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INTRODUCTION/AIMS Motion artifact signals (MASs) created by the relative movement of intramuscular wire electrodes are an indicator of the mechanical stimulus arrival time to the muscle belly. This study proposes a method that uses wire electrodes as an intramuscular mechanosensor to determine the stretch reflex (SR) latency without lag time. METHODS Gastrocnemius SR was induced by tendon tap, heel tap, and forefoot tap. The MASs recorded by intramuscular wire electrodes were extracted from background electromyographic activity using the spike-triggered averaging technique. Simultaneous recordings were obtained from multiple sites to validate the MAS technique. RESULTS Using intramuscular wire electrodes, the MASs were successfully determined and extracted for all stimulus sites. In the records from the rectus femoris, MASs were also successfully extracted; thus, the reflex latency could be calculated. DISCUSSION Wire electrodes can be used as an intramuscular mechanosensor to determine the mechanical stimulus arrival time to the muscle belly.

Although several methods have been used to estimate exercise-induced changes in human neuronal networks, there are growing doubts about the methodologies used. This review describes a single motor unit-based method that minimizes the errors inherent in classical methods. With this method, it is now possible to identify human neuronal networks' changes due to exercise.

Objectives Amyotrophic lateral sclerosis (ALS) disrupts motoneurons that control movement and some vital functions, however, exact details of the neuronal circuits involved in ALS have yet to be fully endorsed. To contribute to our understanding of the responsible neuronal circuits, we aimed to investigate the spinal recurrent inhibition (RI) and post-activation depression (P-AD) in ALS patients. Methods In two groups of ALS patients, i.e. lumbar-affected (clinical signs in leg muscles) and nonlumbar-affected (clinical signs in arms or bulbar region but not in the legs), RI and P-AD on the soleus muscle were investigated using single motor units and amplitude changes of H-reflex in surface electromyography, respectively. The data were compared with healthy subjects. Results Compared to controls, P-AD of H-reflex was reduced severely in lumbar-affected patients and reduced to a certain degree in nonlumbar-affected patients. Similarly, a significant reduction in the duration of RI on firing motoneurons was found in lumbar-affected patients (11.5 ± 2.6 ms) but not in nonlumbar-affected patients (29.7 ± 12.4 ms, P Conclusion The current study revealed that spinal inhibitory circuits are impaired in ALS. Significance These findings may provide insight for proposing new therapeutic approaches and following disease progression in humans.

To determine a stimulus rate that is not influenced by homosynaptic post-activation depression for H-reflex studies in patients with chronic spasticity.A cohort of 15 chronic stroke patients with soleus spasticity who received inpatient treatment at our rehabilitation centre participated in this study. The effect of stimulus frequency related depression on H-reflex size was tested using four different stimulus rates (0.1, 0.2, 0.3 and 1 Hz). The affected sides stibial nerve was stimulated by a bipolar electrode. The H-reflex was recorded from the affected sideed sidee sidehe affected smine stimulus frequency related depression of H-reflex size, amplitude of the first H-reflex response (HHHigher frequency stimulation of Ia afferents than 0.1 Hz induced a stimulus frequency-related depression of H-reflex size in patients with chronic spasticity. The optimal stimulus rate for H-reflex was found to be 0.1 Hz.

Whole-body vibration (WBV) is applied to the sole of the foot, whereas local mechanical vibration (LMV) is applied directly to the muscle or tendon. The time required for the mechanical stimulus to reach the muscle belly is longer for WBV. Therefore, the WBV-induced muscular reflex (WBV-IMR) latency may be longer than the tonic vibration reflex (TVR) latency. The aim of this study was to determine whether the difference between WBV-IMR and TVR latencies is due to the distance between the vibration application point and the target muscle.Eight volunteers participated in this study. The soleus reflex response was recorded during WBV, LMVs, and tendon tap. LMVs were applied to the Achilles tendon and sole of the foot. The latencies were calculated using the cumulative averaging technique.The latency (33.4±2.8 ms) of the soleus reflex induced by the local foot vibration was similar to the soleus TVR latency (30.9±3.2 ms) and T-reflex (32.0±2.4 ms) but significantly shorter than the latency of the soleus WBV-IMR (42.3±3.4 ms) (FThe present study points out that the neuronal circuitries of TVR and WBV-IMR are different.

Purpose There is growing evidence that vertebral column function and dysfunction play a vital role in neuromuscular control. This invited review summarises the evidence about how vertebral column dysfunction, known as a central segmental motor control (CSMC) problem, alters neuromuscular function and how spinal adjustments (high-velocity, low-amplitude or HVLA thrusts directed at a CSMC problem) and spinal manipulation (HVLA thrusts directed at segments of the vertebral column that may not have clinical indicators of a CSMC problem) alters neuromuscular function. Methods The current review elucidates the peripheral mechanisms by which CSMC problems, the spinal adjustment or spinal manipulation alter the afferent input from the paravertebral tissues. It summarises the contemporary model that provides a biologically plausible explanation for CSMC problems, the manipulable spinal lesion. This review also summarises the contemporary, biologically plausible understanding about how spinal adjustments enable more efficient production of muscular force. The evidence showing how spinal dysfunction, spinal manipulation and spinal adjustments alter central multimodal integration and motor control centres will be covered in a second invited review. Results Many studies have shown spinal adjustments increase voluntary force and prevent fatigue, which mainly occurs due to altered supraspinal excitability and multimodal integration. The literature suggests physical injury, pain, inflammation, and acute or chronic physiological or psychological stress can alter the vertebral column’s central neural motor control, leading to a CSMC problem. The many gaps in the literature have been identified, along with suggestions for future studies. Conclusion Spinal adjustments of CSMC problems impact motor control in a variety of ways. These include increasing muscle force and preventing fatigue. These changes in neuromuscular function most likely occur due to changes in supraspinal excitability. The current contemporary model of the CSMC problem, and our understanding of the mechanisms of spinal adjustments, provide a biologically plausible explanation for how the vertebral column’s central neural motor control can dysfunction, can lead to a self-perpetuating central segmental motor control problem, and how HVLA spinal adjustments can improve neuromuscular function.

