Reciprocal Inhibition Versus Reciprocal Facilitation In Spinal Cord Injury Patients

Study Overview
=================
Brief Summary
-----------------
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).

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.

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

Conditions
-----------------
Spinal Cord Injuries

Intervention / Treatment
-----------------
* Diagnostic Test: Tendon tap
* Diagnostic Test: Tibial nerve stimulation


Participation Criteria
=================
Eligibility Criteria
-----------------
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

Ages Eligible for Study
-----------------
Minimum Age: 25 Years
Maximum Age: 60 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Basic Science
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Group I. Spinal cord injuries Group II. Healthy Control
Masking: None (Open Label)


Arms and Interventions

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

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Spinal Cord, motor neuron, Spasticity