The effects of force, fatigue, alcohol, aspirin and caffeine on the...
Transcript of The effects of force, fatigue, alcohol, aspirin and caffeine on the...
DfGREf FOR W i C H THESIS WAS WSENTED' . GRADE POUR LEWbjCElTE THESE N T &S&VT~E
d YEAR THfS DEGREE C F ~ D / A N N & D'OBTENTICW DE CE GRADE 1979
- - - - - -
Pennissiorr is hw@y granted to the NATIOPJAl L W R Y OF L'au-torisation est, par la prgsente, accordge B la BIBL~OTH~?-
i CANADA to rnicrdi lrn this thesis and to lend or set t copies QUE NATIONALE DU CANADA de micrdilmer cette these et t
of me film. de p r h r tw de vendre des exemplaires du film.
The author reserws other publication rights, and neither the L'avteur se &serve Ies eutres droits de publicatim; ni fa
wise reproduced without the arthor's mitten pennissim. w sutreqmnt reproduits sans J'autorisatim Bcrite de I'auteur.
- - - -- -LA- --- P
The qualiry of this microfiche is W r y deplendent upon the quality of the originat thesis submined for rninofitrning. Every effon tbas been made to m r e the hiflhen quality of reproduction &bb.
- -
' tf are missing, contact the university which granted the degree.
+?
Some pages may have indistinct print especially if the miginat naa# were typed with a poor typewriter ribbon or if the university sent us a poor photocopy.
Reproduction in f u t t or in-part of this film is gav- emed by ttPe Cadian Copyright Act, R.S.C. 1970, c, C-30- ffease mad the authorization forms which aaxmgmy this tfreu's.
THtS DtSSERTATlON HAS BEEN MICROFILMED EXACTLY AS RECEIVEES
La quafit4 de cette microfiche &pend grandement de la qualitti de la t t h soumi* au microfilmage. Nous avons tWt fait pour assurer une qualith sufirieure de reproduction.
r ~ l manque des pages, veuinez communiquer avec I'univenite qui a confere le grade.
la qualite d'impresion de eertaines pages peut faisser a &sirer, surtout si les pages originales ont et6 dsctyfographith B I'aide d'un ruban u& w si I'univer- sit6 nws a fait pawenir une photocopie de mauvaise qua ti&
Les documents qui font dejB I'objet d'un droit d'auteur (articles de rewe, examens pubfib,. etc.) ne ~ ~ t . e f ~ . - -- - P-p -
La reproduction, d m e pslrtiefle, de ce microfilm est sbumise a la to i mnadienne sur k droit d'auteur, SRC 1970, c. C-30. Veuiliez prendre ccwrnaissance des farmules d'autm-sation qui accompagnent cette thk .
LA THESE A ETE MICROFILMEE TELLE QUE NOUS L'AVONS RECUE
THE EFFECTS UP FORCE, FATIGZfE, ALCOHOL,
ASPIRIN AND CAFFEINE ON TRE
Sunday Theoph i lus Eke-Okoro
B-Sc.. (Physiotherapy), University of Ibadan, N i g e r i a , 1975 -
- - - - - -
4- A THESIS SWMITTED IN PARTIAL FULFILLMENT OF
T m -REQUIREMENTS FOR THE DEGREE OF
.MASTER OF SCIENCE (KINESIOLOGY)
i n the Department
Kines io logy
Sunaay Theoph i lus Eke-Okoro 1979
Sf YON FRASER UNIVERSITY
J u n e 1979 /'
A l l r i g h t s r e s e r v e d . T h i s thesis may n o t b e - - - - - - - - - - - -- - -
-
- reFrmZucedl%wKoIe I n p=tT3y pho tocopy o r o t h e r mans, w i t h o u t peimission o f t h e aukhor.
PARTIAL COPYRIGHT LICENSE
I hereby grant to Sinon Fraser University the right to lend
my t h r i s or diesertation (the t i t l e of which i s rhom below) to users
of the Simon Ftastr Univers i ty Library, and to make partial or s ingle
e e p i e a only for- such users or in response t o a request f r m the library
-- - -- --- - - F a r ~ r d t i c a r T o n a 3 f n s r rtiitTi%t~%Tt s 'awn
behalf or for one.of its users. I fur ther agree that peredssiar for
w f t i p l e copying of t h i s rhesfs for scho>rly purposes lsay be granted -- -- -- - -- - pp - - - - - --- - - --
by me or the Dean of Graduate S t u d i e s . I t is understood that copylng
or publication of t h i s thesie for financial gain shall not be allowed
without my written permtssion,
Title of Thee is /D-
Author: - ( 8 igna tu re )
3 3 C
- (date)
Y a w : Sunday Theuphilus Eke-Okoro
Degree: Master of Science (~inesiology) *
Tit le of thesis: The effects o f force, fatigue, alcohol,
aspirin and caffeine on the Hoffmam
Examining Gmni t tee : - -
Qlainnan: f.1 .fi. Savage
d
T.K. Calvert Senior Supervisor
--
C.M. Davls Psychology Depar-tment
P.N. Bawa Kinesiology Department
ABSTRACT
The Hof fmann r e f l e x repyesents a ' r e l a t i v e l y unexplored ? -
phenomenon i n neurology and neurophysiology. I ts production -- -- - A- - - - - - - - - - - -
by e l e c t r i c a l s t imulus and i t s prominent responses make it
n o t only e a s i l y e l ' i c i t a b l e but a l s o r ead i ly q u a n t i f i a b l e . The
i t s presence i n the quadriceps femoris and h&an masseter has
been confirmed more recent ly . The purpose of t h i s study i s t o
use t h e H-reflex t o observe the e f f e c t s on the nervous system
of agents which have a widespread e f f e c t (a lcohol , a s p i r i n , and
ca f fe ine ) and agents which have a l o c a l e f f e c t ( f o r c e and
f a t i g u e ) , t o determine how sensLtive t e r e f l e x 'h for use as l"L a model of t h e nervous system and t o examine t h e p o s s i b i l i t y
of q u a n t i f i c a t i o n kn ref fex .testing.
Five paid undergraduate s tudents of d i f f e r e n t d i s c i p l i n e s
were used as sqbjects. The s u b j e c t ldy prone on = t a b l e with
pi l low supports for the head and ankle. A ground e l e c t r o d e was
s t rapped on t h e c a l f and su r face e l ec t rodes were placed j u s t ' - - - - - - - - -- - - - -- - -- - -- -- - - - -- - -- - - - - - --
below the c a l f . The s t imula t ing e lec t rode was a small cathode
placed i n the popl i teaf fossa while the i n d i f f e r e n t e l e c t r o d e
was l a r g e and placed j u s t below the p a t e l l a . Control recordings
were made j u s t be fo re t h e test condit ions were appl ied , c a r e -
iii
- - - -- -- ---
being t aken to ensure that s u b j e c t s d i d n o t al ter their
p o s i t i o n .
From the experiments i t was observed t h a t force, alcohol,
a s p i r i n , c a f f e i n e a ~ d f a t i g u e had s i g n i f i c a n t e f f e c t s on t h e
I t is suggested t h a t the f a c i l i t a t o r ~ e f f e c t s of alcohol
=d - d f e i ~ can be a -re QZ +he excitabilky oif- #e
nervous system. I t is inplied that q u a n t i t i e s of alcohol and *
c a f f e i n e great'eer than those used i n t h i s s tudy may n o t have
f a c i f i t a t o r y e f f e c t s and may have o t h e r non-benef ic ia l e f f e c t s
on the body. The e f f e c t of c o f f e e which was due t o i t s
caffeine c o n t e n t tf00-150 mg) was marked p o t e n t i a t i o n of the - - -
reflex and the direct muscle {MI response. This sugges t s an inc reased a r o u s a l of t h e nervous system.
The depres san t e f f e c t of a s p i r i n on the r e f l e x i n d i c a t e d
a depress ion of t h e nervous system, I t is known t h a t a s p i r i n
kills pain by depress ing pain r e c e p t o r s and suppress ing t h e
release o i b radyk in in - l i ke po lypept ides which produce pain .
projected t o be due t o inc reased feedback t o the h ighe r c e n t e r s
which f a c i l i t a t e the spinal c e n t e r s t o compensate f o r loss of
i v
force. Other observations in the fat5gue study w e r e the
gradual rise in i n t eg r a t ed EEfG (IEMG) and a marked depression
of the *response. fatigue produced by the method used i n this
ischemia than on neuromuscular j u n c t h f
-- - - - - --A
The reflex is projected as a d iagnos t i c tool for a number
of patholog ica l conditions and as a s e n s i t i v e measure of the - - - - -- - -- - - -- -- --
effects of drugs on the nervous system.
I w i s h t o express my s i n c e r e g r a t i t u d e t o D r . T. W.
Ca lver t , my Senior Supervisor , f o r h i s advice and support - -- - - -- -- - - - - - - - - - -
during this study. M y thanks -a lso go t o the o the r members of
t h e Thesis Committee ,for t h e i r guidance and a b i l i t y t o meet
even w h e n i t w a s impramp%& and ta khe A u d i o Y ~ ~ Depar-e
for making it poss ib le f o r m e t o produce acceptable f igures .
I would a l s o l i k e t o thank my.senior bor the r , Mr. Herbert
Eke-Okoro, f o r being a t r u e guardian.
TABLE OF CONTENTS f
A P P R O V A L . . . . . . . . . . . . . . . . . . . . . . . . . i i *
ABSTRACT. . . . . . . . . . . . . . . . . . . . . . . . . .iii ACKNCMLEDGEMENTS. . . . . . . . . . . . . . . . . . . . . . ,i
* . . . . . . . . . . . . . . . . . . . . . . LIST OF TABLES. x 6
L I S T O F F I G U R E S . , . . . . . . . . . . . . . . . . . . . . x i - ---- ~ LL-LAL-L---- ~~ --.. - ~ - -L- ~ ~ A
I .. INTR~DUCTION. . . . . . . : . . . . ' . . . . : . . 1
C h a r a c t e r i s t i c s o f the R e f l e x . . . . . . . . . - 4
r l i n i c a l a l l p r t a n ~ . ~ ~ , -, , , , * * * , * * - - * , -,- -4- - - - - -- 11. . R E V I E W O F TEE LITERATURE. . . . . . . . . . . . . 1 3
P h y s i o l o g i c a l Mechanisms Influencing the
. . . . . . H - R e f l e x , , . . . . . . . . . . . . . 1 4
V i s u a l Influences . . . . . . . . . . . . . . . 1 7
H e a d P o s i t i o n s . . . . . . . . . , . . . . . . . 1 7
Respiratory E T f e c t s T . . . . . . . . . . . . . . 1 8
. S l e e p . . . . . . . . . . . . . . . . . . . . . 1 8
C l i n i c a l A p p l i c a t i o n s . . . . . . . . . . . . . 1 9
P a r k i n s o n s ' s D i s e a s e . . . . . . . . . . . . . . 1 9 t
: Detection and A s s e s s m e n t of C e n t r a l , I
. . . . . . . . . Nervous Sys tern (CNS) L e s i o n s . 20
Determination of Motoneurone ~ x c i t a b i l i t ~ 22 1 . . . . i f !