Study design An experimental design. Objectives The aim of this study was to determine the latencies of vibration-induced reflexes in individuals with and without spinal cord injury (SCI), and to compare these latencies to identify differences in reflex circuitries. Setting A tertiary rehabilitation center in Istanbul. Methods Seventeen individuals with chronic SCI (SCI group) and 23 participants without SCI (Control group) were included in this study. Latency of tonic vibration reflex (TVR) and whole-body vibration-induced muscular reflex (WBV-IMR) of the left soleus muscle was tested for estimating the reflex origins. The local tendon vibration was applied at six different vibration frequencies (50, 85, 140, 185, 235, and 265 Hz), each lasting for 15 s with 3-s rest intervals. The WBV was applied at six different vibration frequencies (35, 37, 39, 41, 43, and 45 Hz), each lasting for 15 s with 3-s rest intervals. Results Mean (SD) TVR latency was 39.7 (5.3) ms in the SCI group and 35.9 (2.7) ms in the Control group with a mean (95% CI) difference of -3.8 (-6.7 to -0.9) ms. Mean (SD) WBV-IMR latency was 45.8 (7.4) ms in the SCI group and 43.3 (3.0) ms in the Control group with a mean (95% CI) difference of -2.5 (-6.5 to 1.4) ms. There were significant differences between TVR latency and WBV-IMR latency in both the groups (mean (95% CI) difference; -6.2 (-9.3 to -3.0) ms, p = 0.0001 for the SCI group and -7.4 (-9.3 to -5.6) ms, p = 0.011 for Control group). Conclusions The results suggest that the receptor of origin of TVR and WBV-IMR may be different.

Injury as a result of tripping is relatively common among older people. the risk of falling increases with fatigue and of importance is the ability to dorsiflex the foot through timely activation of the tibialis anterior (TA) muscle to ensure the foot clears the ground, or an obstacle, during the swing phase of walking. We, therefore, questioned whether the muscle spindle input to the motoneurons alters with ongoing fatigue in older people. We electrically stimulated the common peroneal nerve to assess the TA primary afferent efficacy using H-reflex before, immediately following and after a fatiguing maximal isometric contraction. M-response was kept unchanged throughout the experiment to ensure a similar stimulus intensity was delivered across time points. H-reflex increased significantly while the TA muscle was in a state of fatigue for the younger participants but tended to decrease with increasing age. the main contributor to the tonicity of TA muscle, i.e., excitatory synapses of spindle primary endings of motoneurons that innervate TA muscle, tend to lose their efficacy during fatigue in the older individuals but increased efficiency in the majority of the younger people. Since TA muscle is the main dorsiflexor of the foot and it needs to be active during the swing phase of stepping to prevent tripping, older individuals become more susceptible to falling when their muscles are fatigued. This finding may help improve devices/treatments to overcome the problem of tripping among older individuals., Turkiye Bilimsel ve Teknolojik Arastirma Kurumu [2211] Funding Source: Medline

The effect of Jendrassik Maneuver (JM) has been extensively studied on monosynaptic reflexes in numerous muscles below the level at which the maneuver was performed. Here we hypothesize that the effect of JM could be observed also on other reflexes, indicating a widespread influence of performing a motor act such as the JM. We examined polysynaptic reflexes caudal (i.e., the withdrawal reflex of the lower extremities) and rostral (i.e., the blink reflex to supraorbital nerve stimulation) to the level of JM contraction. We have assessed soleus tendon (T) reflex; withdrawal reflex in tibialis anterior and soleus muscle; blink reflex (BR), blink reflex excitability recovery curve (BR-ER) and prepulse inhibition of the blink reflex. Our results showed that (1) T-reflex amplitude increased during JM and decreased just after and 15 min after JM; (2) no change in the withdrawal reflex; (3) R2 area of BR reduced significantly just after or 15 min after JM; (4) Prepulse inhibition in BR reduced significantly during JM; (5) no change in BR-ER. Our results indicate that JM leads to generalized effects on neural excitability at both caudal and rostral levels. Furthermore, JM has a selective effect on excitability of reflex circuitries.

KEY POINTS To uncover the synaptic profile of Renshaw inhibition on motoneurons, we stimulated thick motor axons and recorded from voluntarily-activated motor units. Stimuli generated a direct motor response on the whole muscle and an inhibitory response in active motor units. We have estimated the profile of Renshaw inhibition indirectly using the response of motor unit discharge rates to the stimulus. We have put forward a method of extrapolation that may be used to determine genuine synaptic potentials as they develop on motoneurons. These optimized techniques can be used in research and in clinics to fully appreciate Renshaw cell function in various neurological disorders. ABSTRACT Although Renshaw inhibition (RI) has been extensively studied for decades, its precise role in motor control is yet to be discovered. One of the main handicaps is a lack of reliable methods for studying RI in conscious human subjects. We stimulated the lowest electrical threshold motor axons (thickest axons) in the tibial nerve and analysed the stimulus-correlated changes in discharge of voluntarily recruited low-threshold single motor units (SMUs) from the soleus muscle. In total, 54 distinct SMUs from 12 subjects were analysed. Stimuli that generated only the direct motor response (M-only) on surface electromyography induced an inhibitory response in the low-threshold SMUs. Because the properties of RI had to be estimated indirectly using the background discharge rate of SMUs, its profile varied with the discharge rate of the SMU. The duration of RI was found to be inversely proportional to the discharge rate of SMUs. Using this important finding, we have developed a method of extrapolation for estimating RI as it develops on motoneurons in the spinal cord. The frequency methods indicated that the duration of RI was between 30 and 40 ms depending on the background firing rate of the units, and the extrapolation indicated that RI on silent motoneurons was ∼55 ms. The present study establishes a novel methodology for studying RI in human subjects and hence may serve as a tool for improving our understanding of the involvement of RI in human motor control.

