A pilot study to measure upper extremity H-reflexes following neuromuscular electrical stimulation therapy after stroke.

Upper extremity (UE) hemiparesis persists after stroke, limiting hand function. Neuromuscular electrical stimulation (NMES) is an effective intervention to improve UE recovery, although the underlying mechanisms are not fully understood. Our objective was to establish a reliable protocol to measure UE agonist-antagonist forearm monosynaptic reflexes in a pilot study to determine if NMES improves wrist function after stroke. We established the between-day reliability of the H-reflex in the extensor carpi radialis longus (ECRL) and flexor carpi radialis (FCR) musculature for individuals with prior stroke (n=18). The same-day generation of ECRL/FCR H-reflex recruitment curves was well tolerated, regardless of age or UE spasticity. The between-day reliability of the ECRL H-reflex was enhanced above FCR, similar to healthy subjects [20], with the Hmax the most reliable parameter quantified in both muscles. H-reflex and functional measures following NMES show the potential for NMES-induced increases in ECRL Hmax, but confirmation requires a larger clinical study. Our initial results support the safe, easy, and efficacious use of in-home NMES, and establish a potential method to measure UE monosynaptic reflexes after stroke.

Preserved and impaired aspects of feed-forward grip force control after chronic somatosensory deafferentation.

BACKGROUND: Although feed-forward mechanisms of grip force control are a prerequisite for skilled object manipulation, somatosensory feedback is essential to acquire, maintain, and adapt these mechanisms. OBJECTIVE: Individuals with complete peripheral deafferentation provide the unique opportunity to study the function of the motor system deprived of somatosensory feedback. METHODS: Two individuals (GL and IW) with complete chronic deafferentation of the trunk and limbs were tested during cyclic vertical movements of a hand-held object. Such movements induce oscillating loads that are typically anticipated by parallel modulations of the grip force. Load magnitude was altered by varying either the movement frequency or object weight. RESULTS: GL and IW employed excessive grip forces probably reflecting a compensatory mechanism. Despite this overall force increase, both deafferented participants adjusted their grip force level according to the load magnitude, indicating preserved scaling of the background grip force to physical demands. The dynamic modulation of the grip force with the load force was largely absent in GL, whereas in IW only slower movements were clearly affected. CONCLUSIONS: The authors hypothesize that the deafferented patients may have utilized visual and vestibular cues and/or an efferent copy of the motor command of the arm movement to scale the grip force level. Severely impaired grip force-load coupling in GL suggests that sensory information is important for maintaining a precise internal model of dynamic grip force control. However, comparably better performance in IW argues for the possibility that alternative cues can be used to trigger a residual internal model.