Reciprocal Inhibition Versus Reciprocal Facilitation In Spinal Cord Injury Patients

Does Reciprocal Inhibition, a Rehabilitation Technique, Convert to Reciprocal Facilitation in Patients With Upper Motor Neuron Lesions?

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).

Study Overview

• Status: Completed
• Conditions: Spinal Cord Injuries
• Intervention / Treatment: Diagnostic test: Tendon tap; Diagnostic test: Tibial nerve stimulation

Detailed 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.

• Study Type: Interventional
• Enrollment (Actual): 10
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey, 34180
    • İstanbul Physical Therapy Training and Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Spinal cord injuries; 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.	Diagnostic test: Tendon tap; While examining the T reflex, the ankle was held passively in neutral, dorsiflexion and plantar flexion positions by the investigator.; Other Names: T-reflex; Diagnostic test: Tibial nerve stimulation; H-reflex responses were examined by tibial nerve stimulation; Other Names: H-reflex
Active Comparator: Healthy Control; 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.	Diagnostic test: Tendon tap; While examining the T reflex, the ankle was held passively in neutral, dorsiflexion and plantar flexion positions by the investigator.; Other Names: T-reflex; Diagnostic test: Tibial nerve stimulation; H-reflex responses were examined by tibial nerve stimulation; Other Names: H-reflex

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reciprocal Inhibition	H reflex and T reflex tests were performed in the soleus and tibialis anterior muscle, and it was evaluated whether there was reciprocal inhibition in the tibialis anterior muscle.	up to 2 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
H-reflex	Electric current was delivered through the popliteal fossa to tibial nerve for eliciting the soleus H-reflex	up to 2 weeks
T-reflex	The Achilles tendon was hit with using a reflex hammer to elicit the soleus T-reflex.	up to 2 weeks

Collaborators and Investigators

• Sponsor: Istanbul Physical Medicine Rehabilitation Training and Research Hospital
• Investigators: Study Director: İLHAN KARACAN, MD, Prof, İstanbul Physical Therapy Rehabilitation Training & Research Hosptial

Study record dates

Study Major Dates

• Study Start (Actual): January 5, 2023
• Primary Completion (Actual): January 17, 2023
• Study Completion (Actual): August 1, 2023

Study Registration Dates

• First Submitted: August 2, 2023
• First Submitted That Met QC Criteria: August 2, 2023
• First Posted (Actual): August 14, 2023

Study Record Updates

• Last Update Posted (Actual): August 15, 2023
• Last Update Submitted That Met QC Criteria: August 11, 2023
• Last Verified: August 1, 2023

More Information

Terms related to this study

• Keywords: Spasticity; Spinal Cord; motor neuron
• Additional Relevant MeSH Terms: Central Nervous System Diseases; Nervous System Diseases; Wounds and Injuries; Trauma, Nervous System; Spinal Cord Diseases; Spinal Cord Injuries
• Other Study ID Numbers: RIVRFSCIP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No