Reciprocal Inhibition Versus Reciprocal Facilitation In Spinal Cord Injury Patients

Sponsor
Istanbul Physical Medicine Rehabilitation Training and Research Hospital (Other)
Overall Status
Completed
CT.gov ID
NCT05985031
Collaborator
(none)
10
1
2
6.8
1.5

Study Details

Study Description

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).

Condition or Disease Intervention/Treatment Phase
  • Diagnostic Test: Tendon tap
  • Diagnostic Test: Tibial nerve stimulation
N/A

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 Design

Study Type:
Interventional
Actual Enrollment :
10 participants
Allocation:
Non-Randomized
Intervention Model:
Parallel Assignment
Intervention Model Description:
Group I. Spinal cord injuries Group II. Healthy ControlGroup I. Spinal cord injuries Group II. Healthy Control
Masking:
None (Open Label)
Primary Purpose:
Basic Science
Official Title:
Does Reciprocal Inhibition, a Rehabilitation Technique, Convert to Reciprocal Facilitation in Patients With Upper Motor Neuron Lesions?
Actual Study Start Date :
Jan 5, 2023
Actual Primary Completion Date :
Jan 17, 2023
Actual Study Completion Date :
Aug 1, 2023

Arms and Interventions

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
  • Outcome Measures

    Primary Outcome Measures

    1. Reciprocal Inhibition [up to 2 weeks]

      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.

    Secondary Outcome Measures

    1. H-reflex [up to 2 weeks]

      Electric current was delivered through the popliteal fossa to tibial nerve for eliciting the soleus H-reflex

    2. T-reflex [up to 2 weeks]

      The Achilles tendon was hit with using a reflex hammer to elicit the soleus T-reflex.

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    25 Years to 60 Years
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    Yes
    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

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 İstanbul Physical Therapy Training and Research Hospital Istanbul Turkey 34180

    Sponsors and Collaborators

    • Istanbul Physical Medicine Rehabilitation Training and Research Hospital

    Investigators

    • Study Director: İLHAN KARACAN, MD, Prof, İstanbul Physical Therapy Rehabilitation Training & Research Hosptial

    Study Documents (Full-Text)

    None provided.

    More Information

    Publications

    None provided.
    Responsible Party:
    Mustafa Kökçe, assistant doctor, Istanbul Physical Medicine Rehabilitation Training and Research Hospital
    ClinicalTrials.gov Identifier:
    NCT05985031
    Other Study ID Numbers:
    • RIVRFSCIP
    First Posted:
    Aug 14, 2023
    Last Update Posted:
    Aug 15, 2023
    Last Verified:
    Aug 1, 2023
    Studies a U.S. FDA-regulated Drug Product:
    No
    Studies a U.S. FDA-regulated Device Product:
    No
    Keywords provided by Mustafa Kökçe, assistant doctor, Istanbul Physical Medicine Rehabilitation Training and Research Hospital
    Additional relevant MeSH terms:

    Study Results

    No Results Posted as of Aug 15, 2023