Widely Accepted D i a g n o s t i c Areas . . . 22 . .
~- -- - - - -- - ~- -- -
- s A g e n t s u n d e r Study. 23 * . . . . . . . . . . . . . . .
vii '
- - - - - - - - -- -
1
/
Ill. MATERIALS AND HETRODS -. . . . . . . . . . . . . 25 1 - d 3
Experimental Object ives and Hypotheses . . , . . 25 Experimental Procedure . . . . . . . -, . . . . .. 28
F o r c e , . . . . . . . . . . . . . . . . . . . , 29
Alcohol. . . , , . . . . . . . . . . . . . . . 30 "
p i n ,,,. - - . . ., 2 4
C a f f e i n e . :. . . . . . . . . . . . . . . . . 31 4
Localized Fatigue. . . . . . . . . . . . . . . 31 -
---- - m. RESULTS. . . . . , .. . . . . . . . . . . . . . . 39 Data Analysis. . . . . . . . . . . . . . . . . . 4 5
Graphical Method . . . . . . . . . . . . . . . 4 5 ,'
Percentage Method. . . . . . . . . . . . . . . 45
Hmax/M Ratio . . , . . . . . . . . . . . . . . 46 - -
Histograms. . . . . . . . . . . . . . . . . . . 46
Measurements, . . . . . . . . . . . . .. . . . . . 47
N o r m a l . . . . . . . .. . . . . . . . . . . . . 50 Force. . . , . . . . . . . . . . . , , . . . . 50
A l c o h o l . , . . , . . . . . . . . . . . . . . 51 Aspirin. . . . . . . . . . . . . . . . . . . : 57
The Effec t s of Agents w i t h Widespread
Influence on
General. . Alcohol*
. Aspirin, ,
Caffeine .
. . f
the Nervous System. . 73
. . . . . . . . . . . . . . . . . . . . General. 76
. . . . . . . . . . . . . . . . . . . Force. ; 76 -
- - -- ppp- - - - - --- - - - -
. . . . . . . . . . . . . . . . . . . Fatigue. 77
. . . . . . . . . . ,Limitations and Future Work. 78 . I . . . . . . . . . . . . . . . . . . I . CONCLUSIUNS. 3 00
J - . . . . . . . . . . . . . . . . . . . . . . . . . APPENDIX A 81 . APPENDIX B . . . . . . . . . . . . . . . . . . . . 85 'r
Peak H - A r e p l i t d ~ s , ,- ,-, , -, ,--, ,-, , , + ,---, 83
Second to the Peak H-Amplitude . . . . . . ' . . . . . . . 84 . . . . . . . . . . Third to the Peak H-Amplitude. 84
. . . . . . . . . . . . . . Mean tias as (X,Y, 2 ) 85
. . . . . . . . . . . . . . . . . . . . . . . APPENDIX C 86
. . . . . . . . . . . . . . . . Standard Deviation 86
Deviations (6) . . . . . . . . . . . . . . . . . 86 . . . . . . . . . . . . . . . . . . . d squared. 87
zme.-hf kh3zSciaticme- - -- - 7 ,
The Lumbosacral Plexus 9
Method Used i n the ~ r o c G t i o n of the Hoffmann Reflex 11 - - ppp
Experimeritaf Design forp~laxed%asurements 33---
Experhental Design f o r t h e F o r q T e s t 35
Method Used to Study the. Effect of F a t j y u e on
the Hoffmann Reflex
H and M Recruitment Curves for a T y p i c a l Normal
-- - - -
Curves for T e s t and
with a Typical Subject t o Show Cont ro l Experiments
the Graphical Nethod of Data Analysis
p r i n t o u t Shwing the Effect on Stimulus I n t e n s i t y
1. Considered w i t h Control
-H and M Recruitmeat Curves with Alcohol compared
w i t h the C o n t r o l 55
12. I3 and M Recrui tment Curves f o r A s p i r i n 59
1 3 . H and N Recrui tment Curves f o r Ca f f e ine
Plotted with t h e Con t ro l
14. H o f fmaOl Ref lex Changes i*n Fat igue :
H and M Wave Response Curves, IEMG, and H/M R a t i o 63
1 5 . Hoffm d n Ref lex Changes i n Fa t i gue : _ -
The Experiment I l l u s t r a t e d i n F igure 1 4 was t
Repeated w i t h t h e Same Sub jec t .
i n Fa t igue
17. Bistograrn Showing t h e E f f e c t s of Tes ted Agents
0% t h e Hoffmann Reflex 69
xii
I. INTRODUCTION 1
A r e f l e x is a n a u t o m a t i c r e s p o n s e t o a s p e c i f i c s t i m u l u s .
and may b e med ia t ed by monosynap t i c , d i s y n a p t i c o r p o l y s y n a p t i c
pa thways , R e f l e x e s may be d e e p o r s u p e r f i c i a l . Deep r e f l e x e s a r e - - - -- - - - -- - - - -2
e l i c i t e d by s t r e t c h i n g m u s c l e s , ( e .g . t h e musc le s t r e t c h r e f l e x )
and s u p e r f i c i a l r e f l e x e s a r e produced b y - s t i m u l a t i n g t h e body
s u r f a c e , - ( e .g . t h e f l e x o r r e f l e x - c a u s e d by n o x i o u s s t i m u l i ) .
P a t h o l o g i c a l r e f l e x e s accompany d i s e a s e c o n d i t i o n s ; examples
i n c l u d e t h e B a b i n s k i r e s p o n s e and t h e g r a s p r e f l e x . Many
r e f l e x e s a r e e a s y t o tes t and are used t o m o n i t o r t h e
7 p h y s i o l o g i c a l s t a t e o f \ t h e neuromuscular sys tem. Al though t h e \ ---.
c h a r a c t e r i s t i c s o f a r e f l e x a r e n o t comple t e c o n f i r m a t i o n o f a
p a t h o l o g i c a l c o n d i t i o n t h e y may s u g g e s t it, w h i l e g i v i n g way to- --
more e l a b o r a t e methods o f e x a m i n a t i o n .
S t r e t c h r e f l e x e s are. i m p o r t a n t i n t h e c o n t r o l o f movement
and p o s t u r e . For t h e s e d e e p r e f l e x e s t h e r e c e p t o r s a r e musc le
s p i n d l e s and t h e g a i n s are c o n t r o l l e d by t h e h i g h e r c e n t e r s o f
t h e c e n t r a l n e r v o u s s y s t e m (Matthews, 1 9 6 8 ) . Thus i n upper motor
neu rone l e s i o n s ( p y r a m i d a l t r a c t l e s i o n s ) s u c h as- h e m i p l e g i a , t h e
s t r e t c h r e f l e x e s are f r e e d f r o m inhibition-EF-higkercenEers.- -
-m r e f - V e f o r e i n c r e a s ~ d 7 .L:- : m e s e aeep a m c ~ l l s r m a t - i s o f t e n c h a r a c t e r i z e d by c l o n u s . . U s u a l l y t h e t e s t i n g of
- - - - -- - * r e f l e x e s i n v o l v e s comparison wi th t h e o p p o s i t e body segments t o
de te rmine d e v i a t i o n from t h e normal, b u t t h e s e comparisons a r e
h a r d l y q u a n t i t a t i v e and canno t be f u l l y r e l i e d upon when
e s t i m a t h g t h e s e v e r i t y of a p a t h o l o g i c a l c o n d i t i o n . Thus t h e
need t o q u a n t i f y s p i n a l r e f l e x t e s t s canno t be overemphasized.
I t is f o r t h e purpose o f q u a n t i f i c a t i o n i n d i a g n o s t i c - -
r e f l e x o l o g y and f o r t h e e v a l u a t i o n of t r e a t m e n t - t h a t t h e
Hoffmann r e f l e x h a s become an impor tan t t o p i c o f r e c e n t
r e s e a r c h . Unques t ionably t h e r e f l e x h a s d e s i r a b l e
c h a r a c t e r i s t i c s f o r c l i n i c a l u s e , and t h i s r e s e a r c h is t h e r e f o r e - F;
d i r e c t e d towards d e t e r m i n i n g how t h e s e - c h a r a c t e r i s t i c s can be
b e n e f i c i a l l y u t i l i z e d .
The Hoffmann r e f l e x is a monosynaptic r e f l e x and it is t h e
e l e c t r i c a l e q u i v a l e n t o f t h e l e n d o n j e r k . I t was f i r s t ' desc r ibed
by Hoffmann, (1918) and was named t h e Hoffmann r e f l e x by
Magladery and McDougal, (1958) - Its s h o r t form d e s c r i p t i o n is
t h e H-reflex.
The s c i a t i c ne rve ( F i g . 1) from which t h e t i b i a 1 nerve
b ranches is t h e major n e r v e of t h e lumbosacra l p l e x u s (F ig . 2 ) - w i t h widespread r o o t s of o r i g i n i n t h e s p i n a l cord (L4,5,
4 - - - - - - -- -
S1,2,3), 1t is t h e l a r g e s t n e r v e i n the-human body and t h e
c e n t r a r m o t o r n e m n e poo l n n e r v a t e d muscles is extensi-.~ -Tii
view o f t h i s l a r g e motoneurone poo l , n e a r l y a n y t h i n g t h a t - (II
- -
a f f e c t s t h e lumbar and s a c r a l r e g i o n s w i l l a f f e c t some r o o t s of
t h e ne rve . The pr imary media to r of t h e g a s t r o c s o l e u s H-reflex i s
t h e t i b i a l nerve which is t h e l a r g e s t braneh of t h e s c i a t i c -
n e r v e , having c o n t r i b u t i o n from a l l i ts r o o t s , The H-reflex i s
o b t a i n a b l e i n t h e s o l e u s because t h e I a a f f e r e n t s are l a r g e r t h a n
t h e a l p h a motoneurone axons i n t h e t i b i a l nerve . The s e v e r a l f
r o o t s of t h e t i b i a l ne rve and i t s e x t e n s i v e c e n t r a l neurone pool
make t h e H-reflex a d i a g n o s t i c t o o l f o r morfitoring t h e n e u r a l
s t a t e of the l m b o s a c r a f r e g i o n and to some e x t e n t t h e s t a t e o f
t h e h i g h e r c e n t e r s .
. -
The method used t o produce t h e H-reflex is shown i n (Fig .
3 ) . E l e c t r i c a l pe rcu taneous s t i m u l a t i o n of t h e t i b i a & nerve
t a k e s p l a c e i n t h e p o p l i t e a l f o s s a . The s t i m u l u s (S) d e p o l a r i z e s
t h e a l p h a motoneurone axons r e s u l t i n g i n t h e development of
e l e c t r i c a l a c t i o n i n t h e e x t r a f u s a l f i b e r s . The M-wave
i n d i c a t i n g d i r e c t s t i m u l a t i o n o f t h e muscle t h e r e f o r e appears .
The s t i m u l u s a l s o c a u s e s a synchronous s t i m u l a t i o n o f t h e l a r g e
p r imary I a a f f e r e n t s g e n e r a t i n g an impulse t o t h e s p i n a l co rd
and t o h igher c e n t e r s . When t h i s impulse comple tes t h e
monosynaptic r e f l e x a r c , t h e H- r e f l e x is produced and is - - -- - -- - --
r e p r e s e n t e d by t h e H-wave recorded from t h e muscle. a
- - - - - - - - - - - - pp -
The a p p l i c a t i o n o f t h 9 e l e c t r i c a l s t i m u l u s a l s o produces a n
a n t i d r o m i c v o l l e y a long t h e l a r g e a l p h a motoneurone axons i n t h e
s p i n a l c o r d . When t h e s t i m u l u s is submaximal f o r t h e a l p h a
motoneurone axons , t h e a n t i d r o m i c v o l l e y w i l l g o t be s t r o n g
enough t o b lock t h e r e f l e x by c a l l i s i o n o r by a c t i v a t i n g s e v e r a l
Renshaw ce l l s . When t h e s t i m u l u s is maximal, t h e a n t i d r o m i c
v o l l e y ( F i g . 3) w i l l e l i m i n a t e t h e r e f l e x by t h e s e d u a l a c t i o n s .
C h a r a c t e r i s t i c s o f t h e R e f l e x
The H- re f l ex i s a monosynap t i c r e f l e x which is e l i c i t e d
w i t h modera te e l e c t r i c a l s t i m u l a t i o n b u t e l i m i n a t e d by maximal
s t i m u l a t i o n . The r e f l e x is due s o l e l y t o low t h r e s h o l d I a
a f f e r e n t s , m o s t l y f rom t h e t i b i a 1 b r a n c h o f t h e s c i a t i c n e r v e .
I t c a n be b locked by a n t i d r o m i c v o l l e y s and d e p r e s s e d by
p r e s y n a p t i c i n h i b i t i o n . The l a t e n c y rarlge i s appgox ima te ly 25 t o f a + , + +
30 m i l l i s e c o n d s and a m p l i t u d e r a n g e is approximate&y 0 . 4 4 t o 1.1
m i l l i v o l t s . The Hmax/Mmax r a t i o is i n t h e r a n g e 0 . 2 2 t o 0 . 6 9
(where tFmax and Mmax a r e maximum p o s s i b l e r e f l e x and musc le
r e s p o n s e s o b t a i n a b l e . d u r i n g expe r imen t ) . 4
C l i n i c a l Impor t ance
Owing t o t h e p r o j e c t e d impor t ance o f t h e H- re f l ex i n t h e
f i e l d o f n e u r o l o g y , it h a s become one o f t h e mos t s t u d i e d human
r e f l e x e s . Most w o r k e r s a r e i n agreement t h a t t h e r e f l e x f rom t h e - - - - - - -
s o l e u s and q u a d r i c e p s f e m o r i s c a n be o f use i n t h e f o l l y i n g - - - - - - - - - --
\
a r e a s : measurement and a s s e s s m e n t o f s p a s t i c i t y i n a v a r i e t y o f
m e d i c a l c o n d i t i o n s , d e t e r m i n a t i o n o f t h e e f f e c t i v e n e s s o f d r u g s ,
e .g. Levo-Dopa IL-Dopa) , Nembutal and Diazepam, e v a l u a t i o n o f
t h e p r e s e n c e of S 1 r a d i c u l o p a t h y , s t u d y i n g e a r l y e v e n t s i n
s p i n a l s h o c k , d e t e r m i n a t i o n o f m a t u r a t i o n i n t h e n e r v o u s sys t em
o f i n f a n t s , and t h e a s s e s s m e n t o f p rox ima l n e r v e c o n d u c t i o n i n
lumbar and s a c r a l d i s e a s e c o n d i t i o n s : Thus t h e r e is a g e n e r a l
need t o b e t t e r u n d e r s t a n d t h e meqhanism o f s p i n a l c o r d r e f l e x e s - - f
- -
and i n o r d e r t o d o t h i s , i t was d e c i d e d t o i n v e s t i g a t e t h e
e f f e c t s o f a v a r i e t y o f common a g e n t s which a r e known t o a f f e c t
The p r e s e n t r e s e a r c h w i l l i n v e s t i g a t e t h e e f f e c t s o f f o r c e ,
f a t i g u e , a l c o h o l , a s p i r i n , and e x . The
p o t e n t i a l b e n e f i t s o f t h i s \
u s e f u l t h e r e f l e x i s f o r u s e a s a model o f t h e n e r v o u s sys t em
and e x a m i n a t i o n o f t h e p o s s i b i l i t y o f q u a n t i f i c a t i o n i n t h e
&' t e s t i n g o f t h e r e f l e x . The w o ~ s h o u l d a l s o p r o v i d e a n / /
i n d i c a t i o n o f which n e r v e s i n t h e body have I a f i b e r s b i g g e r
t h a n t h e a l p h a motoneurone f i b e r s . I n t h e normal a d u l t s o n l y t h e
t i b i a 1 n e r v e , f e m o r a l n e r v e and n e r v e t o t h e m a s s e t e r musc le
have some f a f i b e r s b i g g e r t h a n a l l a l p h a motoneurones . I n
i n f a n t s many o t h e r n e r v e s c o u l d have l a r g e r I a f i b e r s , b u t a s
deve lopmen t takes p l a c e , t h e a l p h a motoneurones grow b i g g e r t h a n
c o n d i t i o n s , i f t h e 3 - r e f l e x c a n be e l i c i t ed i n c o n d i t i o n s where - - - - - - - - - - -
i t is n o t u s u a l l y p r e s e n t , t h e r e is an i n d i c a t i o n t h a t a l p h a
motoneurones have been a f f e c t e d .
I n Chapte r 2 , t h e h i s t o r y o f t h e H- re f l ex is rev i ewed and '
t h e l i t e r a t u r e o n i t s c l i n i c a l and r e s e a r c h a p p l i c a t i o n s i s
d i s c u s s e d . The l i t e r a t u r e on t h e e f f e c t s o f f o r c e , f a t i g u e ,
a l c o h o l , a s p i r i n , and c a f f e i n e on t h e n e r v o u s s y s t e m a r e
r ev i ewed . Chap te r 3 d e a l s w i t & e x p e r i r nen t a l . o b j e c t i v e s ,
hypotheses, equipment i t n d m e t h d s including e x p e r i t a e n t a l - --
p r o c e d u r e . I n C h a p t e r 4 , t h e methods o f d a t a a n a l y s i s a r e
d i s c u s s e d and t h e r e s u l t s o b t a i n e d from t h e d i f f e r e n t
e x p e r i m e n t s a r e r e p o r t e d , w h i l e Chap te r 5 c o n t a i n s d i s c u s s i o n
and c o n c l u s i o n s ,
11. REVIEW OF TEE LITERATURE
me description of the Roffmann reflex by H o f f m a n n i n 1918
marked a new era i n reflexology. A d e t a i l e d study of the r e f l e x
was made by Magladery and McDougal (1950) . They repeated
Hof fmnnn's experiraent by s t imulat ing the t i b i a 1 nerve i n the
popliteal fossa and obtaining the r e f l e x from calf muscles.
H-ref l e x as a shoxt form description ( F i g . 3) .
H-Reflex in Other H u s c e f s
Although the reflex was originally obtained from the c a l f .
muscles - (gas trocso leus) , other workers have searched for the
r e f l e x i n other muscles of the body, I t has been obtained from
the quadriceps fernoris by s t imulat ing the femoral nerve i n the
femoral triangle just belw the inguinal ligament {Mungia, 1972;
Guiheneuc and Ginet, 1974). The reflex has been obtained from
hman arnsseter by God2tux and Desabedt (1975) who stimulated the
masseter branch of the raandibu1a.r nerve, and from hand muscles
by percutaneous stirsufatiCm of the u h a r nerve of newborns and
3 n e mamas anit Eiadz~rt ;-%XO F % = e w o r o n e , - - e - - --
I , f r r L% U L ~ ~ T -s lt . la . * 2
suppressed w i t h age jThnn;ln and L a b e r t , 1960) It has also
been obtained f rasa Irax2.s of spastic patients tTeasdall, et al.
1952) .