Objective In this study, we examined if 6–9 Hz jaw tremor, an indirect indicator of Periodontal Mechanoreceptor (PMR) activity, is different in bruxists compared to healthy participants during production of a low-level constant bite force. Methods Bite force and surface EMG from the masseter muscle were recorded simultaneously as participants (13 patients, 15 controls) held a force transducer between the upper and lower incisors very gently. Results Tremor in 6–9 Hz band for bruxists was greater on average compared to controls, but the difference was not significant, both for force recordings and EMG activity. Conclusions The low effect sizes measured with the current protocol contrast highly with those of our previous study, where larger, dynamic bite forces were used, and where jaw tremor was markedly different in bruxists compared with controls. Significance We have now gained important insight into the conditions under which abnormal jaw tremor can be elicited in bruxism. From a scientific standpoint, this is critical for understanding the ‘abnormality’ of PMR feedback in bruxism. From a clinical perspective, our results represent progress towards the development of an optimal protocol in which jaw tremor can serve as a biological marker of bruxism.

Sudden foot dorsiflexion lengthens soleus muscle and activates stretch-based spinal reflexes. Dorsiflexion can be triggered by activating tibialis anterior (TA) muscle through peroneal nerve stimulation or transcranial magnetic stimulation (TMS) which evokes a response in the soleus muscle referred to as Medium Latency Reflex (MLR) or motor-evoked potential-80 (Soleus MEP80), respectively. This study aimed to examine the relationship between these responses in humans. Therefore, latency characteristics and correlation of responses between soleus MEP80 and MLR were investigated. We have also calculated the latencies from the onset of tibialis activity, i.e., subtracting of TA-MEP from MEP80 and TA direct motor response from MLR. We referred to these calculations as Stretch Loop Latency Central (SLLc) for MEP80 and Stretch Loop Latency Peripheral (SLLp) for MLR. The latency of SLLc was found to be 61.4 ± 5.6 ms which was significantly shorter (P = 0.0259) than SLLp (64.0 ± 4.2 ms) and these latencies were correlated (P = 0.0045, r = 0.689). The latency of both responses was also found to be inversely related to the response amplitude (P = 0.0121, r = 0.451) probably due to the activation of large motor units. When amplitude differences were corrected, i.e. investigating the responses with similar amplitudes, SLLp, and SLLc latencies found to be similar (P = 0.1317). Due to the identical features of the soleus MEP80 and MLR, we propose that they may both have spinal origins.

Purpose: To determine whether unilateral leg whole-body vibration (WBV) strength training induces strength gain in the untrained contralateral leg muscle. The secondary aim was to determine the potential role of spinal neurological mechanisms regarding the effect of WBV exercise on contralateral strength training. Materials and Methods: Forty-two young adult healthy volunteers were randomized into two groups: WBV exercise and Sham control. An isometric semi-squat exercise during WBV was applied regularly through 20 sessions. WBV training was applied to the right leg in the WBV group and the left leg was isolated from vibration. Sham WBV was applied to the right leg of participants in the Control group. Pre- and post-training isokinetic torque and reflex latency of both quadricepses were evaluated. Results: The increase in the strength of right (vibrated) knee extensors was 9.4 ± 10.7% in the WBV group (p = .001) and was 1.2 ± 6.6% in the Control group (p = .724). The left (non-vibrated) extensorsvibrated) knee extensors w4 ± 8.4% in the WBV group (p = .038), whereas it decreased by 1.4 ± 7.0% in the Control (p = .294). The strength gains were significant between the two groups. WBV induced the reflex response of the quadriceps muscle in the vibrated ipsilateral leg and also in the non-vibrated contralateral leg, though with a definite delay. The WBV-induced muscle reflex (WBV-IMR) latency was 22.5 ± 7.7 ms for the vibrated leg and 39.3 ± 14.6 ms for the non-vibrated leg. Conclusions: Chronic WBV training has an effect of the cross-transfer of strength to contralateral homologous muscles. The WBV-induced muscular reflex may have a role in the mechanism of cross-transfer strength.

Introduction Although there are numerous protocols to adjust the amplitude of the Hoffmann reflex (H-reflex) relative to the size of the direct motor response (M-response), the optimal stimulating location has not been described. We sought to determine the optimal positioning of the stimulating cathode when evoking the tibial nerve H-reflex and M-response. Methods A small cathode was placed on defined points in the popliteal fossa while an anode was fixed on the patella. The tibial nerve was stimulated electrically, and the response of the soleus muscle was recorded using intramuscular and surface electromyography. Results We found that more-lateral points along a line drawn across the popliteal fossa were the best locations to obtain only the M-response, whereas stimulating the midpoint was optimal for obtaining only the H-reflex. Discussion By using specified locations for electrical stimulation to evoke H-reflex and M-response, the functionality of the tibial nerve can be assessed. Muscle Nerve 58:828-833, 2018.

The effects of masticatory muscles’ overloading on jaw-motor control are not yet fully clarified. Therefore, it was tested whether eccentric and concentric exercises of the human masticatory muscles would influence inhibitory jaw reflex responses. Eleven participants (6 males, 5 females) performed 6, 5-minutes bouts of eccentric-concentric contractions. Before, immediately after, 24 hours, 48 hours and 1 week afterwards, visual analogue scale (VAS) scores for jaw muscle fatigue and pain, maximum voluntary bite force (MVBF) and inhibitory jaw reflexes were recorded. Reflex data were analysed with the cumulative sum control chart error box method. Immediate and delayed masticatory muscle fatigue and pain were provoked. Further, 24 hours after the exercises, MVBF tended to decrease (P =.056), suggesting that delayed-onset muscle soreness (DOMS) was provoked in the masticatory muscles. In addition, the inhibitory jaw reflex showed a delayed increase in size 24 hours after the exercise (P

Electrodes for recording electroencephalogram (EEG) are placed on or around cranial muscles; hence, their electrical activity may contaminate the EEG signal even at rest conditions. Due to its role in maintaining mandibular posture, tonic activity of temporalis muscle interferes with the EEG signal particularly at fronto-temporal locations at single motor unit (SMU) level. By obtaining surface representation of a motor unit, we can evaluate its interference in EEG and if we could sum surface representations of several tonically active motor units, we could estimate the overall myogenic contamination in EEG. Therefore, in this study, we followed re-composition (RC) approach and generated EEG-like artefact model using surface representations of single motor units (RC). Furthermore, we compared signal characteristics of RC signals with simultaneously recorded EEG signal at different locations in terms of power spectral density and coherence. First, we found that RC signal represented the power spectral distribution of an EMG signal. Second, RC signal reflected the discharge rate of a SMU giving the greatest surface representation amplitude and strongest interference appeared as distinguishable frequency peak on RC power spectra. Moreover, for strong interferences, RC also contaminated the EEG at F7 and other EEG electrodes. These findings are important to illustrate the susceptibility of EEG signal to myogenic artefacts even at rest and the research using EEG coherence comparisons should consider muscle activity while drawing conclusions about neuronal interactions and oscillations.

