Clinical trial NCT05985031: Reciprocal Inhibition Versus Reciprocal Facilitation In Spinal Cord Injury Patients
Official title: Does Reciprocal Inhibition, a Rehabilitation Technique, Convert to Reciprocal Facilitation in Patients With Upper Motor Neuron Lesions?
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Spinal Cord Injuries
Keywords: Spinal Cord
motor neuron
Spasticity
Lead sponsor: Istanbul Physical Medicine Rehabilitation Training and Research Hospital
Sponsor class: OTHER_GOV
First posted: 2023-08-14
Enrollment: 10
Sex: ALL
Minimum age (years): 25
Maximum age (years): 60
Standard ages: ADULT
Accepts healthy volunteers: yes
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Group I. Spinal cord injuries Group II. Healthy Control
Primary purpose: BASIC_SCIENCE

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.

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

Primary outcomes:
measure: Reciprocal Inhibition
timeFrame: up to 2 weeks
Secondary outcomes:
measure: H-reflex
timeFrame: up to 2 weeks
measure: T-reflex
timeFrame: up to 2 weeks
Other outcomes:
Locations:
city: Istanbul
country: Turkey
facility: İstanbul Physical Therapy Training and Research Hospital
Study officials:
affiliation: İstanbul Physical Therapy Rehabilitation Training & Research Hosptial
name: İLHAN KARACAN, MD, Prof
role: STUDY_DIRECTOR
References: