Muscle, reflex and central components in the control of the ankle joint in healthy and spastic man.

Abstract

In understanding the control of the ankle joint during different motor tasks, we have to investigate at least three components, namely the influence of i) the passive and intrinsic properties of the intact and active muscle system around the joint (termed the non-reflex component), ii) the mechanical importance of the stretch reflex in the stretched and unloaded muscles, and iii) the supraspinal control of the stretch reflex. This thesis is dealing with the importance of the three components in healthy and spastic persons during sitting, standing, and walking. The results are based on stretch reflex and H-reflex measurements from the ankle extensor muscles. During stretch reflex experiments the foot was mounted to a platform (portable during walking) from which the ankle joint torque and the position were measured. To elicit a stretch reflex, the ankle joint was rotated by a strong motor connected to the platform. The mechanical importance of the stretch reflex was investigated by measuring the changes in joint torque. Electrically, the stretch reflex was recorded as the compound muscle action potential through bipolar surface EMG electrodes placed over the soleus muscle. During H-reflex experiments, the tibial nerve was stimulated at the popliteal fossa and the H-reflex recorded over the soleus muscle as during stretch reflex experiments. To investigate how the contractile properties of a muscle in humans depend on the history of activation, we investigated the intrinsic stiffness of the ankle extensors in healthy subjects. At matched background contraction in sitting subjects, a prolonged contraction increased the intrinsic muscle stiffness by 49%. Muscle yielding has been considered especially important for understanding the reflex compensation. We found a general lack of muscle yield and a mechanically important non-reflex stiffness of the ankle extensors showing that non-reflex stiffness is a prominent factor in normal movements of the ankle joint. In both healthy and spastic persons, we found a mechanically strong stretch reflex in the isometric, contracted muscles during sitting. This posed the question; how is the reflex regulated during more functional motor tasks. This was dealt with by studying the H-reflex during isometric ramp contractions and during walking in healthy and spastic persons. In the healthy subjects the H-reflex was modulated in consistency with a task dependent control. In the spastic patients the H-reflex lacked a task dependent modulation. In consistency with earlier findings it was suggested that the decreased modulation could have been caused by decreased control of the pre-synaptic inhibition of the Ia terminals or a change in recruitment gain. To test if the stretch reflex behaved as the H-reflex, the short latency stretch reflex was investigated during walking. Here we found that the stretch reflex was strongly modulated during a step in healthy subjects as seen for the H-reflex, but when comparing the stretch reflex at matched excitation levels (same background EMGs) during standing and walking, no task-specific reflex modulation was found except the one relating to the excitation level. Therefore, the results emphasise that at least during walking and standing it is not always possible to draw conclusions about the stretch reflex based on observations of the H-reflex. When investigating the modulation of the short latency stretch reflex during walking in spastic patients, we found that the stretch reflex modulation was impaired in spastic patients at least to the extent demonstrated earlier for the H-reflex. The passive stiffness of the ankle joint was at the same time increased in the patients. At matched ankle extensor contraction levels, stretch responses were compared before and after reversible block of the common peroneal nerve and during an attempted, voluntary, fictive dorsiflexion after common peroneal nerve block. (ABSTRACT TRUNCATED)