Phys io log ica l Mechanisms In f luenc ing t h e H-Reflex
Having i d e n t i f i e d t h e r e f l e x i n man it became neces sa ry t o
i d e n t i f y the f a c t o r s which c o n t r i b u t e t o the r e f l e x and h& it . .
can be b e n e f i c i a l t o c l i n i c a l neurology. The r e l a t i o n s h i p
between motoneurone pools i n t h e s p i n a l cord and t h e H-reflex - -
has been s t u d i e d . J e f f e r s o n and Benson (1953) determined t h a t
between 12.5 t o 2 6 . 5 p e r c e n t of the motoneurone pool i n t h e
s p i n a l cord f i r e i n t h e product ion o f t h e H-reflex. Angel and
Hoffmann ( 1 9 6 3 ) showed t h a t t h e f r a c t i o n of motoneurone pool
involved i s r ep re sen ted by t h e H/M f r a c t i o n (where H and M a r e
B- and H-wave anpfitudes) . T a b r i k o v a (1966) i n i t i a l l y
r epo r t ed t h a t i n m a n 100 pe rcen t of t h e motoneurone pool i s
involved. When Taborikova and Sax (1968) repea ted t h e e a r l i e r
i n v e s t i g a t i o n s they concluded that as smal l a s 24 pe rcen t ,
u s u a l l y 50 p e r c e n t and sometimes v i r t u a l l y 100 p e r c e n t of
motoneurone pool could be involved i n t h e e l i c i t a t i o n of t h e
reflex. The fraction of mtoneurone pool f i r i n g depends on t h e
background f a c i f i t a t i o n during t h e experiment and can t h e r e f o r e
aibiays f a l l within h e ranges p o s t u l a t e d by both g r o u p s o f
~~~~~~~~~m-inf+ence is that t he s t z e n g t h o f t h e r e f l e x
de-ends on t h e g e n e r a l a r o u s a l of the nervous system.
The con t ro l of t h e H-reflex from t h e h igher c e n t e r s has I
been t h e s u b j e c t of controversy: Accumulating evidence is i n
favour of a t l e a s t some supraspina l cont ro l . J endrass ik ' s
manoeuvre ( a f t e r Ernes t Jendrassik, a Physician i n Hungary,
1858-1921) is a technique by which a s u b j e c t hooks t h e f i n g e r s
of two hands together and f o r c i b l y p u l l s one a g a i n s t t h e o ther .
The manoeuvre was o r i g i n a l l y used f o r t e s t i n g of t h e knee jerk
r e f l e x b u t now it is being used i n t e s t i n g o t h e r r e f l e x e s a l so .
The e f f e c t of t h i s manoeuvre on t h e H-reflex is t h a t of
f a c i l i t a t i o n (Mark, 1963; F e r r a r i , e t a l . 1966; and Bussel, e t
a l . 1978) . The mechanism by which Jendrass ik ' s manoeuvre
f a c i l i t a t e s t h e H-reflex i s no t completely c l e a r . Burg, e t a l .
(1974) reported t h a t p o t e n t i a t i o n of the r e f l e x i s due t o
fusimotor d r ive . Spindle a c t i v a t i o n i s o f t en accompanied by
some cont rac t ion of t h e e x t r a f u s a l f i b e r s meaning i n d i r e c t alpha
motoneurone a c t i v a t i o n . Bussel, e t a l . (1978) emphasized t h a t
f a c i l i t a t i o n of the Hoffmann r e f l e x is no t s o l e l y due t o gamma
e motoneurone a c t i v a t i o n b u t t h a t d i r e c t alpha motoneurone
a c t i v a t i o n could be an important con t r ibu t ing f a c t o r . '
Though- p o t e n t i a t i o n of t h e H-ref l ex by Jendrass ik ' s
manoeuvre has t o a l a r g e e x t e n t been a t t r i b u t e d t o fusimotor - - - - -- - - - - - - --
a c t i v a t i o n , Procaine block of fusimotor f i b e r s i s unable t o end - - p~
- ~
p o t e n t i a t i o n (Taborikova, 1973). I t i S the re fo re pos tu la ted
t h a t t h e supraspina l inf luences a p a r t from a c t i n g on gamma
motoneurones a l s o a c t on alpha motoneurones increas ing t h e i r
e x c i t a b i l i t y (Taborikova, 1 9 73) . In acute s p i n a l shock,
a r e f l e x i a is due t o t h e cessa t ion of supraspina l inf luences .
I t has been suggested t h a t s t imula t ion of t h e a n t e r i o r I
cerebellum reduces t h e e x c i t a b i l i t y of motoneurones and could
depress o r even e l imina te t h e H-reflex through presynapt ic
i n h i b i t i o n (Morris and Penn, 1978) .
Taborikova (1973) has surmised t h a t t h e following t r a c t s
a r e t h e routes f o r supraspina l inf luences on t h e Hoffmann
re f l ex : Cor t icospina l t r a c t (CST) t o the motoneurones and
s p i n a l interneurones; t h e r e t i c u l o s p i n a l t r a c t (ReST) t o the
s p i n a l motor cen te r and t o t h e motoneurones. The
ves t ibu losp ina l t r a k/ (VST) appears t o inf luence t h e moto-
neurones e i t h e r v i a t h e interneurones o r d i r e c t l y . n
The inf luence of the v e s t i b u l a r system on propriocept ive
r e f l exes of human lower limbs has been inves t iga ted (Delwaide
and Delbecq, 1973). They reported po ten t i a t ion of tendon
r e f l e x e s bu t n o t t h e H-reflex. Probably t h i s would i n d i c a t e
a pa thologica l condi t ion-
Visual Inf luences
Evidence of v i s u a l inf luence on the r e f l e x i s a v a i l a b l e
i n the l i t e r a t u r e . Using b l indfolded and eyes-open s u b j e c t s ,
Shashami(l977) s tud ied v i s u a l inf luence on t h e Hoffmann
r e f l e x . In t h i s s tudy , - re f l ex amplitude w a s depressed w i t h - - A
bl indfolded and enhanced with eyes-open subjec ts .
Po ten t i a t ion i n eyes-open sub jec t s could be due t o increased
s t imula t ion of the eyes compared t o t h e decreased s t imula t ion
of b l indfolded sub jec t s . This implies t h a t t h e f i r i n g r a t e of
t h e c e n t r a l nervous system i n eyes-open s u b j e c t s is g r e a t e r
than f o r b l indfolded sub jec t s .
Bead Pos i t ions
The e f f e c t of t o n i c neck r e f l e x e s on t h e H-reflex was
s tud ied by Isaacs , e t a l . (1968) They repor ted i n c o n s i s t e n t
r e f l e x changes a s soc ia ted with pos i t ions of t h e head and i t s
movements. Hayes and Sul l ivan (l976) reported g r e a t e r
H-reflex amplitude when t h e r i g h t l e g w a s t e s t e d with s u b j e c t
looking t o the r i g h t than i n any o t h e r head pos i t ion ,
Respiratory Ef fec t s
Forced i n s p i r a t i o n causes f a c i l i t a t i o n of the Hoffmann
r e f l e x b u t nonnal r e s p i r a t i o n produces no v i s i b l e e f f e c t s
(Bishops, e t a l . 1970). F a c i l i t a t i o n of t h e r e f l e x i n forced
i n s p i r a t i o n i s l i k e l y due t o t h e s t rong muscular con t rac t ion
a s seen i n Jendrass ik ' s manoeuvre. Although t h e gamma
motoneurones a r e t h e primary r e c i p i e n t s of f a c i l i t a t i o n
(Bishops, e t al. 1970) t h e alpha motoneurones a l s o con t r ibu te
t o r e f l e x f a c i l i t a t i o n .
Sleep
Hodes and Dement (1964) inves t iga ted t h e r e f l e x i n man
during low vol tage electroencephalograph (EEG) s l e e p and
not iced t h a t the r e f l e x was depressed i n rapid eye movement
(REM) s l e e p and enhanced i n relaxed wakefulness. A s i m i l a r
r e s u l t was e a r l i e r reported i n i n f a n t s odes and Gribetz ,
1963) . The pathways involved i n t h e depression of t h e r e f l e x
i n (REM) s l e e p have been s tud ied (Shimizu, e t a l 1966) .
C l i n i c a l Appl ica t ions
Parkinson ' s Disease
Changes i n tKe H-reflex i n Parkinsonian syndrome p a t i e n t s
have been s t u d i e d . While doing electromyographic s t u d i e s of
monosynaptic r e f l e x e s i n t h e s e p a t i e n t s I o ~ u , e t a l . (1965)
n o t i c e d abnormal f a c i l i t a t i o n of t h e r e f l e x e s . Inc rease i n
a lpha motoneurone e x c i t a b i l i t y i n Parkinsonism,was r epo r t ed
by McLeod, (1972).
P a r k i n s o n ' s ' d i s e a s e i s g e n e r a l l y t r e a t e d wi th L-Dopa, and
t h e e f f e c t of t h i s drug on t h e H-reflex has been i n v e s t i g a t e d ' d
i n p a t i e n t s (McLeod and Vander Muelen, 1972; Herbinson, 1973).
The f a c t t h a t L-Dopa depresses t h e ampli tude of t h e H-reflex was
obta ined by bo th groups of workers. I n h i s own s tudy of t h e ,
e f f e c t of L-Dopa on the r e f l e x , Sax, e t a l . (1976) suggested
t h a t t h e rate of r e y v e r y of depressed r e f l e x curve could be 1
used t o determine e f f e c t of medication on r e f l e x a c t i v i t y .
..
-
Detection and Assessment of Central Nervous System (CNS) Lesions
Measurement of t h e Hoffmann r e f l e x appears t o be a
s e n s i t i v e method of de tec t ing and assess ing upper motoneurone
l e s i o n s (Upton, e t a L 19 72) . Increased motoneurone
e x c i t a b i l i t y and hyper re f l ex ia i n p a t i e n t s with upper
motoneurone l e s ions have been reported by Magladery, e t a 1
(1952). Diamantopoulos and Zaner (1967) observed an i n i t i a l
decrease i n s p i n a l motoneurone e x c i t a b i l i t y followed -by
increased motoneurone e x c i t a b i l i t y . Garcia-Mullin, and Mayer
(1972) s tud ied a l l grades of vascular hemiplegia and observed a
decrease i n motoneurone e x c i t a b i l i t y within t h e f i r s t two days
compared t o t h e unaffected limb. In some hemiplegics whose
cases had become purely chronic , an increase i n motoneurone
e x c i t a b i l i t y was obtained. The r e f l e x was a l s o obtained from
t h e a m muscles of t h e chronic hemiplegics.
