Remote muscle contraction enhances spinal reflexes in multiple lower-limb muscles elicited by transcutaneous spinal cord stimulation

  • Yohei Masugi
  • Atsushi Sasaki
  • Naotsugu Kaneko
  • Kimitaka NakazawaEmail author
Research Article


Transcutaneous spinal cord stimulation (tSCS) is a useful technique for the clinical assessment of neurological disorders. However, the characteristics of the spinal cord circuits activated by tSCS are not yet fully understood. In this study, we examined whether remote muscle contraction enhances the spinal reflexes evoked by tSCS in multiple lower-limb muscles. Eight healthy men participated in the current experiment, which required them to grip a dynamometer as fast as possible after the presentation of an auditory cue. Spinal reflexes were evoked in multiple lower-limb muscles with different time intervals (50–400 ms) after the auditory signals. The amplitudes of the spinal reflexes in all the recorded leg muscles significantly increased at 50–250 ms after remote muscle activation onset. This suggests that remote muscle contraction simultaneously facilitates the spinal reflexes in multiple lower-limb muscles. In addition, eight healthy men performed five different tasks (i.e., rest, hand grip, pinch grip, elbow flexion, and shoulder flexion). Compared to control values recorded just before each task, the spinal reflexes evoked at 250 ms after the auditory signals were significantly enhanced by the above tasks except for the rest task. This indicates that such facilitatory effects are also induced by remote muscle contractions in different upper-limb areas. The present results demonstrate the existence of a neural interaction between remote upper-limb muscles and spinal reflex circuits activated by tSCS in multiple lower-limb muscles. The combination of tSCS and remote muscle contraction may be useful for the neurological examination of spinal cord circuits.


Jendrássik maneuver Remote muscle Spinal reflex Transcutaneous spinal cord stimulation 



Abductor pollicis brevis


Anterior deltoid


Biceps brachii


Biceps femoris






Extensor carpi radialis


First dorsal interosseous


Flexor carpi radialis


Hoffmann reflex


Jendrássik maneuver


Maximum voluntary contraction


Maximum voluntary force


Medial gastrocnemius


Root mean square






Tibialis anterior


Transcutaneous spinal cord stimulation


Vastus medialis



This work was supported by JSPS KAKENHI Grant number 18K17760.

Compliance with ethical standards

Conflict of interest

The authors declare that no conflict of interests exist.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

221_2019_5536_MOESM1_ESM.tif (7.4 mb)
Supplementary Fig.1: Results of the double-pulse stimulation test: A) Typical example of the averaged waveform of the responses elicited by double-pulse stimulation (n=1) in multiple lower-limb muscles. tSCS was delivered at 0 ms and 50 ms. B) Medians (n=8) of the peak to-peak amplitude of both the first and the second response. The lines in the box plots indicate the medians. The ends of the boxes represent the 25th and 75th percentiles. The whiskers on the boxplot illustrate the 10th and 90th percentiles. Legend: * = p<0.05 (TIFF 7569 kb)
221_2019_5536_MOESM2_ESM.tif (6.9 mb)
Supplementary Fig.2: Results of the double-pulse stimulation test: A) Typical example of the averaged waveform of the responses elicited by double-pulse stimulation (n=1) in multiple lower-limb muscles. tSCS was delivered at 0 ms and 50 ms. B) Medians (n=8) of the peak to-peak amplitude of both the first and the second response. The lines in the box plots indicate the medians. The ends of the boxes represent the 25th and 75th percentiles. The whiskers on the boxplot illustrate the 10th and 90th percentiles. Legend: * = p<0.05 (TIFF 7047 kb)
221_2019_5536_MOESM3_ESM.tif (3.8 mb)
Supplementary Fig. 3: Background EMG activity as observed in experiment 1. Filled circles represent the mean (n=8). Unfilled circles represent the individual data points from each participant (TIFF 3890 kb)
221_2019_5536_MOESM4_ESM.tif (2.1 mb)
Supplementary Fig.4: Background EMG activity as observed in experiment 2. The lines in the box plots indicate median values. The ends of the boxes represent the 25th and 75th percentiles. The whiskers on the boxplot illustrate the 10th and 90th percentiles. Legend: * = p<0.05 (TIFF 2118 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Yohei Masugi
    • 1
    • 2
  • Atsushi Sasaki
    • 1
  • Naotsugu Kaneko
    • 1
  • Kimitaka Nakazawa
    • 1
    Email author
  1. 1.Department of Life Sciences, Graduate School of Arts and SciencesThe University of TokyoTokyoJapan
  2. 2.Institute of Sports Medicine and ScienceTokyo International UniversitySaitamaJapan

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