title: Increases in human motoneuron excitability after cervical spinal cord injury depend on the level of injury.
abstract: After human spinal cord injury (SCI), motoneuron recruitment and firing rate during voluntary and involuntary contractions may be altered by changes in motoneuron excitability. Our aim was to compare F waves in single thenar motor units paralyzed by cervical SCI to those in uninjured controls because at the single-unit level F waves primarily reflect the intrinsic properties of the motoneuron and its initial segment. With intraneural motor axon stimulation, F waves were evident in all 4 participants with C4-level SCI, absent in 8 with C5or C6injury, and present in 6 of 12 Uninjured participants (P < 0.001). The percentage of units that generated F waves differed across groups (C4: 30%, C5or C6: 0%, Uninjured: 16%; P < 0.001). Mean (±SD) proximal axon conduction velocity was slower after C4SCI [64 ± 4 m/s (n = 6 units), Uninjured: 73 ± 8 m/s (n = 7 units); P = 0.037]. Mean distal axon conduction velocity differed by group [C4: 40 ± 8 m/s (n = 20 units), C5or C6: 49 ± 9 m/s (n = 28), Uninjured: 60 ± 7 m/s (n = 45); P < 0.001]. Motor unit properties (EMG amplitude, twitch force) only differed after SCI (P ≤ 0.004), not by injury level. Motor units with F waves had distal conduction velocities, M-wave amplitudes, and twitch forces that spanned the respective group range, indicating that units with heterogeneous properties produced F waves. Recording unitary F waves has shown that thenar motoneurons closer to the SCI (C5or C6) have reduced excitability whereas those further away (C4) have increased excitability, which may exacerbate muscle spasms. This difference in motoneuron excitability may be related to the extent of membrane depolarization following SCI.
  
  
  
  Unitary F waves were common in paralyzed thenar muscles of people who had a chronic spinal cord injury (SCI) at the C4level compared with uninjured people, but F waves did not occur in people that had SCI at the C5or C6level. These results highlight that intrinsic motoneuron excitability depends, in part, on how close the motoneurons are to the site of the spinal injury, which could alter the generation and strength of voluntary and involuntary muscle contractions.
authors.affiliation: The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida; cthomas3@med.miami.edu.
authors.forename: Christine K
authors.initials: CK
authors.lastname: Thomas
authors.affiliation: Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden; and.
authors.forename: Charlotte K
authors.initials: CK
authors.lastname: Häger
authors.affiliation: Guangdong Work Injury Rehabilitation Center, Guangzhou, People's Republic of China.
authors.forename: Cliff S
authors.initials: CS
authors.lastname: Klein
mesh_terms: D000328:Adult; D001369:Axons / Q000502:physiology; D066193:Cervical Cord / Q000473:pathology; D004558:Electric Stimulation; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009046:Motor Neurons / Q000502:physiology*; D009431:Neural Conduction / Q000502:physiology; D013119:Spinal Cord Injuries / Q000473:pathology*; D018709:Statistics, Nonparametric; D055815:Young Adult
keywords: F wave; proximal axon conduction velocity; single motor unit