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Flexion reflex modulation during stepping in human spinal cord injury

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Abstract

The flexion reflex modulation pattern was investigated in nine people with a chronic spinal cord injury during stepping using body weight support on a treadmill and manual assistance by therapists. Body weight support was provided by an upper body harness and was adjusted for each subject to promote the best stepping pattern with the least manual assistance required by the therapists. The flexion reflex was elicited by sural nerve stimulation with a 30 ms pulse train at 1.2–2 times the tibialis anterior reflex threshold. During stepping, stimuli were randomly dispersed across the gait cycle which was divided into 16 equal bins. A long latency (>110 ms) flexion reflex was present in all subjects, while a short (>30 ms) and a medium latency (>70 ms) flexion reflex were present only in three subjects. For each response, the non-stimulated EMG was subtracted from the stimulated EMG at identical time windows and bins, normalized to the maximal corresponding EMG, and significant differences were established with a Wilcoxon rank-sum test. The long latency flexion reflex was facilitated at late stance and during the swing-to-stance transition phase. A reflex depression was present from heel strike until mid-stance and during the swing-to-stance transition phase. The short and medium latency flexion reflexes were depressed during mid-stance followed by facilitation during the stance-to-swing transition phase. Regardless of the latency, facilitatory flexion responses during the swing phase coincided with decreased activity of ipsilateral ankle extensors. The flexion reflex was modulated in a phase dependent manner, a behavior that was absent for the soleus H-reflex in most of these patients (Knikou et al. in Exp Brain Res 193:397–407, 2009). We propose that training should selectively target spinal reflex circuits in which extensor muscles and reflexes are involved in order to maximize sensorimotor recovery in these patients.

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Acknowledgments

This work was supported by the New York State Spinal Cord Injury Research Trust Fund through Department of Health Contract No. C020933 to Maria Knikou. Authors thank the clinical research team of the Frazier Rehab Institute, the research participants for their valuable contribution, and Dr. Yangsheng Chen for his excellent engineering contribution to this work.

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Authors and Affiliations

  1. Health Sciences Doctoral Programs, The Graduate Center, City University of New York, 2800 Victory Boulevard, Staten Island, NY, 10314, USA

    Maria Knikou

  2. Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Maria Knikou

  3. Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA

    Maria Knikou

  4. Department of Neurological Surgery, University of Louisville, Louisville, KY, USA

    Claudia A. Angeli, Christie K. Ferreira & Susan J. Harkema

  5. Frazier Rehab Institute, Louisville, KY, USA

    Claudia A. Angeli, Christie K. Ferreira & Susan J. Harkema

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  1. Maria Knikou
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  2. Claudia A. Angeli
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  3. Christie K. Ferreira
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  4. Susan J. Harkema
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Correspondence to Maria Knikou.

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Knikou, M., Angeli, C.A., Ferreira, C.K. et al. Flexion reflex modulation during stepping in human spinal cord injury. Exp Brain Res 196, 341–351 (2009). https://doi.org/10.1007/s00221-009-1854-x

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