With t he production of t h e H-wave, a temporary depression
of t h e a n t e r i o r horn c e l l e x c i t a b i l i t y occurs, causing an
i n t e r v a l of 100 t o 200 mil l iseconds t o e l apse before another
13-wave can be produced (Magladery, e t a1.1952) . Campbell,
and Green (1964) have shown t h a t the i n t e r v a l - between two
successive H-waves decreases - i n cases - - of upper - - motoneurone -
l e s ions . The reduction i n i n t e r v a l they claimed i s due t o
f a c i l i t a t o r y impulses a r r i v i n g a t the a n t e r i o r horn c e l l s .
I n c l i n i c a l absen&s ( s e i z u r e s ) , it has been shown t h a t
i n i t i a l f a c i l i t a t i o n i s almost always followed by i n h i b i t i o n
of t h e H-reflex (Rabending, 1967). The marked succeeding in-
h i b i t i o n may be an at tempt by the body t o end t h e s e i z u r e by
reducing t h e excess ive sudden discharge of t h e grey matter.
Graphospasm i s a d i sease charac ter ized by d i f f i c u l t y i n
wr i t ing . Kaneko, e t al. (1966) s tud ied t h e H-ref l e x i n
p a t i e n t s with t h i s condi t ion, They obtained c a l f H-ref lexes
from t h e sub jec t s while wr i t ing t h a t d i d n o t d i f f e r markedly
from r e s t i n g normal s u b j e c t s ; i n the p a t i e n t group t h e H-wave
amplitude obtained while w r i t i n g was twice, t h e value i n
r e s t i n g s t a t e . I n normal sub jec t s t h e r e a r e l i t t l e o r no
a l t e r a t i o n i n H-wave amplitudes during son ic , p h o t i c
s t ~ u l a t i o n , mental a r i thmet ic and hypervent i la t ion (Sobue,
c i t e d i n Kaneko, e t al . 1966).
4 The r e l a t i o n s h i p between ankle je rk and Hoffmann r e i l e x e s
i n muscle dystrophy has been s tud ied by Singh, e t al. (1971). , r
They s tud ied t h e following types: Duchenne, ~ d b ~ i r d l e and
Facioscapulohumeral. I n t h e Duchenne type they repor ted
H-reflex being absent i n 7 of 11 cases with bilateral. ~ ~ J L I x - - - -
*
i e r k s . This would mean t h a t only 4 had H-reflexes. I n t h r e e
cases with u n i l a t e r a l ankle jerk, t h e H-reflex w a s absent on both
s i d e s . It w a s absent i n two cases where ankle je rks w e r e absent.
In the Limbgirdle type, H-reflex of small amplitudes was
p resen t i n 2 of t h e 5 cases s tudied where ankle je rks were
present . In t h e remaining 3 cases t h e r e w e r e no H-reflexes.
In the Facioscapulohumeral type, of the two cases s tud ied t h e
H-reflex was absent i n one i n which ankle je rk w a s absent , I n
t h e o the r case t h e ankle jerk was normal and an H-reflex of
s m a l l s i z e was produced (it i s poss ib le t h a t t h e I a a f f e r e n t
had been a f f e c t e d by the d i s e a s e ) . They concluded t h e i r tests
with the observation t h a t t h e H-reflex i s a more s e n s i t i v e
index than the ankle je rk .
Determination of Motoneurone E x c i t a b i l i t y
S tudies have been done on haw t h e H-reflex could be used
t o determine t h e e x c i t a b i l i t y of motoneurones (Yap, 1967; Tobin,
1969) . Got t l i eb and Agarwal (1972) studying t h e r o l e of t h e
myotat ic r e f l e x i n voluntary con t ro l of movement (voluntary
i sometr ic p lan ta r f l ex ions and dors i f l ex ions of t h e f o o t a t t h e
a n k l e ) , suggested t h a t the peak-to-peak amplitude of t h e H-wave
is propor t ional t o t h e s e n s i t i v i t y of t h e s p i n a l r e f l e x arc .
They a l s o observed enhancement of r e f l exes during s p a s t i c i t y .
The eventual prominence of t h e H-reflex as a d iagnos t i c
t o o l is the r e s u l t of i t s ingenious study by s e v e r a l wqrkers
(Angel and Hoffmann, 1963; Weaver, e t al.1963; Diamantopoulos
and G a s s e l , 1965; Guiheneuc and Ginet, 1973, 1974; Braddom and
Johnson, 19 74 ; Notermans and ~ i n g e r h o e t s , 19 74 ; and Schuchmann , 1976, 1978) . The use of t h e H-reflex as a d iagnos t i c t o o l i n
r o o t compression of L5 and S1 has been suggested by Notermans
an&.uirlgerhaeh (1974) ; and Schuchmann (1976, 1978) . Thex have- - --
shown t h a t la tency w i l l increase i n r o o t compression. The use
of t h e r e f l e x as a d iagnos t i c t o o l i n S1 root compression was
emphasized by Braddom and Johnson (1974) who enumerated severa l
workers' suggestions f o r c l i n i c a l app l i ca t ions a s follows:
a n t e r i o r t i b i a 1 muscle H-reflexes a r e d iagnos t ic (except f o r
i n f a n t s ) of c e n t r a l nervous system les ions from t h e brainstem
ros t ra lwards , i n proximal neuropathy and S1 radiculopathy the
H-reflex may be absent o r show a delayed la tency when present ,
t h e presence of t h e H-reflex i n t h e arm of i n f a n t s a f t e r t h e
age of one is d iagnos t ic of c e n t r a l nervous system immaturity
dysfunction.
Agents Under Study
Apart from loca l i zed f a t i g u e and fo rce , none of t h e agents
t o be s tud ied has been s tud ied v i a the H-reflex. The e f f e c t s of - -- --- -- --- -
l o c a l i z e d f a t i g u e on the H-ref lex have been reported by Hayes
C1975F, GZDietZ (1978) . Both workers reported p o t e n t i a t i o n of
t h e r e f l e x i n f a t igue . Other r e l a t e d experiments on f a t i g u e
include, Romanul (1965) ; Stephens and Taylor (1972) ; and
Stephens, e t a L ( 1 9 7 3 ) who showed a depression of the EMG
amplitude i n f a t igue .
Got t l i eb and Agarwal (1972) demonstrated p o t e n t i a t i o n of ,
t he H-reflex with p lan ta r f l ex ion and depression wi th
dors i f lex ion . Dming p lan ta r f l ex ion , a s t h e force in the c a l f
muscles increased, t h e H-reflex increased r e f l e c t i n g increased
f a c i l i t a t i o n of t h e t r i c e p s motoneurone pool. During
dors i f leqdion; when t h e t ibia1i.s muscle is Contracting, t r i c e p s
alpha motoneurones rece ive rec ip roca l i n h i b i t i o n and hence t h e
H-reflex is depressed.
I11 : MATERIALS AND METHODS
1
Experimental Object ives and Hypotheses
One purpose of t h i s study is t o explore t h e e f f e c t s of
some agents which have a widespread inf luence on the nervous --
system (a lcohol , a s p i r i n , ca f fe ine ) on t h e H-reflex. A second
purpose was t o study the e f f e c t s of loca l i zed phenomena ( fo rce
and f a t i g u e ) . The i n t e n t was t o v e r i f y how s e n s i t i v e the
r e f l e x is f o r use a s a model of t h e nervous system, t o examine
the p o s s i b i l i t y of q u a n t i f i c a t i o n i n r e f l e x t e s t i n g and t o s e e
har it could be b e n e f i c i a l i n understanding s p i n a l mkor cantxol,
It was hypothesized t h a t a lcohol of t h e quan t i ty t o be used
in t h i s study would p t e n t i a t e the H-reflex. L m , e t a L (1962)
have shown t h a t l a w concentrat ions of alcohol f a c i l i t a t e , -C
human neuromuscular junct ions. Aspir in may depress t h e H-reflex
s i n c e i t i s able t o suppress pain and headache which are of
nervous o r i g i n , Caffeine would be expected t o p o t e n t i a t e t h e
the H-reflex (Gottlieb and Agarwal, 1 9 7 2 ) . In this study
sustained force wauld b& applied and as such a depression of the
El-reflex would be e x p e c m * d . Fatigue may potent ia te the r e f l e x , ,
as such an effect w a s reported by Hayes i n 1975.
%r
.Xethods and Equipmerit
-- -- f i v e noma1 mafe Waergra&ate students between the ages
4 a,
3 .
of 19 and 28 were chosen as subjects.\ ..They were selected on the %
b a s i s that their H-reflex was easily e l , i c i tab le from their calf - - - - - -
e
suscles and that they had accepted the condit ions of the
experiments by s icping the subject consent forms-see Appendix -
Af .
head
mey w e r e all ?aid f o r their s e r v i c e s , .
~ u b j e c t s l a y prone on a table with pi l l ow support for the
and a n k l e s . They w e r e c a m p l e t e l y relax& d w e r e not i
allowed to move f r o m the correct p o s i t i o n . The neck 'zfemained
s t r a i g h t such that the head was not turned to any s i d e during
the period of the expr iment . Tfie pillow support for the Can)cle
served a- dual purpose. F i r s t l y , it contributed with another
arrang-nt below it to maintain the ankle and knee at the
reqaired angles. Secondly, it improved the subject's relaxation ;
by releasing tension in the h a s t r i n g s . The angle between the
flexion (Fig, 4 ) .
The ground electrode (16x2 a) w a s placed on the middle of
the c a l f such that it fitted the circumference of the l e g , and
was connected to the BE preamplifier. The recording surface
e l e c t r o d e s w e r e p f a d 3 a. apart at the lower border o f the
ca l f along the midlinel These elecixodes were then connected
of a large anode (6x4 cm.) placed just below the pate l la and a
s m a l l cathode of diameter 3 . 2 cm. T h e cathode was placed on
was d i r e c t l y below it.
The stimulating current was drawn from an Ortec 4710 Dual
Channel Stimulator. The c u r r e n t passed through an SIU 4678
Grass i so la t ion unit t o which the electxodes were connected. - - - - - -
Xectangular wave pulses of 0 . 7 to 1.0 milliseccmds duration were
used i n a l l experiments, Stimulus was also fed to the TECA EMG
Unit to produce a stimulus channel on the output display for
comparison with the channels.
Connections from the s t imula tor and TECA EMG U n i t t o the
osc i l loscope i n f r o n t of the sub jec t made it poss ib le for the
output t o b e displayed. T h i s arrangement made it poss ib le fo r
the subjec t t o a t t e a p t t o a l t e r the r e f l ex and a l s o fo r the
experimenter t o determine when the r e f l ex response had been
obtained. For the purpose of this research, both the 8- and - L
H-waves were required.
