A novel therapy to regain control of spinal motoneurons in stroke survivors

Abstract

The purpose of this research was to demonstrate that hemiplegic stroke survivors possess the ability to modulate their H-reflex amplitude through exercise induced operant conditioning. To better understand the changes in the spinal cord associated with hemiplegic stroke, two important inhibitory spinal cord mechanisms, namely post activation depression (PAD) and Group I reciprocal inhibition (RI) were also examined. Examining PAD with conditioning-test intervals between 80 to 300 ms showed a substantial depression in the amplitude of the H-reflex in healthy individuals. In stroke patients there was significantly less inhibition at all intervals, with full recover of the H-reflex at the 300 ms interval.

In healthy individuals conditioning the soleus H-reflex with common peroneal nerve stimulation caused an initial inhibitory phase at about 10 ms interval (D1 inhibition) and a second phase of inhibition at longer intervals (> 100 ms; D2 inhibition). In stroke patients, no statistically significant inhibition was observed, although partial interaction analysis suggested that D1 inhibition followed a pattern similar to that of healthy individuals.

Finally, a three-week exercise induced operant conditioning program was examined in three stroke patients. All patients demonstrated success for down-regulating the amplitude of the soleus H-reflex. More importantly, after training all subjects demonstrated improvements in gait parameters.

It is concluded that spinal cord inhibitory mechanisms are different between healthy controls and stroke patients, and that exercise induced operant conditioning is a promising method for regaining functional control of motoneurons.