Objective: for many decades, the Jendrassik maneuver (JM) has been used as a reinforcement for stretch reflexes, although the underlying mechanism of this reinforcement is still not fully understood. Moreover, the term JM has been used for many different muscle contraction strategies as there is no fixed movement for the maneuver in the literature. In this study, we aimed to investigate the effects of clenched hand pull, teeth clenching, and their combined effects to reach standardization. Methods: achilles tendon tap reflex responses in the soleus were recorded during rest (R), hand pull (HP), teeth clench (TC), and HP + TC combined, hereafter referred to as the JM. Results: reflex response amplitudes significantly increased during JM, HP, and TC in the soleus. HP and JM significantly changed the background activity in the soleus, but TC alone did not. Conclusion: these results suggest that dominantly presynaptic disinhibitory mechanisms may be responsible for the increase in the tendon tap reflex during HP, TC, and JM. Significance: because the findings indicate that HP increases the background activity of the soleus, we suggest that researchers should use only TC during the Jendrassik maneuver to avoid any confounding background activity change., Koç University School of Medicine

Surface or intramuscular electromyography (EMG) is used to record motor unit action potentials during skeletal muscle activation. The fidelity of the EMG parameters depends on numerous intrinsic and extrinsic factors summarized in this chapter. Additional motion artefacts due to vibration-induced high accelerations can influence the electronic properties of the EMG system and the electrode-skin interface. These accelerations can also excite the muscle spindles and modulate motor units’ activation by locking their firing rates to the vibration frequency via spinal and supraspinal pathways. Therefore, conventional filtering approaches are not appropriate for studying the effects of vibration on muscle activation. This chapter outlines some preventative measures to improve the signal-to-noise ratio during recording. An off-line data processing method combining high-pass filtering with full-wave rectification for discriminating the motor unit action potentials from motion artefacts is also presented. This method has been validated against intramuscular and simulated EMG recordings and allows the reliable study of vibration benefits for training and rehabilitation.

This chapter describes a new method for pinpointing the latency of the vibration-induced muscular reflex. To determine the reflex latency, the vibration-altered electromyography (EMG) and acceleration data were spike triggered and averaged using the tip of the EMG response as the trigger. Averaged results belonging to several different vibration frequencies were then superimposed to achieve a ‘cumulative averaged record’. The lowest standard error of the cumulative averaged record for the acceleration data was marked to indicate the effective stimulus point on the vibration cycle. Similarly, the lowest standard error of the cumulative averaged record for the EMG data showed the start of the reflex response. The time between the effective stimulus point and the start of the reflex response on EMG data was designated as the ‘reflex latency’ of this circuit. Using this technique, we have examined the latency of whole-body vibration (WBV)-induced reflexes. We found that the WBV induced two different reflex responses depending on the vibration amplitude. While low amplitude WBV (0.1–0.4 mm) produced short latency reflex similar to muscle spindle-based T-reflex (34 ms), high amplitude vibration (1.1–2.8 mm) generated long latency reflex response (44 ms) which may have a different receptor origin than the spindles. We have also summarized the modulatory effects of vibration on spindle-based reflexes and indicated that these reflexes are reduced during and/or following vibration. It is suggested that this effect may originate from the reduction in effectiveness of the spindle synapses on motoneurons via premotoneuronal means.

Painful stimulation of the hand results in an inhibitory response in the hand muscles known as the cutaneous silent period (CSP). In this study, we employed probability- and frequency-based analysis methods to examine the CSP induced by laser stimuli. Subjects were asked to contract their first dorsal interosseous muscle so that selected motor units discharged at a rate of about 8Hz. Laser pulses were delivered to the palm of the hand, and reflex responses were recorded. The stimuli generated CSP in all test subjects. We found that the latency of the CSP evoked using laser stimulation was longer than that the previously published latency values of the CSP evoked using electrical stimulation. Using only the presently generated laser induced CSP data, the CSP duration was longer when analyzed via peristimulus frequencygram method compared to the probability-based methods such as peristimulus time histogram and surface electromyogram. In the light of the current results, we suggest that laser stimulation could be used when studying pain pathways in human subjects and the frequency-based analysis methods can be preferred because they are previously shown to be more reliable for obtaining the synaptic activity profile. These results can be used to standardize the CSP methods in basic and clinical research.

Amplitude variation of Hoffmann Reflex (H-reflex) was used as a tool to investigate many neuronal networks. However, H-reflex itself is a subject to intrinsic changes including post-activation depression (P-AD). We aimed to investigate P-AD and its implication on motor control in humans. Upon tibial nerve stimulation in 23 healthy participants, peak-to-peak amplitude change of H-reflex was investigated using surface electromyography (SEMG) of soleus muscle. Variety of stimulus intensities, interstimulus intervals (ISIs), voluntary contraction levels/types and force recording were used to investigate the nature of P-AD. We have shown that P-AD was significantly stronger in the shorter ISIs. The only exception was the ISI of 200 msecs which had a weaker P-AD than some of the longer ISIs. Sudden muscle relaxation, on the other hand, further increased the effectiveness of the ongoing P-AD. Moreover, P-AD displayed its full effect with the first stimulus when there was no muscle contraction and was efficient to reduce the muscle force output by about 30%. These findings provide insight about the variations and mechanism of P-AD and could lead to improvements in diagnostic tools in neurological diseases.

