Reciprocal Inhibition Versus Reciprocal Facilitation In Spinal Cord Injury Patients

Spinal Cord Injuries Clinical Trial

Official title:

Does Reciprocal Inhibition, a Rehabilitation Technique, Convert to Reciprocal Facilitation in Patients With Upper Motor Neuron Lesions?

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05985031
• Other study ID #: RIVRFSCIP
• Status: Completed
• Phase: N/A
• Start date: January 5, 2023
• Est. completion date: August 1, 2023

Study information

• Verified date: August 2023
• Source: Istanbul Physical Medicine Rehabilitation Training and Research Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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).

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 10
• Est. completion date: August 1, 2023
• Est. primary completion date: January 17, 2023
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 25 Years to 60 Years

Eligibility

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

Related Conditions & MeSH terms

• Spinal Cord Injuries

Intervention

Diagnostic Test:
• Tendon tap
While examining the T reflex, the ankle was held passively in neutral, dorsiflexion and plantar flexion positions by the investigator.
• Tibial nerve stimulation
H-reflex responses were examined by tibial nerve stimulation

Locations

Country	Name	City	State
Turkey	Istanbul Physical Therapy Training and Research Hospital	Istanbul

Sponsors (1)

Lead Sponsor	Collaborator
Istanbul Physical Medicine Rehabilitation Training and Research Hospital

Country where clinical trial is conducted

Turkey, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Reciprocal Inhibition	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.	up to 2 weeks
Secondary	H-reflex	Electric current was delivered through the popliteal fossa to tibial nerve for eliciting the soleus H-reflex	up to 2 weeks
Secondary	T-reflex	The Achilles tendon was hit with using a reflex hammer to elicit the soleus T-reflex.	up to 2 weeks