Relationship between spinal reflexes and leg motor function in sub-acute and chronic stroke patients

Yoko Takahashi; Michiyuki Kawakami; Rena Mikami; Toshiya Nakajima; Towa Nagumo; Tomofumi Yamaguchi; Kaoru Honaga; Kunitsugu Kondo; Ryota Ishii; Toshiyuki Fujiwara; Meigen Liu

doi:10.1016/j.clinph.2022.02.025

Relationship between spinal reflexes and leg motor function in sub-acute and chronic stroke patients

Clin Neurophysiol. 2022 Jun:138:74-83. doi: 10.1016/j.clinph.2022.02.025. Epub 2022 Mar 16.

Authors

Affiliations

¹ Department of Physical Therapy, Faculty of Health Science, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Tokyo Bay Rehabilitation Hospital, 4-1-1, Yatsu, Narashino-shi, Chiba 275-0026, Japan.
² Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Electronic address: michiyukikawakami@hotmail.com.
³ Tokyo Bay Rehabilitation Hospital, 4-1-1, Yatsu, Narashino-shi, Chiba 275-0026, Japan.
⁴ Department of Physical Therapy, Faculty of Health Science, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
⁵ Tokyo Bay Rehabilitation Hospital, 4-1-1, Yatsu, Narashino-shi, Chiba 275-0026, Japan; Department of Biostatistics, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
⁶ Department of Biostatistics, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
⁷ Department of Physical Therapy, Faculty of Health Science, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
⁸ Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.

PMID: 35366480
DOI: 10.1016/j.clinph.2022.02.025

Abstract

Objective: To assess the relationship between spinal reflexes and motor function in sub-acute (SAS) and chronic stroke (CS) patients.

Methods: Twelve SAS and 16 CS patients underwent electrophysiological assessment of heteronymous facilitation (HF), heteronymous inhibition (HI), disynaptic reciprocal inhibition (DRI), and D1 inhibition (D1). The Fugl-Meyer Assessment Lower Extremity (FMA-LE) and modified Ashworth scale (MAS) were assessed. The relationship between spinal reflexes and motor function was examined in a cross-sectional manner. SAS patients were also longitudinally evaluated before and after intensive rehabilitation for approximately 2 months.

Results: SAS patients with triceps surae muscle spasticity (MAS ≥ 1) showed higher HF values (p = 0.03) than those without spasticity. SAS patients with quadriceps muscle spasticity showed higher HF values (p < 0.01); patients with hamstring muscle spasticity showed higher DRI value (disinhibition) (p < 0.01) than those without spasticity. CS patients showed no significant correlation between spinal reflexes and motor function. The longitudinal study revealed a significant correlation between increase in D1 inhibition and FMA-LE improvement in SAS patients (r = 0.69).

Conclusions: The association between impaired spinal reflexes varies with the stage of stroke; HF and DRI may be spasticity indicators in SAS patients.

Significance: Spinal reflexes as potential biomarkers may facilitate tailor-made rehabilitation of stroke patients.

Keywords: D1 inhibition; Heteronymous facilitation; Heteronymous inhibition; Presynaptic inhibition; Reciprocal inhibition; Spasticity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Humans
Leg
Longitudinal Studies
Lower Extremity
Muscle Spasticity / diagnosis
Stroke Rehabilitation*
Stroke* / complications
Treatment Outcome