Reciprocal Inhibition Versus Reciprocal Facilitation In Spinal Cord Injury Patients

Istanbul Physical Medicine Rehabilitation Training and Research Hospital

Status: Completed

Conditions: Spinal Cord Injuries

Treatments: Diagnostic Test: Tendon tap; Diagnostic Test: Tibial nerve stimulation

Study type: Interventional

Funder types: Other

Identifiers

NCT05985031

RIVRFSCIP

Details and patient eligibility

About

Reciprocal inhibition is a medulla spinalis control mechanism that facilitates motor activities in healthy people. As the agonist muscle contracts, the antagonist muscle is inhibited so that the agonist action can take place properly. In the literature, there are studies showing that in patients with upper motor neuron lesions, this reverses, and reciprocal facilitation occurs instead of inhibition. However, there is no clear situation in this regard, there is a need for more methodologically sound studies. Our aim in this study is to investigate the presence of reciprocal facilitation in patients with spinal cord lesions (SCL).

Full description

Reciprocal inhibition is a spinal segmental control mechanism that facilitates motor activities in healthy people and is also used in treating spasticity. Considering the current literature, there are some studies claiming that this is reversed in patients with upper motor neuron lesions and that there is reciprocal facilitation instead of inhibition. However, the proposed evidence is not convincing. Our aim in this study was to investigate the presence of reciprocal facilitation in detail in patients with upper motor neuron lesions. This study was conducted in five patients with spinal cord lesions and five healthy individuals. Both the tibialis anterior and soleus muscles of the cases were recorded using surface and multi-motor unit electromyography (EMG) electrodes. To elicit an H reflex in the soleus muscle, an electric current was delivered through the popliteal fossa using the monopolar technique. The Achilles tendon was tapped with the reflex hammer to elicit a T reflex. Since the H-reflex and T-reflex responses were detected in the tibialis anterior muscle surface and multi-motor unit EMG recordings, the findings were evaluated as direct stimulation, cross-talk, and reciprocal facilitation. Methodologically, This research aimed to be a guiding study for future studies.

Enrollment: 10 patients

Sex: All

Ages: 25 to 60 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Patients with spinal cord injury between the ages of 18-60
• A minimum of 6 months of SCL history
• Soleus spasticity

Exclusion criteria

• Patients with premorbid neuromuscular disease
• History of autonomic dysreflexia
• Patients in the spinal shock period
• Those who have a coronavirus disease clinic
• Less than 2 hours sitting tolerance

Trial design

Primary purpose: Basic Science

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

10 participants in 2 patient groups

Spinal cord injuries

Experimental group

Description:

This was the patient group. Achilles tendon hits were performed for eliciting the soleus T reflex while the ankle was in neutral, dorsiflexion, and plantar flexion. Surface and multi-unit EMG recordings were taken from the anterior and soles muscles of the tibialis during the tendon tapping.

Treatment:

Diagnostic Test: Tibial nerve stimulation

Diagnostic Test: Tendon tap

Healthy Control

Active Comparator group

Description:

This was the healthy control group. Achilles tendon hits were performed for eliciting the soleus T reflex while the ankle was in neutral, dorsiflexion, and plantar flexion. Surface and multi-unit EMG recordings were taken from the anterior and soles muscles of the tibialis during the tendon tapping.

Treatment:

Diagnostic Test: Tibial nerve stimulation

Diagnostic Test: Tendon tap