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Assessing sensorimotor excitability after spinal cord injury: a reflex testing method based on cycling with afferent stimulation

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Abstract

Several studies have examined spinal reflex modulation during leg cycling in healthy and spinal cord injury (SCI) subjects. However, the effect of cutaneous plantar afferent input on spinal excitability during leg cycling after SCI has not been characterised. The aim of the study was to test the feasibility of using controlled leg cycling in combination with plantar cutaneous electrical stimulation (ES) cycling to assess lower limb spinal sensorimotor excitability in subjects with motor complete or incomplete SCI. Spinal sensorimotor excitability was estimated by measuring cutaneomuscular-conditioned soleus H-reflex activity. Reflex excitability was tested before and after a 10-min ES cycling session in 13 non-injured subjects, 6 subjects with motor incomplete SCI (iSCI) who had moderately impaired gait function, 4 subjects with motor iSCI who had severely impaired gait function, and 5 subjects with motor complete SCI (cSCI). No modulation of soleus H-reflex with plantar cutaneous stimuli was observed after either iSCI or cSCI when compared to non-injured subjects. However, after ES cycling, reflex excitability significantly increased in subjects with iSCI and moderately impaired gait function. ES cycling facilitated spinal sensorimotor excitability only in subjects with motor iSCI with residual gait function. Increased spinal excitability induced with a combination of exercise and afferent stimulation could be adopted with diagnostic and prognostic purposes to reveal the activity-based neurorehabilitation profile of individual subjects with motor iSCI.

Trial registration: ISRCTN26172500; retrospectively registered on 15 July 2016

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Acknowledgements

We are grateful for the continued support of the medical staff of the “Servicio de Rehabilitación”, for the help of the therapists at the “Hospital Nacional de Parapléjicos” in recruiting subjects with spinal cord injury, and for the time dedicated by all individuals who agreed to participate to this study.

Funding

This study has been supported by the “Ministerio de Ciencia e Innovación”, HYPER (CSD2009-00067) and the Commission of the European Union, BIOMOT (FP7-ICT-2013.2.1-611695).

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Authors and Affiliations

  1. Neural Rehabilitation Group, Cajal Institute, CSIC, 28002, Madrid, Spain

    Stefano Piazza, Diego Torricelli & José Luis Pons

  2. Sensorimotor Function Group, Hospital Nacional de Parapléjicos, 45072, Toledo, Spain

    Julio Gómez-Soriano, Diego Serrano-Muñoz, Gerardo Ávila-Martín, Iriana Galán-Arriero & Julian Taylor

  3. Toledo Physiotherapy Research Group (GIFTO), Nursing and Physiotherapy School, University of Castilla-La Mancha, 45072, Toledo, Spain

    Julio Gómez-Soriano

  4. Tecnológico de Monterrey, Monterrey, Mexico

    José Luis Pons

  5. Stoke Mandeville Spinal Research, National Spinal Injuries Centre, Aylesbury, HP21 8AL, UK

    Julian Taylor

  6. Harris Manchester College, University of Oxford, Oxford, OX1 3TD, UK

    Julian Taylor

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  1. Stefano Piazza
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  8. Julian Taylor
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Contributions

S. P. made substantial contributions to the conception, design and development, and acquisition of the data; data statistical analysis; and interpretation of the data. He was involved in drafting and revising the manuscript for important intellectual content.

D. T. made substantial contributions to the conception and interpretation of the data and in drafting the manuscript and its revision.

J. G.-S. made substantial contributions to the conception and design and interpretation of the data. He was involved in drafting the manuscript and its revision. He was also responsible for all manuscript changes during the peer review process.

D. S.-M. made important contributions to the data acquisition and interpretation of the data.

G. Á.-M. provided the technical support and made important contributions to the interpretation of the data and revising the manuscript.

I. G.-A. provided the technical support and made important contributions to the interpretation of the data and revising the manuscript.

J. L. P. made substantial contributions to the conception and was responsible for funding.

J. T. made substantial contributions to the conception and interpretation of the data and to drafting the manuscript and revising it critically.

All authors gave final approval of the manuscript for publication, agreeing all aspects of the work and ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Julio Gómez-Soriano.

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Ethics, consent, and permission

All applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during this research. The protocol was approved by the Toledo Hospital Clinical Ethical Committee (CEIC 07/05/2013, CEIC 15/07/2013, and CEIC 17/1/2012). All recruited subjects signed the informed consent form before the study commenced.

Conflict of interest

The authors declare that they have no conflict of interest.

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Piazza, S., Torricelli, D., Gómez-Soriano, J. et al. Assessing sensorimotor excitability after spinal cord injury: a reflex testing method based on cycling with afferent stimulation. Med Biol Eng Comput 56, 1425–1434 (2018). https://doi.org/10.1007/s11517-018-1787-2

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