Introduction: the first bout of eccentric exercise is known to have a protective effect on the consequent bouts. This effect is still disputable as it is not known whether it protects muscle damage by reducing force production or by improving force recovery in the healing process. The underlying mechanisms of this protective effect have not been fully understood. Objectives: to determine the mechanisms of this protective effect, three different loads were used for the first eccentric bout. This was done to investigate whether the protective effect is related to the size of the load in the first bout. To determine the neural adaptations, voluntary activation was assessed and to determine the muscular adaptations, the resting twitch was measured. Method: thirty healthy participants were selectively allocated into three groups (low-, moderate-and high-load group) to match for maximal voluntary contraction (MVC) (n = 10 per group). Participants in each group performed only one of the three sets of ten eccentric (ECC) exercises of the elbow flexors (10%, 20% and 40% of MVC) as their first eccentric bout. The second bout of eccentric exercise was performed two weeks later and was identical for all the three groups, i.e., 40% ECC. Results: the results showed that for the first bout, MVC, voluntary activation and the resting twitch displayed significant (p < 0.0001) interaction (group x time). This was not the case however for the second bout as there was no significant (group x time) interaction in all outcome variables immediately after exercise. When the first and second bouts were compared, it was found that the high-load group had faster recovery in MVC at day 1 and 4 corresponding to voluntary activation and only at day 4 corresponding to the resting twitch. Conclusions: in this study, it was found that high-load exercise aids fast recovery either via neural or muscular adaptations., Thailand Research Fund and Commission on Higher Education; Research Fund from The Research Administration Center, Chiang Mai University

The objective of this study was to investigate whether a single session of chiropractic care could increase strength in weak plantar flexor muscles in chronic stroke patients. Maximum voluntary contractions (strength) of the plantar flexors, soleus evoked V-waves (cortical drive), and H-reflexes were recorded in 12 chronic stroke patients, with plantar flexor muscle weakness, using a randomized controlled crossover design. Outcomes were assessed pre and post a chiropractic care intervention and a passive movement control. Repeated measures ANOVA was used to asses within and between group differences. Significance was set at p < 0.05. Following the chiropractic care intervention there was a significant increase in strength (F (1,11) = 14.49, p = 0.002; avg 64.2 +/- 77.7%) and V-wave/Mmax ratio (F(1,11) = 9.67, p = 0.009; avg 54.0 +/- 65.2%) compared to the control intervention. There was a significant strength decrease of 26.4 +/- 15.5% (p = 0.001) after the control intervention. There were no other significant differences. Plantar flexor muscle strength increased in chronic stroke patients after a single session of chiropractic care. An increase in V-wave amplitude combined with no significant changes in H-reflex parameters suggests this increased strength is likely modulated at a supraspinal level. Further research is required to investigate the longer term and potential functional effects of chiropractic care in stroke recovery., United Chiropractic Association; Hamblin Chiropractic Research Fund Trust; The Rubicon Group; Scottish Chiropractic Association; Halsa Chiropractic and Physiotherapy; New Zealand College of Chiropractic

Recent research has shown that chiropractic spinal manipulation can alter central sensorimotor integration and motor cortical drive to human voluntary muscles of the upper and lower limb. The aim of this paper was to explore whether spinal manipulation could also influence maximal bite force. Twenty-eight people were divided into two groups of 14, one that received chiropractic care and one that received sham chiropractic care. All subjects were naive to chiropractic. Maximum bite force was assessed pre- and post-intervention and at 1-week follow up. Bite force in the chiropractic group increased compared to the control group (p = 0.02) post-intervention and this between-group difference was also present at the 1-week follow-up (p < 0.01). Bite force in the chiropractic group increased significantly by 11.0% (+/- 18.6%) post-intervention (p = 0.04) and remained increased by 13.0% (+/- 12.9%, p = 0.04) at the 1 week follow up. Bite force did not change significantly in the control group immediately after the intervention (-2.3 +/- 9.0%, p = 0.20), and decreased by 6.3% (+/- 3.4%, p = 0.01) at the 1-week follow-up. These results indicate that chiropractic spinal manipulation can increase maximal bite force., Koç University; New Zealand College of Chiropractic

The objective of this study was to construct peristimulus time histogram (PSTH) and peristimulus frequencygram (PSF) using single motor unit recordings to further characterize the previously documented immediate sensorimotor effects of spinal manipulation. Single pulse transcranial magnetic stimulation (TMS) via a double cone coil over the tibialis anterior (TA) motor area during weak isometric dorsiflexion of the foot was used on two different days in random order; pre/post spinal manipulation (in eighteen subjects) and pre/post a control (in twelve subjects) condition. TA electromyography (EMG) was recorded with surface and intramuscular fine wire electrodes. Three subjects also received sham double cone coil TMS pre and post a spinal manipulation intervention. From the averaged surface EMG data cortical silent periods (CSP) were constructed and analysed. Twenty-one single motor units were identified for the spinal manipulation intervention and twelve single motor units were identified for the control intervention. Following spinal manipulations there was a shortening of the silent period and an increase in the single unit I-wave amplitude. No changes were observed following the control condition. The results provide evidence that spinal manipulation reduces the TMS-induced cortical silent period and increases low threshold motoneurone excitability in the lower limb muscle. These finding may have important clinical implications as they provide support that spinal manipulation can be used to strengthen muscles. This could be followed up on populations that have reduced muscle strength, such as stroke victims.

Background Sudden foot dorsiflexion generates medium and long latency responses in soleus muscle which are thought to be the stretch reflex and have a spinal origin. Peroneal nerve stimulation results in foot dorsiflexion and produces a medium latency reflex in soleus muscle (SOL-MLR). Similarly, transcranial magnetic stimulation (TMS) of motor cortex corresponds to the leg area evokes a response analogous to SOL-MLR, referred to as soleus motor evoked potential 80 (SOL-MEP 80). Material and methods In this study, the origin of SOL-MLR and SOL-MEP 80 were investigated in 15 healthy volunteers using surface electromyography. SOL-MEP 80 was evoked by non-invasive TMS of leg area of motor cortex on the scalp using a round coil. On the other hand, SOL-MLR was obtained through electrical stimulation of the peroneal nerve during the foot was slightly dorsiflexed. Given that the contraction of the tibialis anterior (TA) muscle results in foot dorsiflexion, so, the stretch reflex in the soleus muscle. Therefore, the latency of SOL-MLR and SOL-MEP 80 was compared with the muscle action potential generation in TA muscle with similar methodology, TA direct motor response and TA MEP. Results The latency difference between SOL-MLR and TA direct motor response was 64.0 ± 4.0 ms while the difference was 61.4 ± 5.6 ms between SOL-MEP 80 and TA-MEP. Conclusions Comparable latency features and similar behavior pattern of the responses propose that SOL-MLR and SOL-MEP 80 may have a related origin. This project (3135) supported by Akdeniz University Scientific Research Unit .

