied. The tibialis anterior (TA) and soleus maximum H-reflex/M-wave (Hmax/Mmax) ratios and maximum voluntary contractions (MVC) were measured and compared with those in age-matched control participants. Reciprocal inhibition was measured as a depression of the ongoing electromyographic (EMG) activity produced by antagonist muscle-nerve stimulation.
  
  
  RESULTS
  Participants with CNS lesions had significantly higher soleus Hmax/Mmax ratios than control participants, and reduced voluntary modulation of the reflexes occurred in both muscles. Reciprocal inhibition of soleus from common peroneal (CP) nerve stimulation was not significantly different from controls in either group. Inhibition of the TA by tibial nerve stimulation decreased and was eventually replaced by excitation in participants with nonprogressive disorders. No significant change occurred in progressive disorders. Use of a foot drop stimulator increased the TA, but not the soleus MVC overall. H-reflexes only showed small changes. Reciprocal inhibition of the TA increased considerably, while that of the soleus muscle decreased toward control values.
  
  
  CONCLUSIONS
  Disorders that produce foot drop also produce reflex changes, some of which only develop over a period of years or even decades. Regular use of a foot drop stimulator strengthens voluntary pathways and changes some reflexes toward control values. Thus, stimulators may provide multiple benefits to people with foot drop.
authors.affiliation: Center for Neuroscience, University of Alberta, Edmonton, Canada.
authors.forename: Aiko K
authors.initials: AK
authors.lastname: Thompson
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Estabrooks
authors.forename: Suling
authors.initials: S
authors.lastname: Chong
authors.forename: Richard B
authors.initials: RB
authors.lastname: Stein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000503:physiopathology; D004599:Electric Stimulation Therapy / Q000379:methods*; D004576:Electromyography; D005528:Foot / Q000294:innervation / Q000503:physiopathology*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006181:H-Reflex / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology*; D009433:Neural Inhibition / Q000502:physiology; D009434:Neural Pathways / Q000503:physiopathology; D010291:Paresis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D012021:Reflex, Abnormal / Q000502:physiology*; D020521:Stroke / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult