[ILLUSTRATED PHYSIOPATHOLOGY. MEDULLARY REFLEXES AND MUSCULAR TONUS. VI. THE STRETCH REFLEX. (ROLE OF THE EXTENT OF STRETCH)].
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Humans↗
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Assessment of the infraspinatus spinal stretch reflex in the normal, athletic, and multidirectionally unstable shoulder.
To examine neural aspects of motor control in the glenohumeral joint, this study evaluates utilization of an innate spinal segmental pathway, the spinal stretch reflex, as an investigational tool that reflects neural circuitry. The purpose of this study was to determine if this reflex could be evoked from the infraspinatus muscle, if the testing apparatus and protocol for elicitation were reliable, and if the reflex response varies between groups of subjects and therefore could be useful clinically. These reflex characteristics were evaluated in the infraspinatus muscle, since rotator cuff muscle activity in subjects with glenohumeral instability exhibits differences in electromyographic activity and coordination patterns, implicating its role in dynamic stability. Normal shoulders were compared with athletic shoulders and shoulders with multidirectional instability. The spinal stretch reflex was elicited in a controlled and reliable manner. Shoulders with multidirectional instability exhibited a more-prominent spinal stretch reflex response than normal shoulders, whereas athletic shoulders exhibited a more-quiescent spinal stretch reflex response. As the spinal stretch reflex probably plays a role in motor control, variation in this reflex profile may reflect some differences in development that contribute to the variable expression of dynamic glenohumeral stability. This study suggests that the spinal stretch reflex profile may be a useful clinical tool to assist in discriminating between the normal and pathologic state. This information may also be useful in the evaluation of new treatment approaches exploiting spinal cord plasticity and spinal stretch reflex mutability through neuromuscular training.
Adolescent↗
[ILLUSTRATED PHYSIOPATHOLOGY. MEDULLARY REFLEXES AND MUSCULAR TONUS. VII. THE STRETCH REFLEX (ROLE OF THE RATE OF STRETCH AND OTHER FACTORS)].
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Humans↗
Regulation of wrist stiffness by the stretch reflex.
In restoring the angular position after a displacement, the role of the muscle stretch reflex was investigated by comparing the restored angular torques and angular positions in the wrist under ischaemic and non-ischaemic conditions in normal human subjects. The wrist compliance (COM), defined as the dynamic relation between the angular position and the angular torque of the joint, was calculated to quantify the changes in the restoration of a displacement after abolishing the stretch reflex by ischaemia. The elasticity from the COM-function was found to be single most important factor controlled by the stretch reflex. The elasticity that equals the static stiffness of the system increased by more than 100%, from 0.21 Nm degree-1 with abolished reflex to 0.45 Nm degree-1 with intact reflex. Our results have shown that the stretch reflex assists in the rapid return of the limb to its original position after a mechanical displacement. When the reflex was blocked by ischaemia, the perturbation displaced the limb further away from the initial position.
Adult↗
The aging effects on the EMG and mechanical responses of the human wrist flexor stretch reflexes.
The purpose of this study is to investigate the effects of aging on the human stretch reflexes. The EMG and torque responses of the stretch reflex of the wrist flexors were evoked by ramp-and-hold mechanical perturbations. The stretch reflexes were recorded at seven test conditions with different stretch velocity and muscle preload. The test results from young and older healthy adult subjects were compared. In average, the absolute amplitude of the short-latency (20-40 ms) EMG (recorded from flexor carpi radialis) reflex response was significantly lower in the older group. If the data were normalized and expressed in percentage of the maximal voluntary EMG activity, however, this group difference was not significant. There was no change in the reflex gain of the short-latency reflex with aging. For the long-latency (50-90 ms) EMG reflex response, both the normalized amplitude and the reflex gain were significantly enhanced with aging, probably through supraspinal mechanisms. There was no significant difference in the threshold velocity for the evoked EMG reflexive activities between age groups. There were also no changes in the reflexive wrist flexion torque with aging. These results suggested that the number of motor units recruited during the stretch reflex activity declined with aging although the percentage of motor units recruited was not affected by aging. It is concluded that the central regulating mechanisms of the spinal motoneuron excitability are not compromised by aging. The automatic gain compensation phenomenon is also preserved with aging.
Adult↗
Phasic and tonic stretch reflexes in muscles with few muscle spindles: human jaw-opener muscles.
We investigated phasic and tonic stretch reflexes in human jaw-opener muscles, which have few, if any, muscle spindles. Jaw-unloading reflexes were recorded for both opener and closer muscles. Surface electromyographic (EMG) activity was obtained from left and right digastric and superficial masseter muscles, and jaw orientation and torques were recorded. Unloading of jaw-opener muscles elicited a short-latency decrease in EMG activity (averaging 20 ms) followed by a short-duration silent period in these muscles and sometimes a short burst of activity in their antagonists. Similar behavior in response to unloading was observed for spindle-rich jaw-closer muscles, although the latency of the silent period was statistically shorter than that observed for jaw-opener muscles (averaging 13 ms). Control studies suggest that the jaw-opener reflex was not due to inputs from either cutaneous or periodontal mechanoreceptors. In the unloading response of the jaw openers, the tonic level of EMG activity observed after transition to the new jaw orientation was monotonically related to the residual torque and orientation. This is consistent with the idea that the tonic stretch reflex might mediate the change in muscle activation. In addition, the values of the static net joint torque and jaw orientation after the dynamic phase of unloading were related by a monotonic function resembling the invariant characteristic recorded in human limb joints. The torque-angle characteristics associated with different initial jaw orientations were similar in shape but spatially shifted, consistent with the idea that voluntary changes in jaw orientation might be associated with a change in a single parameter, which might be identified as the threshold of the tonic stretch reflex. It is suggested that functionally significant phasic and tonic stretch reflexes might not be mediated exclusively by muscle spindle afferents. Thus, the hypothesis that central modifications in the threshold of the tonic stretch reflex underlie the control of movement may be applied to the jaw system.
Electromyography↗
Stretch reflex and Hoffmann reflex responses to osteopathic manipulative treatment in subjects with Achilles tendinitis.
CONTEXT: Irvin M. Korr, PhD, hypothesized that sensitivity of the monosynaptic stretch reflex (ie, deep tendon reflex) plays a major role in the restriction-of-motion characteristic of somatic dysfunction, and that restoration of range of motion through osteopathic manipulative treatment (OMT) could be achieved by resetting of the stretch receptor gain. OBJECTIVE: To test Korr's hypothesis in the context of Achilles tendinitis, examining whether OMT applied to patients with Achilles tendinitis reduces the strength of the stretch reflex. METHODS: Subjects were recruited through public advertisements and referrals from healthcare professionals. There were no recruitment restrictions based on demographic factors. Amplitudes for stretch reflex and H-reflex (Hoffmann reflex) in the triceps surae muscles (the soleus together with the lateral and medial heads of the gastrocnemius) were measured in subjects with diagnosed Achilles tendonitis (n=16), both before and after OMT. These measurements were also made in asymptomatic control subjects (n=15) before and after sham manipulative treatment. RESULTS: As predicated on the concepts of the strain-counterstrain model developed by Lawrence H. Jones, DO, the use of OMT produced a 23.1% decrease in the amplitude of the stretch reflex of the soleus (P<.05) in subjects with Achilles tendinitis. Similarly significant responses were measured in the lateral and medial heads of the gastrocnemius in OMT subjects. The H-reflex was not significantly affected by OMT. In control subjects, neither reflex was significantly affected by sham manipulative treatment. By using a rating scale on questionnaires before treatment and daily for 7 days posttreatment, OMT subjects indicated significant clinical improvement in soreness, stiffness, and swelling. CONCLUSION: The reduction of stretch reflex amplitude with OMT, together with no change in H-reflex amplitude, is consistent with Korr's proprioceptive hypothesis for somatic dysfunction and patient treatment. Because subjects' soreness ratings also declined immediately after treatment, decreased nociceptor activity may play an additional role in somatic dysfunction, perhaps by altering stretch reflex amplitude.
Achilles Tendon↗
The mode of action of 5-hydroxytryptophan in facilitating a stretch reflex in the spinal cat.
1. Intravenous injection of 5-hydroxytryptophan (5-HTP) excites discharges of gamma motoneurones to extensor muscles of the hind limbs of decerebrate spinal cats and this occurs with a short latency (1-2 min). 2. 5-HTP also facilitates the stretch reflex in the spinal cat but, in contrast, there is a latency of about 10 min with a maximum action after 20 min. 3. Facilitation of the stretch reflex by 5-HTP still occurs when the gamma loop has been opened by cutting all ventral roots supplying the muscle. Thus excitation of gamma motoneurones by 5-HTP is not required for facilitation of the stretch reflex. 4. A possible contribution to the stretch reflex from the increased discharge of gamma motoneurones has been assessed. Selectively removing gamma activity rarely altered the reflex response to stretch and in only 3 out of 15 spinal cats could we conclude that gamma discharges contributed towards facilitation of the stretch reflex by 5-HTP; 5; Methysergide (0.25 mg/kg) blocked completely the facilitation of the stretch reflex caused by 5-HTP in the spinal cat but only partially antagonised the reflex in the decerebrate cat, even when injected intra-arterially close to the lumbar spinal cord. 6. Lysergic acid diethylamide (LSD) was found to mimic the actions of 5-HTP. It facilitated the stretch reflex and excited extensor gamma motoneurones in the spinal animal.
5-Hydroxytryptophan↗
Quantification of hyperreflexia in amyotrophic lateral sclerosis (ALS) by the soleus stretch reflex.
UNLABELLED: The aim of this study was to quantify upper motor neuron (UMN) involvement in amyotrophic lateral sclerosis (ALS) by the soleus stretch reflex. METHODS: In a group of 24 ALS patients and ten healthy controls the soleus stretch reflex was elicited by a four degree rotation at the ankle joint. Amplitude of the short-latency stretch reflex, threshold, and sensitivity were determined. Peripheral excitation/contraction properties were evaluated by supramaximal stimulation of the tibial nerve. Clinical scores of upper motor neuron involvement were applied. RESULTS: A highly significant correlation between threshold and sensitivity of the stretch reflex and clinical score of upper motor neuron involvement was found; patients with a low threshold and a high sensitivity in general had a high upper motor neuron score. CONCLUSION: It is suggested that upper motor neuron involvement in ALS can be evaluated by using the soleus stretch reflex. This may be useful in monitoring progression of the disease and evaluating new therapies.
Adult↗
Nonlinear stretch reflex interaction during cocontraction.
1. We investigated the role of stretch reflexes in controlling two antagonist muscles acting at the interphalangeal joint in the normal human thumb. Reflex action was compared when either muscle contracted alone and during cocontraction. 2. The total torque of the flexor pollicis longus (FPL) and extensor pollicis longus (EPL) muscles was measured in response to an externally imposed extension of the interphalangeal joint. The initial joint angle and the amplitude of the extension were constant in all experiments, and the preload of the active muscle(s) was varied. Joint torque was measured at the peak of short-latency stretch reflex action during contraction of the FPL alone, contraction of the EPL alone, and during cocontraction. Incremental joint stiffness was calculated as the change in torque divided by the change in angle. 3. Incremental stiffness increased in proportion to the preload torque during single muscle contractions of either the FPL (lengthening disturbances) or the EPL (shortening disturbances). Thus stiffness was not regulated to a constant value in the face of varying loads for either single muscle stretch or release. 4. Incremental stiffness varied across the range of cocontraction levels while the net torque was maintained at approximately 0. Thus net torque alone did not determine the stiffness during cocontraction. 5. The contributions of each muscle to the net intrinsic torque during cocontraction were estimated by scaling the individual muscles' responses so that their sum gave the best fit (in a least-squares sense) to the cocontraction torque before reflex action. The solution is unique because the individual torques have opposite signs, but the stiffnesses add. This gave estimates of the initial torques of both muscles during cocontraction. 6. The contributions of the two muscles during cocontraction were used to estimate the active joint stiffness that would be expected if the two muscles were activated independently to the same levels as in the cocontraction trials. The stiffness measured at the peak of stretch reflex action during cocontraction trials differed from the sum of the stiffnesses of the two muscles when they were contracting alone. At low cocontraction levels, the measured stiffness was less than expected on the basis of summation of the action of the two muscles, whereas at high cocontraction levels, the measured stiffness was greater than expected. This demonstrates that there is nonlinear stretch reflex interaction. That is, reflex action for a pair of antagonists is not simply the linear sum of the reflex actions of the two muscles acting independently.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
The suppression of the long-latency stretch reflex in the human tibialis anterior muscle by transcranial magnetic stimulation.
The purpose of this study was to investigate the transcortical nature of the long-latency stretch reflex (M3) in the human tibialis anterior muscle. This was achieved by applying a single pulse of subthreshold (90% motor threshold) transcortical magnetic stimulation (subTMS) at the site of the motor cortex. Such a stimulus is able to activate intracortical inhibitory circuits and thereby depress motor cortical output. We hypothesized that it would also suppress a transcortical reflex loop. The stretch reflex was elicited using a pedal attached to an electric motor. SubTMS was applied at several intervals prior to M3. Recordings were repeated 20-40 times. The reflex components were quantified using 20-ms windows in the averaged rectified electromyogram (EMG). SubTMS evoked significantly larger depression of M3 than of the background EMG in the same time frame when applied 55-85 ms prior to M3 ( P<0.05, n=10). Furthermore, the effect on M3 was significantly larger than the effect on the spinal M2 ( P<0.01, n=7). Our results provide evidence that the long-latency stretch reflex in the tibialis anterior muscle is at least partly transcortical.
Adult↗
Are H and stretch reflexes in hemiparesis reproducible and correlated with spasticity?
The measurement of spasticity has always presented a problem to clinicians and researchers alike. As yet, there is no literature addressing the reproducibility of the existing barrage of clinical evaluations of spasticity and reflex measurement. Also not clear is whether or not a systematic relationship might exist between these multiple indices of spasticity. After delineating the differences in spasticity scores and reflex functions between spastic and normal states, the aims of this study were to examine the reliability of these measurements in hemiparetic subjects, and the correlation between altered reflex functions and clinically measured spasticity. An aggregate of lower limb reflexes was compared between ten spastic hemiparetic and seven age-matched normal subjects. Lower limb reflexes examined were: (1) the ratio of maximal H reflex to M response (H/M ratio), (2) the inhibition of the H reflex during vibration (Hvib/Hctl ratio), and (3) soleus stretch reflexes (SR/M ratio). H and stretch reflex latencies were shorter (P < 0.05), and reflex amplitudes were significantly greater (H/M ratios, P < 0.05; SR/M areas, P < 0.005) in spastic subjects. While H/M ratios, Hvib/Hctl ratios, SR/M areas and SR onset angles were highly reproducible, only some physiological measurements showed consistent but non-significant relationships with clinical spasticity. The decreased reflex latencies and increased reflex responses in the hemiparetic subjects suggested that spasticity may be related to reduced reflex thresholds. The physiological measurements and clinically assessed tone were both valid and reproducible, indicating that they can be used to evaluate the long-term effects of therapeutic intervention.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
A pharmacological study of the adrenergic mechanisms involved in the stretch reflex of the decerebrate rat.
1 The effects of catecholamine precursors, enzyme inhibitors, and monoamine depletors have been studied on the stretch reflex in the decerebrate rat.2L-DOPA alone had a biphasic effect, facilitation followed by inhibition and recovery of the reflex.3 About 10% of the preparations did not develop decerebrate rigidity. These preparations did not have a stretch reflex. Within 1 to 5 min of the injection of L-DOPA in these inactive preparations, a stretch reflex could be elicited.4 Control experiments indicate that L-DOPA was acting centrally after decarboxylation.5DL-dihydroxyphenylserine had an inhibitory effect, without a preceding facilitation.6 When L-DOPA was preceded by diethyldithiocarbamate (i.v.) or FLA-63 (i.p.), the predominant response was a sustained facilitation, without an accompanying inhibition.7 It is concluded that in the decerebrate rat, increased stretch reflex activity is associated with increased central levels of dopamine, and decreased stretch reflex activity with increased central levels of noradrenaline. The results are discussed with reference to the possibility that dopamine acts by liberating 5-hydroxytryptamine.
Animals↗
Guided intrathecal baclofen administration by using soleus stretch reflex in moderate-severe spastic multiple sclerosis patients with implanted pump.
We tested the hypothesis that changes in soleus stretch reflex was correlated to changes in intrathecal baclofen dose in 12 multiple sclerosis patients with moderate-severe spasticity treated with intrathecal baclofen pump. Twice patients were evaluated clinically and biomechanically. The short-latency soleus stretch reflex was elicited by rotating the ankle joint 4 degrees with a velocity from 3.1 to 180 degrees/s. There was a strong correlation between changes in intrathecal baclofen dose and amplitude of the short-latency stretch reflex (r=-0.88, P<0.001), which means that with an increase in baclofen dose there is a decrease in the amplitude. In contrast, no correlation exists between changes in intrathecal baclofen dose and clinical assessment of spasticity by using the Ashworth scale. The amplitude of the stretch reflex was very small (5 microV) compared with previous findings (>50 microV), which indicates an effective antispastic effect of intrathecal baclofen. We suggest that clinical evaluation of spasticity using Ashworth scale is insensitive to detect minor changes in moderate-severe spasticity and consequently might not be very useful in evaluating spasticity in relation to ambulatory filling of baclofen pumps. The soleus stretch reflex might be useful in situations when there is doubt about the effect of intrathecally administered baclofen.
Adult↗
Evidence that the secondary as well as the primary endings of the muscle spindles may be responsible for the tonic stretch reflex of the decerebrate cat.
1. The size of the tonic stretch reflex of the soleus or gastrocnemius muscle of the decerebrate cat has been compared with the size of the reflex contraction elicited in the same muscle by high-frequency vibration applied to its tendon.2. On the assumption that vibration preferentially excites the primary endings of the muscle spindles it may be used to estimate the relation between the reflex response and the frequency of the Ia input to the spinal cord. On this basis, the increase in tension evoked by increasing extension is too great to be explained by the increase in Ia input with extension previously found on single fibre recording in comparable preparations.3. When vibration was superimposed on stretch reflexes elicited by different extensions, the size of the additional contraction elicited by the vibration remained approximately constant. If the stretch and vibration reflexes both depended entirely upon the Ia pathway, then occlusion between them would have been expected instead of the simple summation which was found.4. The absence of occlusion was not due to variation of the contractile strength of the muscle with its extension. This was shown by finding that the reflex contraction of soleus produced by stimulating the medial gastrocnemius nerve also remained the same size when elicited at different lengths of the muscle.5. The reflex effects were studied of superimposing alternate stretches and releases of 0.2 mm, on extensions of several mm. The small stretches elicited responses which were larger than expected from the response to large stretches, and which were approximately the same size at different mean lengths of the muscle.6. It is concluded that the tonic stretch reflex of the decerebrate cat cannot readily be explained solely by the increase in Ia discharge produced by stretching, as usually believed. Instead, it is suggested that the group II afferent fibres from the secondary endings of the muscle spindle also play an important part in its production.
Animals↗
Interaction between the long-latency stretch reflex and voluntary electromyographic activity prior to a rapid voluntary motor reaction.
The size of the long-latency component of the stretch reflex has been examined in the time interval between a signal to move and the required rapid voluntary contraction of triceps and flexor pollicis longus in 8 normal subjects. Bilateral movements of the elbow and thumb were made following an auditory signal. In 50% of the trials a torque pulse was applied unilaterally in order to elicit a stretch reflex response in one arm. The voluntary response in the contralateral arm was uncorrupted by a stretch reflex response, so was used as an indicator of voluntary reaction time. Control experiments, using an electrical stimulus to the fingers rather than muscle stretch, verified that both arms reacted almost simultaneously to the auditory cue, even when the reaction time was shortened by the presence of a unilateral electrical stimulus. Similarly, an interposed muscle stretch stimulus considerably reduced the reaction time to the audio signal. Because of this, the start of the voluntary EMG response frequently 'over-lapped' the end of the long-latency stretch reflex. Failure to take this shortening of voluntary reaction time into consideration can lead to the erroneous conclusion that reflex gain is increased prior to a rapid movement. If the 'overlap' of EMG responses is accounted for, very little change in the size of the long-latency stretch reflex is evident prior to activation of the muscles responsible for the movement of either the elbow or the thumb.
Acoustic Stimulation↗
Differences in stretch reflex responses of elbow flexor muscles during shortening, lengthening and isometric contractions.
Stretch reflexes were evoked in elbow flexor muscles undergoing three different muscle contractions, i.e. isotonic shortening (SHO) and lengthening (LEN), and isometric (ISO) contractions. The intermuscle relationships for the magnitude of the stretch reflex component in the eletromyographic (EMG) activities of two main elbow flexor muscles, i.e. the biceps brachii (BB) and the brachioradialis (BRD), were compared among the three types of contractions. The subjects were requested to move their forearms sinusoidally (0.1 Hz) against a constant pre-load between elbow joint angles of 10 degrees (0 degrees = full extension) and 80 degrees during SHO and LEN, and to keep an angle of 45 degrees during the ISO. The perturbations were applied at the elbow angle of 45 degrees in pseudo-random order. The EMG signals were rectified and averaged over a period of 100 ms before and 400 ms after the onset of the perturbation 40-50 times. From the ensemble averaged EMG waveform, the background activity (BGA), short (20-50 ms) and long latency (M2, 50-80, M3, 80-100 ms) reflex and voluntary activity (100-150 ms) components were measured. The results showed that both BGA and reflex EMG activity of the two elbow flexor muscles were markedly decreased during the lengthening contraction compared to the SHO and ISO contractions. Furthermore, the changes of reflex EMG components in the BRD muscle were more pronounced than those in the BB muscle, i.e. the ratios of M2 and M3 magnitudes between BRD and BB (BRD:BB) were significantly reduced during the LEN contractions. These results would suggest that the gain of long latency stretch reflex EMG activities in synergistic muscles might be modulated independently according to the model of muscle contraction.
Adult↗
Effect of noxious electrical stimulation of the peroneal nerve on stretch reflex activity of the hamstring muscle in rats: possible implications of neuronal mechanisms in the development of tight hamstrings in lumbar disc herniation.
STUDY DESIGN: The effect of noxious electrical stimulation of the peroneal nerve on the stretch reflex electromyogram activity of the hamstring muscle (semitendinous) was studied. OBJECTIVE: To verify the following hypothetical mechanisms underlying tight hamstrings in lumbar disc herniation: stretch reflex muscle activity of hamstrings is increased by painful inputs from an injured spinal nerve root and the increased stretch reflex muscle activity is maintained by central sensitization. SUMMARY OF BACKGROUND DATA: It is reported that stretch reflex activity of the trunk muscles is induced by noxious stimulation of the sciatic nerve and maintained by central sensitization. METHODS: In spinalized rats (transected spinal cord), the peroneal nerve was stimulated electrically as a conditioning stimulus. Stretch reflex electromyogram activity of the semitendinous muscle was recorded before and after the conditioning stimulus. RESULTS: Even after electrical stimulation was terminated, an increased stretch reflex activity of the hamstring muscle was observed. CONCLUSIONS: It is likely that a central sensitization mechanism at the spinal cord level was involved in the increased reflex activity. Central sensitization may play a part in the neuronal mechanisms of tight hamstrings in lumbar disc herniation.
Animals↗