s Background For the analysis of inhibitory reflexes, no consensus exists regarding the methodology that should be used. The most commonly used methods are the cumulative sum (CUSUM) error box and the t -test. The aim of this study was to assess the interexaminer reliability of those two analyzing methods and to test whether both methods: yield similar results. Methods Inhibitory jaw reflexes were recorded from the right masseter muscle of 11 participants (6 males, 5 females). Electrical stimuli were applied at the hairy skin of the upper lip on the right side. In total, 16 stimuli were applied while the participants maintained their clenching level at 10% of their maximum voluntary EMG activity. Two different examiners analyzed the reflex data with two different methods: the CUSUM error box and the t -test. The outcome variables were the number of reflex parts, the reflex area size, and the reflex onset. Comparability between examiners and between the two analyzing methods: was assessed with the use of the intraclass correlation coefficient (ICC). Results The interexaminer reliability was fair-to-good to excellent for both the CUSUM error box and the t -test analyses and for all the variables tested. The comparability of the two analyzing methods: was fair-to-good. Comparison with existing methods/conclusion When analyzing the inhibitory reflex data, both the CUSUM error box and the t -test can be used.

Key points Reflex responses of single motor units have been used for the study of spinal circuitries but the methods employed are invasive and limited to the assessment of a relatively small number of motor units. We propose a new approach to investigate reflexes on individual motor units based on high-density surface electromyography (HDsEMG) decomposition. The decomposition of HDsEMG has been previously validated in voluntary isometric contractions but never during reflex activities. The use of HDsEMG decomposition for reflex studies at the individual motor unit level, during constant force contractions, with excitatory and inhibitory stimuli, was validated here by the comparison of results with concurrently recorded intramuscular EMG signals. The validation results showed that HDsEMG decomposition allows an accurate quantification of reflex responses for a large number of individual motor units non-invasively, for both excitatory and inhibitory stimuli. Abstract We propose and validate a non-invasive method that enables accurate detection of the discharge times of a relatively large number of motor units during excitatory and inhibitory reflex stimulations. High-density surface electromyography (HDsEMG) and intramuscular EMG (iEMG) were recorded from the tibialis anterior muscle during ankle dorsiflexions performed at 5%, 10% and 20% of the maximum voluntary contraction (MVC) force, in nine healthy subjects. The tibial nerve (inhibitory reflex) and the peroneal nerve (excitatory reflex) were stimulated with constant current stimuli. In total, 416 motor units were identified from the automatic decomposition of the HDsEMG. The iEMG was decomposed using a state-of-the-art decomposition tool and provided 84 motor units (average of two recording sites). The reflex responses of the detected motor units were analysed using the peri-stimulus time histogram (PSTH) and the peri-stimulus frequencygram (PSF). The reflex responses of the common motor units identified concurrently from the HDsEMG and the iEMG signals showed an average disagreement (the difference between number of observed spikes in each bin relative to the mean) of 8.2 ± 2.2% (5% MVC), 6.8 ± 1.0% (10% MVC) and 7.5 ± 2.2% (20% MVC), for reflex inhibition, and 6.5 ± 4.1%, 12.0 ± 1.8% and 13.9 ± 2.4%, for reflex excitation. There was no significant difference between the characteristics of the reflex responses, such as latency, amplitude and duration, for the motor units identified by both techniques. Finally, reflex responses could be identified at higher force (4 of the 9 subjects performed contraction up to 50% MVC) using HDsEMG but not iEMG, because of the difficulty in decomposing the iEMG at high forces. In conclusion, single motor unit reflex responses can be estimated accurately and non-invasively in relatively large populations of motor units using HDsEMG. This non-invasive approach may enable a more thorough investigation of the synaptic input distribution on active motor units at various force levels.

Mirror movements are unintended movements occurring on one side of the body that mirror the contralateral voluntary ones. It has been proposed that mirror movements occur due to abnormal decussation of the corticospinal pathways. Using detailed multidisciplinary approach, we aimed to enlighten the detailed mechanism underlying the mirror movements in a case subject who is diagnosed with mirror movements of the hands and we compared the findings with the unaffected control subjects. To evaluate the characteristics of mirror movements, we used several techniques including whole exome sequencing, computed tomography, diffusion tensor imaging and transcranial magnetic stimulation. Computed tomography showed the absence of a spinous process of C5, fusion of the body of C5-C6 vertebrae, hypoplastic dens and platybasia of the posterior cranial fossa. A syrinx cavity was present between levels C3-C4 of the spinal cord. Diffusion tensor imaging of the corticospinal fibers showed disorganization and minimal decussations at the lower medulla oblongata. Transcranial magnetic stimulation showed that motor commands were distributed to the motor neuron pools on the left and right sides of the spinal cord via fast-conducting corticospinal tract fibers. Moreover, a heterozygous missense variation in the deleted in colorectal carcinoma gene has been observed. Developmental absence of the axonal guidance molecules or their receptors may result in abnormalities in the leading of the corticospinal fibers. Clinical evaluations and basic neuroscience techniques, in this case, provide information for this rare disease and contribute to our understanding of the normal physiology of bimanual coordination. We would like to thank our index patient and control subjects for their participation. Also, we acknowledge the role of Koç University, Bilkent University as well as Suna and İnan Kıraç Foundation for funding this study.