Ln addition W tests in a relaxed s t a k e , the ~ e f l e x was
a l s o s tudied w i t h muscular e f f o r t . I n t h i s case the s u b j e c t ' s
t e s t foot was comfortably strapped onto a force tranducer t h a t
was connected t o an amplif ier which formed a channel of the TECA
EMG U n i t . The amount of force exerted by the foo t of the sub jec t
was displayed on the osci l loscope and voluntary fo rce regula t ion
was poss ib le a s the sub jec t could see the d i sp lay i n f r o n t of
him. The re f l ex was recorded w i t h d i f f e r e n t force values t o he lp
determine how d i f f e r e n t force l e v e l s a f fec ted the r e f l e x
response. a lues were measured w i t h the force transducer P6-.
which was c a l i b r a t e d w i t h a known force value before each
experiment ( f i g . 5 ) .
Zxper i s e n t a l Procedore
The followinggexXX=r iaentsf measurements were made: --
I. a . %- and H-waves in t he normal relaxed s u b j e c t s ( s t i m u l u s
only) . B- and M-wave changes with fo rce i n the normal
relaxed s u b j e c t s . H- and M-wave changes with alcohol i n t h e relaxed . sub jec t s .
H- and Mrwave changes with a s p i r i n i n the- relaxted- - --
sub jec t s .
H- and M-wave changes with ca f fe ine i n relaxed
sub jec t s .
H- and M-wave i n loca l i zed fa. t igue of t h e c a l f
muscles.
The experiments were done i n the same o rde r f o r a l l
sub jec t s . There was an i n t e r v a l of a t l e a s t one day between
one test and another. Subjec ts were advised before t h e day - -
of each test n o t t o take any of the agents as food before
r epor t ing f o r experiment. When sub jec t s repor ted f o r . t h e
experiment they w e r e again asked by the experimenter what they
had taken f o r a meal j u s t before repor t ing f o r t h e tests.
Force
This involved app l i ca t ion of sus ta ined and regula ted fo rce , - - - - - ---- - - - -
the force transducer having been previously c a l i b r a t e d wi th a - - -
known i o rce . The sub~ect e x e r t e a regula ted ro rce on the E O r C e
t r ansduce r and record ings of t h e r e f l e x were made a s soon a s -3 t h e r equ i r ed f o r c e va lue was seen on t h e o s c i l l o s c o p e .
Alcohol
A 6 oz, g l a s s of L a b a t t ' s Blue b e e r (5% a l coho l ) w a s g iven
t o each s u b j e c t and a f t e r wa i t i ng f o r one hour f o r t h e a l c o h o l
t o e n t e r t h e c i r c u l a t i o n , t h e r e f l e x was monitored (blood
a l coho l concent ra t ion reaches peak va lue one hour a f t e r i n t a k e ,
J (Wallgreen and Barry, 1970) . For average s u b j e c t t h i s
! would g i v e a blood a l coho l concent ra t ion of 0.012 p e r c e n t (6 oz.
of whiskey f o r average ' s ized man i s about 0.12%, Cohen, 1966) .
Aspi r in
A dose of two a s p i r i n t a b l e t s (10 g r . ) w'as given i n each
case . Asp i r in c o n t e n t of t h e blood reaches i t s peak between
1.5 t o 2 hours a f t e r it has been taken (Wilson, e t a l . 1975) . Thus H-responses w e r e recorded 1 .5 hours a f t e r a s p i r i n had been
taken.
C a f f e i n e
S u b j e c t s were g i v e n a t e a c u p f u l l o f Nescafe brand i n s t a n t
c o f f e e (1.3 g ) . I t was a normal l i g h t c o f f e e ( c a f f e i n e c o n t e n t
a b o u t 100-150 mg.). Recordings were made a f t e r one hour when
much of t h e c o f f e e was expec ted - - t o have been d i g e s t e d and pa-ssed _
i n t o t h e g e n e r a l c i r c u l a t i o n .
\ Loca l i zed Fa t igue
The s u b j e c t s tood on h i s t o e s on one l e g wi th t h e weight on
t h e f r o n t o f t h e f o o t (F ig . 6 ) ; t h e hands were used t o main ta in
ba lance . The p o s i t i o n o f t h e f o o t remained unchanged throughout
t h e p e r i o d of t h e exper iment . The r e f l e x was moni tored every
minute u n t i l t h e s u b j e c t c o u l d n o t c o n t i n u e ; each t i m e a
r e c o r d i n g was made t h e p o s i t i o n o f t h e h e e l above t h e wooden
p l a t f o r m was checked. T h i s was done by p l a c i n g a s m a l l c a r t o n
below t h e h e e l such t h a t t h e h e e l j u s t f e l t it d u r i n g t h e
r e c o r d i n g p e r i o d .
For a l l t h e a g e n t s t e s t e d , t h e s t i m u l a t i o n v o l 1 a g e s
depended on t h e a b i l i t y of t h e s u b j e c t t o endure
s t imul i r s pu l se mpmtuae r a n g a b e t w e e T 2 4 a i i ~ ~ m v ~ t ~ ;
- - - -
The EMG a m p l i f i e r s e n s i t i v i t y was between 100 and 500
m i c r o v o l t s per d i v i s i o n w i t h a sweep d u r a t i o n o f $00
m i l l i s e c o n d s pe r d i v i s i o n . The paper speed was u s u a l l y 50
c e n t i m e t e r s pe r second and t h e low and high c u t o f f f r e q u e n c i e s
of t h e EMG a m p l i f i e r s we- set a t 50 h z t o 5 Khz r e s p e c t i v e l y .
The f requency of s t i m u l a t i o n was one s t i m u l u s p e r f i v e seconds.
- , I
SO
LA
TIO
N
ST
IMU
LA
-
I
UN
IT
TO
R
+
I,
I *
EM
G
+
PR
E-
,
OS
CIL
LO-
L
AM
PL
IFIE
R
SCO
PE
I'
R
EC
OR
DE
R
b
I O
SC
ILLO
-
- pL - -
c. <. *
I
IV. RESULTS 4 -
I n o r d e r t o o b t a i n u s e f u l i q f o r m a t i o n from t h e e x p e r i h e n t a l
d a t a , i t was n e c e s s a r y t o c o n t r o l , wherever p o s s i b l e , f o r . s y s t e m a t i c and random v a r i a t i o n s in t roduced by a number o f - .
- -
f a c t o r s . T h i s is b e s t unders tood wi th t h e a i d o f d iagrams
showing t y p i c a l d a t a c o l l e c t e d i n an exper iment ( F i g . 7 and 3).
These f i g u r e s a r e t y p i c a l of t h e v a r i a t i o n s o f H- and
M-wave ampl i tudes w i t h s t i m u l u s v o l t a g e f o r most e x p e r i m e n t a l
s i t u a t i o n s and d a t a were b o l l e c t e d . t o a l l o w s-uch c u r v e s t o be ..
drawn f o r a l l exper iments e x c e p t t h o s e i n v o l v i n g f a t i g u e . The
c u r v e s l a b e l l e d H(c) and H(c ) r e p r e s e n t d a t a c o l l e c t e d under a
norial o r c o n t r o l s i t u a t i o n and B ( s ) and Hfsj r e p r e s e n t d&- ' - - -
c o l l e c t e d under a n e x p e r i m e n t a l s i t u a t i o n (e.g. w i t \ a l c o h o l ) .
The f o l l o w i n g p o i n t s summarize t h e d i f f i c u l t i e s i n
a n a l y z i n g d a t a i n t h i s s t u d y .
1. For a g i v e n s u b j e c t i n a g i v e n exper iment , t h e response
c u r v e s w i l l v a r y w i t h t i m e . T h i s can be due t o changes a t
t h e sk,in e l e c t r o d e i n t e r f a c e f o r bo th s t i m u l a t i n g and
recofding erectyodes a n d t o c h a n g e s p i n t h e i i t e r n a s t a t e P o • ’
* w i . These changes c a n be c o n t r o l l e d f o r by running a
repea ted c o n t r o l (normal)
Figure 8 H and M recruitment curves for test
and control experiments with a - - - - -
typical subject t o show the g&phical
method of data analysis
response / s t imulus c u r v e s o r , where t h i s is n o t p o s s i b l e
( e .g . a f t e r a l c o h o l h a s been a d m i n i s t e r e d ) , by us ing t h e
M-wave ampl i tude a s a c o n t r o l f o r t h e H-wave.
For a g i v e n s u b j e c t , when d i f f e r e n t exper iments a r e
conducted on d i f f e r e n t d a y s , t h e response c u r v e s may va ry
due t o s m a l l e r r o r s i n e l e c t r o d e placement . The s t i m u l a t i n g
e l e c t r o d e is p a r t i c u l a r l y d i f f i c u l t t o r e p l a c e w i t h accuracy
s i n c e v e r y s m a l l changes cause d i f f e r e n t motor and s e n s o r y
f i b e r s i n t h e n e r v e to he s t i m u l a t e d , This is c o n t r o l l e d f o r
by running new normal r e sponse curves f o r each exper iment .
For d i f f e r e n t s u b j e c t s , t h e r e w i l l be d i f f e r e n t r e sponse
c u r v e s f o r t h e r e a s o n s s t a t e d above and because o f <I
d i f f e r e n c e s between t h e s u b j e c t s . The o n l y c o n t r o l iS t o run
normal r e sponse curves . The M-wave is n o t a u s e f u l
i n t e r - s u b j e c t c o n t r o l .
Having e s t a b l i s h e d c o n t r o l s f o r each exper iment , i t is necessa ry . t o choose comparable f e a t u r e s on t h e response curves . The most
prominent f e a t u r e is t h e maximum of t h e H-wave response (Hmax)
and t h i s is s e l e c t e d f o r measurement. The d a t a is t h e n analyzed
e i t h e r by comparing v a l u e s o f Hmax d i r e c t l y , Hmax (s) /Hmax (c) o r ,
by f i r s t normal iz ing by d i v i d i n g t h e Hmax by t h e cor respond ing
where M ( s ) and M(c) a r e H-wave ampl i tudes o b t a i n e d w i t h Hmax (s)
and Hmax ( c ) respect ive ly .
