[ARTICLE] Long-Term Plasticity in Reflex Excitability Induced by Five Weeks of Arm and Leg Cycling Training after Stroke – Full Text HTML


Neural connections remain partially viable after stroke, and access to these residual connections provides a substrate for training-induced plasticity. The objective of this project was to test if reflex excitability could be modified with arm and leg (A & L) cycling training. Nineteen individuals with chronic stroke (more than six months postlesion) performed 30 min of A & L cycling training three times a week for five weeks. Changes in reflex excitability were inferred from modulation of cutaneous and stretch reflexes. A multiple baseline (three pretests) within-subject control design was used. Plasticity in reflex excitability was determined as an increase in the conditioning effect of arm cycling on soleus stretch reflex amplitude on the more affected side, by the index of modulation, and by the modulation ratio between sides for cutaneous reflexes. In general, A & L cycling training induces plasticity and modifies reflex excitability after stroke.

1. Introduction

The arms and the legs are coupled in the human nervous system such that activity in the arms affects activity in the legs and vice versa. In quadrupeds, forelimb–hindlimb coordination is well documented and has been attributed to propriospinal linkages between cervical and lumbosacral spinal central pattern-generating networks [1,2,3,4,5,6]. Bipedal human locomotion is likely built upon elements of quadrupedal coordination [2,5], where it involves coordination of all four limbs. Only indirect evidence for quadrupedal locomotor linkages exists, however.
The modulation of reflex amplitudes can be used to probe for changes in interlimb neural activity [4,7]. Investigations of soleus stretch and H-reflex modulation during rhythmic arm movement provide evidence of neuronal coupling between the arms and the legs [2,3,8,9,10]. Examining cutaneous reflexes during rhythmic movements can also probe for interactions between the limbs. In this context, a widespread interlimb network is revealed by the extensive distribution of reflexes across many muscles in both the arms and the legs regardless of which limb is directly stimulated [4,11,12]. In addition, phase-dependent modulation found in muscles of all four limbs during rhythmic movement is suggestive of coupling between segmental spinal networks [12,13,14,15,16]. Regulation of rhythmic arm and leg movement is supported by somatosensory linkages in the form of interlimb reflexes [12,17,18] and neural coupling between lumbar and cervical spinal cord networks [10,19,20,21,22]. …

Figure 1. Illustration of the testing and training protocols. A multiple baseline within-subject control design was used for this study. An A & L cycle ergometer (Sci-Fit Pro 2) was used for training. The setups for stretch reflex and cutaneous reflex testing are shown. Muscles of interest are shown with a gray oval, and electrical stimulation is shown with a black lightning bolt. For the stretch reflex setup, a brief vibration was delivered to the triceps surae tendon and the reflex was recorded from the soleus (SOL) muscle, separately for each side. For the cutaneous reflex setup, simultaneous electrical stimulation was applied to the superficial radial (SR) and the superficial peroneal (SP) nerves, and reflexes were recorded bilaterally from the soleus (SOL), tibialis anterior (TA), flexor carpi radialis (FCR), and the posterior deltoid (PD) muscles.


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