title: Acoustic startle reflex in patients with chronic stroke at different stages of motor recovery: a pilot study.
abstract: BACKGROUND
  Acoustic startle reflex (ASR) can be used as a tool to examine reticulospinal excitability. The potential role of reticulospinal mechanisms in the development of spasticity has been suggested but not tested.
  
  
  OBJECTIVE
  To examine reticulospinal excitability at different stages of motor recovery in patients with chronic stroke using the ASR.
  
  
  METHODS
  Sixteen subjects with hemiplegic stroke participated in the study. We examined ASR responses at rest and contralateral motor overflow during voluntary elbow flexion.
  
  
  RESULTS
  ASR responses in impaired biceps muscles showed different patterns at different stages. In subjects without spasticity, ASR responses were less frequent (10% on impaired side) and had normal duration (<200 ms). In subjects with spasticity, the responses were more frequent (58.3% on impaired side) and longer lasting (up to 1 minute). However, no correlation between exaggerated reflex responses and Modified Ashworth Scale (MAS) scores was observed. During voluntary elbow flexion on the impaired side, similar positive linear force-electromyogram (EMG) relationships were found in subjects with and without spasticity. Electromyographic activity of the resting nonimpaired limb increased proportionally in subjects with spasticity (r = 0.6313, P = .0004), but no such correlation was found in subjects without spasticity (r = 0.0191, P = .9612).
  
  
  CONCLUSIONS
  Preliminary findings of exaggerated ASR responses and associated contralateral overflow only in spastic biceps muscles in patients with chronic stroke suggest the important role of reticulospinal mechanisms in the development of spasticity.
authors.affiliation: Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, Houston, Texas Neurorehabilitation Research Laboratory, Neurorecovery Research Center, TIRR Memorial Hermann Research Center, Houston, Texas.
authors.forename: Sheng
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Shuo-Hsiu
authors.initials: SH
authors.lastname: Chang
authors.affiliation: Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Gerard E
authors.initials: GE
authors.lastname: Francisco
authors.affiliation: Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Monica
authors.initials: M
authors.lastname: Verduzco-Gutierrez
mesh_terms: D000161:Acoustic Stimulation; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003627:Data Interpretation, Statistical; D004576:Electromyography; D005260:Female; D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D009460:Neurologic Examination; D010865:Pilot Projects; D020127:Recovery of Function; D012018:Reflex / Q000502:physiology; D013216:Reflex, Startle / Q000502:physiology*; D020521:Stroke / Q000523:psychology*; D000071939:Stroke Rehabilitation
keywords: acoustic startle reflex; motor recovery; spasticity; stroke