The effect of body posture on the human soleus H-reflex via electrical stimulation of the tibial nerve at the popliteal fossa was studied. All parameters that may influence the reflex were controlled stringently. H-reflexes were elicited in three different body postures while keeping the level of background muscle activation to a minimum. The H-reflex curve relative to the M-wave curve did not change significantly in any of the body postures. However, the maximal H-reflex amplitude significantly increased in the prone position compared with the sitting (p = 0.02) and standing positions (p = 0.01). The background level of electrical activity of the soleus muscle did not significantly change during varying body postures. Together, these findings indicate that the effectiveness of the spindle primary afferent synapse on the soleus motor neuron pool changes significantly in prone position as compared to sitting and standing positions. Given that we have controlled the confounding factors excluding the head position relative to the gravity and the receptors that may be differentially activated at varying body postures such as the proprioceptors, it is concluded that the tonic activity from these receptors may presynaptically interfere with the effectiveness of the spindle primary afferent synapses on the soleus motor neurons.

PURPOSE: The primary purpose of this study was to investigate whether a single session of spinal manipulation (SM) increases strength and cortical drive in the lower limb (soleus muscle) of elite Taekwondo athletes.METHODS: Soleus-evoked V-waves, H-reflex and maximum voluntary contraction (MVC) of the plantar flexors were recorded from 11 elite Taekwondo athletes using a randomized controlled crossover design. Interventions were either SM or passive movement control. Outcomes were assessed at pre-intervention and at three post-intervention time periods (immediate post, post 30 min and post 60 min). A multifactorial repeated measures ANOVA was conducted to assess within and between group differences. Time and session were used as factors. A post hoc analysis was carried out, when an interactive effect was present. Significance was set at p ≤ 0.05.RESULTS: SM increased MVC force [F(3,30) = 5.95, p CONCLUSION: A single session of SM increased muscle strength and corticospinal excitability to ankle plantar flexor muscles in elite Taekwondo athletes. The increased MVC force lasted for 30 min and the corticospinal excitability increase persisted for at least 60 min.

Background This study is inquiring the origin of the medium latency reflex response (MLR) that occurs in soleus muscle when common peroneal nerve is electrically stimulated. Material and methods In total, 23 SingleMUs from 9 males were obtained. During SMU recruitment, 308 ± 141 stimuli were delivered. We investigated the duration of the inhibitory postsynaptic potential (IPSP) and excitatory postsynaptic potential (EPSP). Results Common peroneal nerve stimulation resulted in M-response at SEMG of TA muscle and MLR in SOL-SEMG as well as accumulation of SMUs between 50 and 120 ms after the stimulus. A reduction in firing probability of SMUs was also observed and the reduction in discharge rate continued much longer than the spike reduction probability in PSTH and CUSUM. This reduction in discharge rate was followed by an increased discharge rate of SMUs. Duration of the IPSP obtained at PSF, 24.5 ± 6.3 ms, and the duration of EPSP, i.e. MLR, in PSF was found as 119.3 ± 54.3 The latency of EPSP was found higher in PSF and SEMG as 68.3 ± 9.9 ms and 74.5 ± 9.7 ms, than PSTH and MMU which were 56.3 ± 4.6 ms and 57.6 ± 4.2 ms, respectively. Conclusions There was a genuine Ia reciprocal inhibition followed by a stretch-induced reflex response in the SOL. The first response was due to the well-known Ia-IPSP pathway connecting antagonist muscles and the second response, the so-called MLR in the literature, was an indirect stretch reflex response caused by the M-response in the TA muscle. This Project (3135) was supported by Akdeniz University Scientific Research Unit .

Our aim was to investigate the jaw reflexes using both the probability- and the discharge rate-based analysis methods. Twelve consenting volunteer subjects participated in this study. Subjects bit gently on bite bars that carried the impression of their teeth. Surface and intramuscular electrical activity of the masseter was recorded. With the help of audio feedback from one motor unit, each subject bit to discharge the unit at a fixed rate. While the subject continuously activated the selected motor unit, 4-N stimuli were delivered to the upper right central incisor either at a rapid or a slow rate. For each trial, ≥300 stimuli were delivered, and, once a trial was completed, local anesthetic block was applied around the stimulated tooth, and the experiment was repeated. While preceding local anesthesia, the rapid-rate stimuli (“tap”) induced substantial inhibitory reflex responses; during local anesthetic block, the same stimulus induced excitatory and inhibitory reflex responses. Slow-rate stimuli (“push”), on the other hand, usually generated a combination of inhibitory and excitatory responses that disappeared completely during the local anesthetic block. This study discovered that the strength of the inhibitory reflex response to a tooth-tap stimulus was much larger than previously reported. This study also found that whereas the probability-based analyses were better for illustrating the existence and latency of small earlier responses, the discharge rate-based method was better for indicating the duration of earlier responses and the existence, sign, and duration of later responses.

We examined the reflex response of the human masseter muscle to electrical stimulation of the lip using both single motor unit and surface electromyogram based methods. Using the classical analysis methods, reflex response to mild electrical stimuli generated two distinct short-lasting inhibitions. This pattern may reflect the development of combinations of short- and long-latency inhibitory postsynaptic potentials as a result of the mildly painful electrical lip stimulation. However, this pattern appearing in the classical analysis methods may have developed as a consequence of earlier responses and may not be genuine. This study examined the genuineness of these responses using both the classical analysis methods and the discharge rate method to uncover the realistic postsynaptic potentials in human trigeminal motor nucleus. Using the discharge rate method, we found that the electrical lip stimulation only generated a long-lasting single or compound inhibitory response that is followed by late, long-lasting excitation. These findings have important implications on the redrawing of the neuronal pathways of the trigeminal nerve that are frequently used to judge neuromuscular disorders of the trigeminal region.

