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Functional reorganization of soleus H-reflex modulation during stepping after robotic-assisted step training in people with complete and incomplete spinal cord injury

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Abstract

Body weight–supported (BWS) robotic-assisted step training on a motorized treadmill is utilized with the aim to improve walking ability in people after damage to the spinal cord. However, the potential for reorganization of the injured human spinal neuronal circuitry with this intervention is not known. The objectives of this study were to determine changes in the soleus H-reflex modulation pattern and activation profiles of leg muscles during stepping after BWS robotic-assisted step training in people with chronic spinal cord injury (SCI). Fourteen people who had chronic clinically complete, motor complete, and motor incomplete SCI received an average of 45 training sessions, 5 days per week, 1 h per day. The soleus H-reflex was evoked and recorded via conventional methods at similar BWS levels and treadmill speeds before and after training. After BWS robotic-assisted step training, the soleus H-reflex was depressed at late stance, stance-to-swing transition, and swing phase initiation, allowing a smooth transition from stance to swing. The soleus H-reflex remained depressed at early and mid-swing phases of the step cycle promoting a reciprocal activation of ankle flexors and extensors. The spinal reflex circuitry reorganization was, however, more complex, with the soleus H-reflex from the right leg being modulated either in a similar or in an opposite manner to that observed in the left leg at a given phase of the step cycle after training. Last, BWS robotic-assisted step training changed the amplitude and onset of muscle activity during stepping, decreased the step duration, and improved the gait speed. BWS robotic-assisted step training reorganized spinal locomotor neuronal networks promoting a functional amplitude modulation of the soleus H-reflex and thus step progression. These findings support that spinal neuronal networks of persons with clinically complete, motor complete, or motor incomplete SCI have the potential to undergo an endogenous-mediated reorganization, and improve spinal reflex function and walking function with BWS robotic-assisted step training.

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Notes

  1. In R10 subject, the soleus H-reflex modulation from the right leg was not assessed during stepping due to a pronounced contracture of the ankle joint, which might have masked the soleus H-reflex function.

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Acknowledgments

My sincere thanks to Chaithanya K. Mummidisetty for the arrangement of all experiments and his help during data acquisition, Andrew C. Smith for the clinical management of the study, the participants whom dedication and motivation made these results possible, and the anonymous reviewers for their in-depth criticisms. Last, I thank Poul Dyhre-Poulsen and Erik B. Simonsen for providing the prototype constant current stimulator, which was build at the University of Copenhagen, Denmark. This work was conducted at the Rehabilitation Institute of Chicago and supported by The Craig H. Neilsen Foundation (Grant number 83607) and the New York State Department of Health (Contract number C023690). Funding sources had no involvement in study design, data collection, data analysis, data interpretation, and decision to publish.

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The author declares that she has no conflict of interest.

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Authors and Affiliations

  1. Electrophysiological Analysis of Gait and Posture Laboratory, Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 East Superior Street, Suite 1406, Chicago, IL, 60611, USA

    Maria Knikou

  2. Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 345 East Superior Street, Suite 1406, Chicago, IL, 60611, USA

    Maria Knikou

  3. Department of Physical Therapy, Graduate Center, City University of New York, College of Staten Island, 2800 Victory Blvd, Bldg 5N-207 Staten Island, New York, NY, 10314, USA

    Maria Knikou

  4. Department of Biology, Graduate Center, City University of New York, New York, NY, USA

    Maria Knikou

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Knikou, M. Functional reorganization of soleus H-reflex modulation during stepping after robotic-assisted step training in people with complete and incomplete spinal cord injury. Exp Brain Res 228, 279–296 (2013). https://doi.org/10.1007/s00221-013-3560-y

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