Masaaki Tsuruike

Age comparison of H-reflex modulation with the Jendrássik maneuver and postural complexity

OBJECTIVE The purpose of this study was to examine modulation of the soleus Hoffmann (H)-reflex in response to the Jendrássik maneuver (JM) in standing positions in young and elderly subjects. METHODS Seventeen elderly (mean age=72.0 years) and 23 young (mean age=23.2 years) apparently healthy subjects were examined in two separate experiments. The first experiment was conducted to compare the prone and standing position. The second experiment was conducted in the standing position with isotonic glideboard back support. The isotonic glideboard back support was inclined 30 degrees. In the standing position with back support, the knee and ankle joints were set at 0 degrees of flexion. All subjects were tested with two foot-positions: (1) with no soleus contraction on the platform (simple task) and (2) with an active calf muscle group contraction (complex task). To compare the amplitude of the H-reflex in each experiment between the control trials (relaxed) and JM trials (squeezing tennis balls), the stimulus intensity of 1.1 x motor threshold of the M-response was used for each subject in all body positions. RESULTS To ensure experimental control, subjects did not show a difference in the amplitude of the trial M-response between the control and JM trials on any of the body positions. Also, no difference was found in the mean amplitude of the M-response between two different positions in either of the two experiments. Trial M-responses were all between 13 and 17% of M-max in the quiet standing position for the young subjects, and 17 and 21% for the elderly subjects. Results demonstrated that the JM facilitated the H-reflex in both young and elderly subjects. However, differential ability to modulate motoneuron excitability evoked by H-reflex pathways was found between the two groups. Young subjects demonstrated a significant difference in the amplitude of the H-reflex between control and JM trials in each standing position (P<0.05). The elderly subjects, in contrast, demonstrated no significant difference in the amplitude of the H-reflex between control and JM trials during normal standing. When examining standing with back support, the young subjects demonstrated a significant difference in the amplitude of the H-reflex between control and JM trials during both the simple and complex tasks (P<0.05). The elderly subjects, in contrast, demonstrated a significant difference only in the simple postural task (P<0.05). CONCLUSIONS These results provide evidence of differential human spinal reflex modulation between young and elderly subjects. Further, these results may point towards the role of presynaptic inhibition in mediating these differences, and may lead to a more complete understanding of the different postural control strategies between young and elderly subjects.

Differential control of H-reflex amplitude in different weight-bearing conditions in young and elderly subjects.

OBJECTIVE This study measured the modulation of conditioned (femoral nerve, paired-stimuli) and unconditioned soleus H-reflexes in young and elderly subjects when changing weight-bearing (WB) requirements and body position. METHODS Conditioned and unconditioned H-reflexes were examined in 14 elderly subjects and 11 young subjects during six different WB conditions: (1) lying supine with no WB, (2) supine position inclined by 30° with 50% WB, (3) standing with 50%, (4) 75%, (5) 100% and (6) 125% WB. RESULTS The elderly subjects had consistently higher background soleus EMG activity across the WB conditions compared to the young. Femoral nerve conditioning caused facilitation of the H-reflex that changed across WB conditions in the young subjects, but not in the elderly subjects. Finally, elderly subjects had less depression with paired-stimulation (PRD) across WB conditions, which was not observed in the young subjects. CONCLUSIONS The elderly may have more direct activation of motoneurons from descending pathways, coupled with less segmental spinal control of inhibitory interneurons, as evidenced by the increased background soleus activity, H/M-max ratios and the lack of modulatory control observed when conditioning the H-reflex. SIGNIFICANCE There was an age-specific response from descending and segmental pathways during conditions that involved either different WB requirements or changes in body position.