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This study investigates whether spinal manipulation leads to changes in motor control by measuring the recruitment pattern of motor units in both an upper and lower limb muscle and to see whether such changes may at least in part occur at the cortical level by recording movement related cortical potential (MRCP) amplitudes. In experiment one, transcranial magnetic stimulation input-output (TMS I/O) curves for an upper limb muscle (abductor pollicus brevis; APB) were recorded, along with F waves before and after either spinal manipulation or a control intervention for the same subjects on two different days. During two separate days, lower limb TMS I/O curves and MRCPs were recorded from tibialis anterior muscle (TA) pre and post spinal manipulation. Dependent measures were compared with repeated measures analysis of variance, with p set at 0.05. Spinal manipulation resulted in a 54.5% +/- 93.1% increase in maximum motor evoked potential (MEPmax) for APB and a 44.6% +/- 69.6% increase in MEPmax for TA. For the MRCP data following spinal manipulation there were significant difference for amplitude of early bereitschafts-potential (EBP), late bereitschafts potential (LBP) and also for peak negativity (PN). The results of this study show that spinal manipulation leads to changes in cortical excitability, as measured by significantly larger MEPmax for TMS induced input-output curves for both an upper and lower limb muscle, and with larger amplitudes of MRCP component post manipulation. No changes in spinal measures (i.e., F wave amplitudes or persistence) were observed, and no changes were shown following the control condition. These results are consistent with previous findings that have suggested increases in strength following spinal manipulation were due to descending cortical drive and could not be explained by changes at the level of the spinal cord. Spinal manipulation may therefore be indicated for the patients who have lost tonus of their muscle and/or are recovering from muscle degrading dysfunctions such as stroke or orthopaedic operations and/or may also be of interest to sports performers. These findings should be followed up in the relevant populations., Australian Spinal Research Foundation; Hamblin Chiropractic Research Fund Trust; New Zealand College of Chiropractic; Koç University

In this study we investigated whether the reflex excitatory and inhibitory inputs to motor neuron pools are uniformly or differentially distributed. We found that the distribution of monosynaptic excitatory (H-reflex) and reciprocal inhibitory inputs to different size motor neurons fitted gamma distributions with different skew values. This result can be interpreted as due to a differential distribution of afferent inputs on motor neurons.

In this study, we aimed to use both the probability- and frequency-based analyses methods simultaneously to examine cutaneous silent period induced by strong electrical currents. Subjects were asked to contract their hand muscles so that single motor unit discharged at a rate of approximately 8 Hz. Strong electrical stimuli were delivered to the back of the hand and induced cutaneous silent period in all units. It was found that the duration of the cutaneous silent period (CSP) was significantly longer when the same data were analysed using frequency-based analysis method compared with the probability-based methods.

This presentation will cover the methods used to investigate neuronal circuitries between peripheral receptors and skeletal muscles in human subjects. There are a number of problems regarding reflex studies using experimental animals. There are also problems in the recording and analysis aspects of these experiments. To overcome these problems we have utilized precisely-controlled mechanical or electrical stimuli to activate receptors and single motor units from human muscles. We also used classical and novel methods to analyze the results to indicate neuronal networks.

We investigated the jaw reflexes using both the probability- and the discharge rate-based analysis methods. While recording the masseter muscle activity, computer controlled slow-rate “push” and rapid rate “tap” stimuli were delivered to the upper right central incisor before and during local anesthetic block. While preceding local anesthesia, the tap stimuli induced inhibitory reflex responses; during local anesthetic block, the same stimulus induced excitatory and inhibitory reflex responses. The push stimuli generated a combination of inhibitory and excitatory responses that disappeared during the local anesthetic block. We found that the discharge rate-based method was better for indicating the duration of earlier responses and the existence, sign, and duration of later responses.

Ozet: Cene ve dislerin norofizyolojik mekanizmalarinin anlasilmasi, bireylerin agiz ve genel vucut sagliginin surdurulmesine onemli katkilar saglar. Cignemenin kontrolunde merkezi rol oynayan periferik reseptorlerin en onemlisi periyodontal mekanoreseptorlerdir. Bu mekanoreseptorler, agiz ici motor fonksiyonlari duzenler ve bu fonksiyonlarin genel motor fonksiyonlarla iliskisini kurar. Bu reseptorlerin su fonksiyonlari da ayrica onemlidir: (1) Ozgun duyusal donanimlari sayesinde agiz ve dis sagligimizi korurlar; (2) motor kontrolde esas olan reflekslerle etkilesim icine girerler; (3) kas-iskelet sistemi ve total vucut kuvvetine olumlu etkileri soz konusudur. Anahtar Kelimeler: cigneme, periyodontal mekanoreseptor, motor kontrol, vucut kuvveti The relationship between neurophysiology of mastication and general motor control ABSTRACT Understanding the role of the jaw and teeth in the control of mastication by the neurophysiological mechanisms provides an important contribution to the maintenance of oral and general health status of individuals. Peripheral receptors play a central role in the control of mastication and the most important of these are the periodontal mechanoreceptors. These receptors regulate intra-oral motor functions and these functions contribute to the general motor functions. Other than helping to crush food particles during chewing, these receptors also have the following functions: (1) They protect mouth and teeth with their special sensory properties; (2) they initiate reflexes that maintain smooth mastication; (3) they contribute to the general musculo-skeletal system and the total body strength. Keywords: mastication, periodontal mechanoreceptors, motor control, body strength

Spindle Ia afferents may be differentially involved in voluntary isometric contraction, depending on the pattern of synaptic connections in spindle reflex pathways. We investigated how isometric contraction of masseter muscles is regulated through the activity of their muscle spindles that contain the largest number of intrafusal fibers among skeletal muscle spindles by examining the effects of vibration of muscle spindles on the voluntary isometric contraction. Subjects were instructed to hold the jaw at resting position by counteracting ramp loads applied on lower molar teeth. In response to the increasing-ramp load, the root mean square (RMS) of masseter EMG activity almost linearly increased under no vibration, while displaying a steep linear increase followed by a slower increase under vibration. The regression line of the relationship between the load and RMS was significantly steeper under vibration than under no vibration, suggesting that the subjects overestimated the ramp load and excessively counteracted it as reflected in the emergence of bite pressure. In response to the decreasing-ramp load applied following the increasing one, the RMS hardly decreased under vibration unlike under no vibration, leading to a generation of bite pressure even after the offset of the negative-ramp load until the vibration was ceased. Thus the subjects overestimated the increasing rate of the load while underestimating the decreasing rate of the load, due to the vibration-induced illusion of jaw opening. These observations suggest that spindle Ia/II inputs play crucial roles both in estimating the load and in controlling the isometric contraction of masseter muscles in the jaw-closed position.