The vibration reflex was studied in 49 patients with traumatic spinal cord lesions. It was elicited in all patients, even after presumably complete division of the cord. The vibration reflex consisted of a short-latency, brief outburst of phasic activity of motor units, followed by rapidly decreasing phasic component and a later slowly declining tonic component. When periods of vibration were repeated at short intervals of 2 to 10 seconds, the responses showed an approximately exponential decline, although the beginning of each subsequent response was always larger than the end of the preceding response. A large part of this decline can be characterized as a habituation of the vibration reflex. In comparison with the vibration reflex in normal subjects, the phasic component was increased and the tonic one reduced. The tonic component was especially susceptible to potentiation and dishabituation by voluntary effort to contract the vibrated muscle, even in some patients with no other evidence that the lesion was incomplete. We suggest that the tonic component of the human vibration reflex depends, at least in part, on segmental interneurons and their descending spinal pathways, while the phasic component depends mainly on the excitability level of spinal motoneurons.
Stimulation at frequencies from 1 to 50 Hz was applied over the dorsal surface of the lumbar enlargement in spinal cord injury subjects. Low-frequency responses appeared that were similar to compound motor action potentials (CMAPs) evoked by peripheral nerve stimulation. Close examination of the EMG response to higher frequencies (30-50 Hz) revealed that the EMG was comprised of a series of CMAPs of varying shape and amplitude. Under appropriate conditions, a constant train of stimuli evoked cyclic bursting activity. Examination of the characteristics of that activity revealed that intra-burst and burst phases were comprised of CMAPs of very different morphologies with markedly different latencies. These findings suggest that stimulation-induced activity was processed through different pathways, depending on the system state.
Abstract This chapter discusses how established procedures using physiotherapy, neuromuscular and peripheral nerve stimulation, and spinal cord stimulation can be used as restorative procedures. It describes how the same restorative neurological procedures can be used to assess motor control. It also presents the intrathecal application of Baclofen and intramuscular injection of botulinum toxin (Botox) as examples of interventions that do not take advantage of residual motor control but rather suppress it. Briefly, it describes how clinical restorative neurological treatment can best be practiced in medical centers where multidiscipline programs exist.