Abstract
Individuals with incomplete spinal cord injury (iSCI) show altered postural reactions leading to increased risk of falls. To investigate neural correlates underlying this deficit, we assessed the modulation pattern of the Soleus H-reflex in iSCI individuals following unexpected perturbations of a base of support. Ten men with iSCI (AIS D) and 8 age-matched controls (CTRL) stood on a force-platform randomly tilted forward or backward. The center of pressure (CoP) excursion, 95% confidence ellipse area and electromyographic (EMG) activity of the Soleus (SOL) and Tibialis Anterior (TA) muscles were analyzed. SOL H-reflex amplitude was assessed by stimulating the tibial nerve prior to and at 100, 150 and 200 ms following perturbation onset. Although SOL and TA short-latency EMG responses were comparable in both groups, long-latency EMG responses occurred later in the iSCI group for both directions: during backward tilt, a decrease in H-reflex amplitude was observed at all stimulus timings post-tilt in CTRL, but only at 200 ms in iSCI. The decrease in H-reflex amplitude was smaller in iSCI participants. During forward tilt, an increase in H-reflex amplitude was observed at 150 and 200 ms in the CTRL group, but no increase was observed in the iSCI group. Decreased and delayed SOL H-reflex amplitude modulation in the iSCI group accompanied impaired balance control as assessed clinically with the Berg Balance Scale and biomechanically through CoP displacement. Overall, delayed and reduced spinal reflex processing may contribute to impaired balance control in people with iSCI.
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Abbreviations
- AIS:
-
American Spinal Injury Association Injury Scale classification
- CoP:
-
Center of pressure
- CTRL:
-
Control
- CST:
-
Cortico-spinal tract
- EMG:
-
Electromyography
- H-reflex:
-
Hoffmann reflex
- iSCI:
-
Incomplete spinal cord injury
- M response:
-
Muscular response
- SD:
-
Standard deviation
- SEM:
-
Standard error of the mean
- TUG:
-
Timed up-and-go
- SOL:
-
Soleus Muscle
- TA:
-
Tibialis anterior Muscle
- SLR:
-
Short-latency response
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Acknowledgements
The authors wish to thank Dr. Frédérique Courtois for her help during the recruitment; Guillaume Elgbeili for statistical support; and Daniel Marineau and Michel Goyette for technical assistance.
Funding
This study was supported by the Réseau Provincial en Adaptation-Réadaptation du Québec (REPAR). DB and CHP are financed by the Fonds de Recherche du Québec—Santé (FRQS).
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All authors contributed to the study. Material preparation, data collection and analysis were performed by CHP, MSt-PB, ZM, MM and DB. The first draft of the manuscript was written by CHP, and all authors commented on previous versions of the manuscript. DB was responsible for the conception, design and funding of the study and approved the final manuscript version.
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Approval was obtained from the local research ethics board of the Center for Interdisciplinary Research in Rehabilitation of Greater Montreal. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
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Communicated by Winston D Byblow.
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Pion, C.H., St-Pierre Bolduc, M., Miranda, Z. et al. Alteration of H-reflex amplitude modulation is a marker of impaired postural responses in individuals with incomplete spinal cord injury. Exp Brain Res 239, 1779–1794 (2021). https://doi.org/10.1007/s00221-021-06081-0
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DOI: https://doi.org/10.1007/s00221-021-06081-0