Wide-pulse-width, high-frequency neuromuscular stimulation: implications for functional electrical stimulation.

Electrical stimulation (1-ms pulses, 100 Hz) produces more torque than expected from motor axon activation (extra contractions). This experiment investigates the most effective method of delivering this stimulation for neuromuscular electrical stimulation. Surface stimulation (1-ms pulses; 20 Hz for 2 s, 100 Hz for 2 s, 20 Hz for 3 s) was delivered to triceps surae and wrist flexors (muscle stimulation) and to median and tibial nerves (nerve stimulation) at two intensities. Contractions were evaluated for amplitude, consistency, and stability. Surface electromyograph was collected to assess how H-reflexes and M-waves contribute. In the triceps surae, muscle stimulation produced the largest absolute contractions (23% maximal voluntary contraction), evoked the largest extra contractions as torque increased by 412% after the 100-Hz stimulation, and was more consistent and stable compared with tibial nerve stimulation. Absolute and extra contraction amplitude, consistency, and stability of evoked wrist flexor torques were similar between stimulation types: torques reached 11% maximal voluntary contraction, and extra contractions increased torque by 161%. Extra contractions were 10 times larger in plantar flexors compared with wrist flexors with muscle stimulation but were similar with nerve stimulation. For triceps surae, H reflexes were 3.4 times larger than M waves during nerve stimulation, yet M waves were 15 times larger than H reflexes during muscle stimulation. M waves in the wrist flexors were larger than H reflexes during nerve (8.5 times) and muscle (18.5 times) stimulation. This is an initial step toward utilizing extra contractions for neuromuscular electrical stimulation and the first to demonstrate their presence in the wrist flexors.

Contribution of M-waves and H-reflexes to contractions evoked by tetanic nerve stimulation in humans.

Tetanic neuromuscular stimulation evokes contractions by depolarizing motor axons beneath the stimulating electrodes. However, we have shown that extra torque can develop due to the discharge of spinal neurons recruited by the evoked sensory volley. The present experiments investigated whether extra torque in the ankle plantar- and dorsiflexors was associated with enhanced H-reflexes. The tibial and common peroneal nerves were stimulated using 7-s trains (20 Hz for 2 s, 100 Hz for 2 s, 20 Hz for 3 s). Extra torque was defined as significantly more torque during 20-Hz stimulation after the 100-Hz burst (time2) than before it (time1). In 9 of 11 subjects, extra plantarflexion torque developed during stimulation just above motor threshold. In these nine subjects, torque increased from 8 to 13% MVC (time1 to time2), the soleus H-reflex increased from 13 to 19% Mmax and the M-wave of approximately 2% Mmax did not change significantly. To evoke extra dorsiflexion torque, greater stimulation intensities were required. In 6 of 13 subjects, extra torque developed at intensities that evoked an M-wave of 5-20% Mmax at time1. In these six subjects, torque doubled from 2 to 4% MVC (time1 to time2), whereas tibialis anterior (TA) H-reflexes and M-waves did not change significantly (H-reflex from 0.8 to 2% Mmax; M-wave from 12 to 14% Mmax). In 7 of 13 subjects, extra torque developed at higher stimulation intensities (35-65% Mmax). In these seven subjects, torque increased from 13 to 20% MVC, whereas TA H-reflexes and M-waves were not significantly different (H-reflex from 0.7 to 1% Mmax; M-wave from 49 to 54% Mmax). Thus enhanced H-reflexes contributed to extra plantarflexion, however, other factors generated extra dorsiflexion.

Diurnal changes in the amplitude of the Hoffmann reflex in the human soleus but not in the flexor carpi radialis muscle.

Changes in the reflex amplitude throughout the day have been observed in non-human mammals. The present experiment tested whether diurnal fluctuations also occur in humans. Hoffmann reflex (H-reflex) amplitude was measured in soleus and flexor carpi radialis (FCR) muscles from the data collected over a 12-h period between 7:00-9:00 a.m. and 7:00-9:00 p.m. At 4-h intervals, M/H recruitment curves were obtained, and two measures of H-reflex excitability were calculated. The maximal H-reflex (H (max)) was calculated as the average of the three largest H-reflexes. H-reflexes were also sampled from the ascending limb of the M/H recruitment curve (H (A), n=10), with a corresponding M-wave of 5% M (max). All values were normalized to the maximal M-wave (M (max)). Soleus H-reflex amplitude and plantar flexion maximal voluntary isometric contraction force (MVIC) were significantly smaller (p<0.05) in the morning (H (max)=57.2% M (max), H (A)=42.3%, M (max), MVIC=162.1 Nm) than in the evening (H (max)=69.1% M (max), a 20.1% increase, H (A)=54.1% M (max), a 27.4% increase and MVIC=195.8 Nm, a 20.8% increase). In contrast, FCR H-reflex amplitude and FCR MVIC were unchanged across all testing sessions. The data show that diurnal fluctuations are present in the amplitude of the human soleus but not in the FCR H-reflex. Diurnal fluctuation in the human soleus H-reflex amplitude must be considered when interpreting H-reflex data, especially when a repeated measures design spanning several days is utilized.