The quest ion t o be answered i s whether i n t h e experimental
s i t u a t i o n Hmax(s) i s s i g n i f i c a n t l y d i f f e r e n t from t h e re l evan t
c o n t r o l Hmax(c). Since each experiment muqt be compared with
i t s own con t ro l , the d a t a is normalized by d iv id ing by t h e
c o n t r o l value Hmax (c ) ( see Appendix B) . . - -
Data Analysis
The methods used i n d a t a a n l y s i s include t h e graphica l
method employed by Dietz (1978), t h e percentage method used by
F i she r , e t a 1 (1979) , maximum H-amplitudes, Hmax/M r a t i o s , and
histograms.
1. Graphical method: H- and M-amplitudes w e r e p l o t t e d aga ins t -
voltage on t h e same s c a l e f o r test and con t ro l . For t h e
f a t i g u e experiment, ,a graph of H- and M-amplitudes,
i n t e g r a t e d EMG (IEMG) and H/M r a t i o s w e r e p l o t t e d on
t h e same s c a l e aga ins t t i m e .
2 . Percentage method
Po ten t i a t ion = ( H ( s ) - H(c) 1 & H (c)
Depression = ( H ( c 1 - H ( s ) I x loo H (c)
H(c) i s con t ro l maximum H-amplitude.
- - -
3 . H-amplitudes: This method involved obta in ing t h e h ighes t '
t h r e e values of H-amplitudes f o r t h e test and comparing
them with t h e h ighes t t h r e e H-amplitudes f o r t h e con t ro l .
The t h r e e value method was bel ieved t o be more r e l i a b l e
than the peak value alone. Potent ia t ion o r depression was
determined by H(s)rnax/H(c)max (when i.t i s observed t h a t t h e
t h r e e peak va lues were g r e a t e r thafi 1, then t h e r e was
po ten t i a t ion ; if equal t o 1, no change i n r e f l e x w a s
reported; and if less than 1, a db$*ssion of r e f l e x was
noted.
4 . Hmax/M r a t i o : In this method po ten t i a t ion o r depression
was determined by considering t h e H/M r a t i o f o r both
con t ro l .and t e s t condi t ions thus
Po ten t i a t ion o r depression = (Hmax/M(s) )
where (s) i n d i c a t e s t e s t condi t ion
( c ) i n d i c a t e s con t ro l ,
5. Histograms: The H-amplitude values obtained
i n ( 3 ) f o r each experiment with each s u b j e c t were normalized
by d iv id ing by t h e corresponding con t ro l values. These were
then averaged and p l o t t e d a s a histogram i n Figure 17, where
t h e ba r s i n d i c a t e t h e s tandard devia t ions f o r each test, - - - - - -- - - - - - -
C
* Measurements
H- and M-waves amplit%des were measured from t h e peak of
the wave _ t o its - lowest poi-nt i r r e s p e c t i v e of t h e position__of_
t h e base l ine (Fig. 3 and 9 ) . The measured values w e r e i n
m i l l i m e t e r s b u t were l a t e r converted t o m i l l i v o l t s by making "
- -
use of €3ie E3TG s e n s i t i v i t y used.
The i n t e r v a l la tency period was measured from t h e beginning
of t h e s t imulus t o t h e beginning of the H-wave. This value was
obtained i n m i l l i m e t e r s and converted t o mil l iseconds by making
use of t h e EMG paper speed (Fig. 3 and 9 ) . - -- ---
The H-reflex w a s obtained with submaximal s t imulus f o r t h e
alpha motoneurone, and it appeared before t h e muscle response.
I n a l l b u t one s u b j e c t t h e H-wave d i d n o t appear below 40 v o l t s
of t h e s t imulus, In one s u b j e c t it occurred as l o w as 24 v o l t s
of s t imulus s t r e n g t h (Fig. 9).
. Figure 9 P r i n t o u t showing the e f f e c t on
stimulus i n t e n s i t y on the H and M
responses
The c h a r a c t h s t i c s of t h e H-wave depended- on t h e following
f a c t o r s : condit ion under test, st imulus vol tage and s u b j e c t ' s
s e n s i t i v i t y , e l ec t rode placement, EMG s e n s i t i v i t y , whether
s u b j e c t was relaxed o r tensed up, Ggle between t h e p o s t e r i o r
su r faces of t h e th igh and l e g ( t h e b e s t angle range used w a s
115 t o 125 degrees) , and the ankle angl; (midplantarf lexion
range) .
Normal
C
The ranges of H-wave'.amplitudes were between 0.2 and 1.5
m i l l i v o l t s with' t h e mean range between 0.4 and 1.0 m i l l i v o l t s
(Tables 1 and 4 ) . The Hmax/M r a t i o range was 0.46 t o - 3 . 8 0 .
The mean value of t h i s r a t i o was 2.24 f o r a l l s u b j e c t s able 2 ) . The &nax/max r a t i o had a rangelof 0 .22 t o b.69 and a mean value
1
of 0.46 f o r a l l s u b j e c t s able 3) . . The response curves f o r t h e !
a H-kef l e x and t h e M-wave o f ' a s u b j e c t a r e shown ' in Figure .7.
Force
4
Submaximal phas ic fo rces po ten t i a t ed t h e H-reflex b u t
maximal sus ta ined fo rces depressed t h e r e t l e x . The o v e r a l l
e f f e c t s of force - on the - H-reflex - - - and - t h e M-wave - - - a r e - - - shown - - - -- i n - - - - - -
Figure 10 f o r a t y p i c a l sub jec t . - - - - - - -- ----- -- - - - - - - - - - -- - -- -- - -
1.57 millivolts with a
(~ables 1 and 4) . The 10.6% for all subjects.
The H-amplitude range was 0.17 to I
- mean range of 0.44 to 1.34 millivolts - -- - A - - a -
mean potentiation of the H-reflex was
A* typical response curve with alcohol is shown in Figure 11.
The - f imax/~ range for alcohol for all subjects was 3
-
5.0 with a mean of 2.42 (Table 2). Thg Hmax/Mm&
0.63 to 0.87 with a mean of 0.77 for all subjects
ratio was
(Table 3).
Asp i r in
I n a l l b u t one s u b j e c t a s p i r i n d e p ~ e s s e d t h e H-reflex as
shown by t h e response curves -of a t y p i c a l s u b j e c t i n F igure 12.
The mean depress ion of t h e r e f l e x f o r a l l s u b j e c t s w a s 13.7%.
H-amp1 i-tde r a n g e fTab3es 1 and 4 ) , was 0.25 t o -1.2 5 rni31ivo~~s- - -
w i th a mean range of 0.32 t o 0.93 m i l l i v o l t s f o r a l l s u b j e c t s . '
The Hmax/M range f o r a s p i r i n w a s 0.65 t o 5.0 and a mean va lue -
of 1.80 (Table 2 ) . Asp i r in showed a range of 0.42 t o 1.6 wi th
a mean va lue o f 0.83 f o r a l l s u b j e c t s (Table 3) . .
Caffe ine
CaEfeine l&ered t h e s t i m u l u s t h re sho ld for t h e - - -
e l i c i t a t i o n af t h e H-reEIex i n a l l s u b j e c t s and i s i l l ~ ~ t r a t e d
f o r a t y p i c a l s u b j e c t i n F igure 13. The mean potentiation of
t h e r e f l e x was 18%. The 3-wave -amplitude range 5or c a f f e i n e
, (Tables 1 and 4) w a s 0.25 t o 1.75 m i l l i v o l t s w i th a mean range
of 0.54 t o 1.33 m i l l i v o l t s f o r a l l s u b j e c t s . The Hmax/M ratio
range f o r c a f f e i n e w a s 1.0 t o 3.0 and a mean of 1.94 f o r a l l
s u b j e c t s (Table 2 ) . The Hmax/max ra t io range was 0.32 t o 0.94
---A --
. , P
Localized Fatigue
\
~ o c a l i z e d f a t i g u e of t h e c a l f muscle; . r e su l t ed i n a
p o t e n t i a t i o n of t h e H-reflex and a depression of t h e M-wave 6
(Figs. 1 4 , 15, 16) . A p o t e n t i a t i o n of 9.3%' was recorded as a ' z
mean f o r a l l sub jec t s . The H-wave amplitude *?ange was 0-18- %Q ---- - - -
1.27 m i l l i v o l t s wi th a mean range of 0.54 t o 1 . 2 m i l l i v o l t s f o r
a l l sub jec t s (Tables 1 hnd 4 ) . The Hmax/M range was 0.53 t o
3.9 and a mean of 1.81 f o r a l l sub jec t s (Table 2 ) . A range of
0.51 t o 2.07 was obtained f o r Hrnax/Mmax r a t i o able 3 ) . The
histograms (Fig. 17) show t h e magnitude of t h e e f f e c t s of a l l
t h e t e s t e d agents on t h e H-reflex and t h e i r staridard devia t ions
( see Appendix C) ,
, . I n t e r v a l la tency time was measured a t supramaximal .vol tages
when H-wave depression w a s high. Measurement was taken i n t h i s
condi t ion because la tency values were c o n s i s t e n t f o r t h e s u b j e c t
and measurement po in t s w e r e w e l l defined. There w a s a la tency
range of 27 t o 32 mi l l i seconds with a mean value f o r a l l
s u b j e c t s of 29.71 mil$iseconds. H-latency w a s n o t a f f e c t e d by -- -- - - - - - --- -
- - --
any of t h e con=tiuxTs t e s t e d ,
Figure 1 4 Hoffmann re f l ex changes i n fat igue:
H aqd M wave response curves, - - - - - --
IEMG, and, H/M r a t i o
Figure Eoffmann reflex changes i n fat igue:
the ekperiment i l l u s t r a t e d i n Figure
was repeated w i t h the same subject
TABLE 1 Hmax RANGES
CONDITION RANGE
Normal 0 . 8 - 1 . 1 5
Alcoho l f .25-1.57
A s p i r i n 8.8-1 - 2 5
Caffeine 8.75-1.65
- -- F a t i g u e - - - - -07 88-& 0-M
CONDITION RAHGE
fformal f ,46-3,8@
Aspirin 8.65-5.0
Caffeine
Fatigue %,53-3.9
MEAN
1.a
1 . 3 4
0.93
1 . 3 3
1 2 ~ 7 - ~
MEAN
2 . 2 4
CONDIT~ON - RANGE Normal -
/' Alcoho l j
A s p i r i n
Caffeine
Fatigue -
mE 5 PATlCUE
PARAMETER 1
H-AMPLITUDE
B/W ratio
H-antpl itudc
I EHG
PERCENTAGE CHANGE
20-116
98-216
5 0 4 % - - - - -
38-55
\ W N RANGE
TYPE OF C H z NGE
I n c r e a s e
1 n c r e a s e
Decrease
I n c r e a s e
V. DISCUSSION
The Ef fec t s of Agents with Widespread Influence on the
Nervous System
The experiments indicate that the H-reflex i s a sensitive
quite different agents un the ~&rvous system. Because of this, t-
there is reason to expect that t h i $ r e f l e x can senre a s an
easily accessible .model for testing the general effects of
drugs on the CNS, Of course i ts use with each new agent w i l l
have to t>e considered separately. Further study is necessary - - - - - - -
to investisate the ef •’e& of different d&es w i t h the agents
t e s ted here. \
There w a s narked potentiation of the ffoffraannreflen and
the *response one h u u after subjects drank a 6 oz. glass of
m a t t % beer f 5% a1 mhof, about 0,012 percent blood
i n a l l s e e pp-
- cancen &tiat:- Tfte -g6tari iaiI-unwarrevea1d
L.
l i terature. ZAlW concentrations of alcohol have been shown to
- - -- --
e x c i t e f r o g nerve-muscle p r e p a r a t i o n s (Knutsson, 1 9 6 1 ) .
Curare-blocked n e u r o n u s c u l a r j u n c t i o n s o f a f r o g ' s s k e l e t a l
muscle have been t r e a t e d with a l c o h o l and an i n c r e a s e i n the
ampl i tude o f endplate p o t e n t i a l obse rved (Okada, and Adachi,
1962). Low, e t a f (1962) have shown that low c o n c e n t r a t i o n s
of a l c o h o l f a c i l i t a t e human neuromuscular j u n c t i o n s . I n - - - - --
c h o l i n e r g i c nerve-lzuscfe: p r e p a r a t i o n s , alcohol was shown by
Sachdev, e t a 1 (1964 ) to p o t e n t i a t e muscle t w i t c h e s . This
a l c o h o l i n t h e present stu&y, 0
I n a s i m i l a r way t o ca lc ium, a l c o h o l ,causes the r e l e a s e of
a c e t y l c h o l i n e from s y n a p t i c vesicles (Wallgren, and Barry, L
1970) ChoLinergic interactions of alcohol w i l l i n v a r i a b l y
affect sodium and potassim movements a c r o s s cell membranes,
causing g e n e r a t i o n o f spikes. This t h e r e f o r e mans that
a l c o h o l will cdntribute-in p o s t s y n a p t i c membrane depolarization.
iIence the increase in the ff-reflex may b e a t t r ibuted n o t on19 t o
the spinal cord excitability b u t also t o a neuramuscular
Aspirin
the .+wave i n all b u t one subject. This effect was r e v e a l e d by
the graphical and B-amplitude methods of data analys is . The
-ax, Emax/M and Hmax/Mmx ranges and means for a l l subjects ,
when compared with values f o r the normal subject revealed
depression but the mean of &nax/h%uax indicated potentiat ion of
the H-reflex. Thi s analget ic drug i s not only ant ipyret ic ,
but a l s o a potent pain k i l l e r , I t e l iminates pain by delressing -L---LL-L-p- - -- - - - - - -- - -
the pain f i b e r s and suppressing the production of polypeptides
(e . g. bradykinin) which actual ly cause the pain (Mountcastle,
inhibi t ing prostaglandin synthesis and release (Vane, 1 9 7 3 ) . '*
Probably it depresses the central nervous system by
prostaglandin inh ib i t ion . Again, since the M-wave decreases, B
the decrease of the B-wave could be due t o a neuromuscular
Caffeine
Caffeine caused marked potentiation of the H-reflex and r
die *response amplitude wits markedly increased i n a l l subjects .
These effects were revealed in aII rrethods used for data
analysis except the mean of RsannfEf ratio. The Eraax and
H=ax/BWax ranges en2 ~eans for a l l subjects indicated potentie-
effect was obtained by taking coffee (caffeine content about
f QO-150 mgj ,
Caffeine s t imula tes t h e c e n t r a l nervous system (Topliss ,
1 9 7 0 ) and thus causes p o t e n t i a t i o n of t b e H-reflSk. Caffeine 2
i n h i b i t s t h e hydrolys is of CAMP, has l i p o l y t i c a c t i o n s and
p o t e n t i a t e s the e f f e c t s of epinephrine (Tr iggle , 1970) . A l l
of these e f f e c t s of c a f f e i n e c o n s t i t u t e important f a c t o r s i n *
the c e n t r a l ac t ion of coffee o n -the H-reflex. A g a i n , as with---- - --
alcohol , it i s seen t h a t t h e H-reflex provides a s e n s i t i v e
i n d i c a t o r of CNS s t imula t ion .
The Ef fec t s of Agents with Local Inf luence
General
The experiments with f o r c e and f a t i g u e show t h a t the
H-reflex can serve a s an i n d i c a t o r of t h e gain of the - - - - -
s p e c i f i c sensory-motor r e f l e x a rc involved. Thus it should be
a useful t o o l f o r fundamental inves t iga t ions of motor c o n t r o l
and f o r c l i n i c a l eva lua t ion of lower rnotorneurone l e s ions .
Force
The e f f e c t of f o r c e on the H-reflex was similar to t h e
e f f e c t of voltage on the r e f l e x ( F i g . 10) . I n most subjects
as force became sustained a pronounced t a l l i n the H-wave
amplitude resu l t ed . The M-response, though unchanged i n one of
the s u b j e c t s , was genera l ly a f f e c t e d i n t h e same way a s t h e
H-wave (Fig. 1 0 ) . These changes were revealed i n t h e graphica l
and ampliMde methods of - da ta analys is .
observat ions on t h e e f f e c t s of fo rce a r e not easy t o
explain, One explanat ion is' t h a t t h e decrease i n t h e H-wave _ _ -_
could be caused r e f l e x i v e l y by the decrease i n t h e M-wave.
Fat igue
I t has been suggested i n the l i t e r a t u r e t h a t t h e r e a r e two
phases t o the buildup of f a t i g u e during a sus ta ined i sometr ic
con t rac t ion (Stephens and Taylor, 1972). I n t h e f i r s t phase 4 ,
t h e decrease i n f o r c e is accompanied by a propor t ional decrease z-
in the synchronous muscle ackior rpoter r t ia l (Pf-wavej whereas i n --
t h e second phase t h e fo rce f a l l s more quickly than t h e ac t ion
p o t e n t i a l . The r e s u l t s repor ted here a r e n o t m p l e t e l y
c o n s i s t e n t with t h i s . In our experiment t h e - t o t a l fo rce was
maintained constant ; presumably t h e bui ld up o f - f a t i g u e i n t h e
- i n i t i a l l y r e c r u i t e d u n i t s r e s u l t s i n ,decreasing fo rce and
a d d i t i o n a l motor units are r e c r u i t e d . T h i s accounts f o r t h e
observed inc rease i n the H-reflex. The decrease i n ~unpii tude ;*
f a t i g u e . These r e s u l t s show that the decrease i n M-amplitude
is r o u g h l a p a r a l l e l to t h e inc rease i n H-antplitude. This is an -.
indirect i nd ica t ion that i n our.experiment h e r e n i s parallel
decrease i n f o r c e and synchronous a c t i o n p o t e n t i a l , i .e . the
two phases observed by o t h e r workers cannot be seen i n our
da t a .
It has been .hypothes ized by o t h e r s (Merton 1954 ; Edwards and
Lippold 1956) t h a t t h e p r i n c i p a l mechanism of f a t i g u e i s the
impairment of the c o n t r a c t i . l e mechanism of t h e muscle,
pos s ib ly 'due t o ischemia, This would probably r e s u l t i n
f o r c e d e c l i n i n g more r a p i d l y than t h e a c t i o n p o t e n t i a l and
accounts f o r t h e second phase i d e n t i f i e d by Stephens and
Taylor (1972). Our d a t a sugges t s a r a t h e r l a r g e decrease i n
t h e a c t i o n p o t e n t i a l (I?-wave) throughout t h e development of
f a t i g u e a n d - t h i s sugges t s t h a t o t h e r mechanisms may be
involved. Other sugges t ions i n c l u d e , c e s s a t i o n i n c e n t r a l
. e 4 c i t a t o r y a c t i v i t y (Big land-Ri tch ie :c i ted i n Die tz 1978) ,
impairment of neuromuscular transrnissi'on (Stephens and Taylor ,
1972) and a drop i n s p i n a l motoneurone f i r i n g r a t e (D ie t z , --.
1978) . The H-reflex may be a u s 2 f u l t o o l t o i n v e s t i g a t e t h e s e - sugges t ions .
L imi t a t i ons and Future Work
This series of exper iments w a s explora iory ln n a t u r e and
the exper im=tal des l fgnhaddef i n i t e l i m i t a t i o n s : a) t h e r e
w a s no r e a l c o n t r o l of the s u b j e c t s t d i e t be fo re each exper iment
b) t h e experiments were performed i n the same order f o r each
s u b j e c t s o a learn ing e f f e c t cannot be excluded; however t h e
s e r i e s was repeated f o r one sub jec t and e s s e n t i a l l y i d e n t i c a l
r e s u l t s were obta ined , cf t he f a t i g u e experiments were
conducted with o n l y one sub jec t d) only one dose l e v e l was
investigated for e a c h agent tested, el the possible I
psychofogical e f f e c t of knowing the nature of t h e experimental
agents ( a l coho l , a s p i r i n and coffee) was n o t inves t iga ted by
repeat ing the experiments with a placebo, f) t h e H-reflex
experiments a r e n e c e s s a r i l y s e n s i t i v e t o many factors--l imb
angles , general a rousa l of s u b j e c t s , d i e t of s u b j e c t s ,
e l ec t rodes e t c . Consequently more r e l i a b l e d a t a would r e s u l t
i f more sub jec t s had been used s ince random v a r i a t i o n s would
tend t o cancel out . I n s p i t e of these r e se rva t ions we a r e q u i t e
conf ident i n the general conclusions we' have drawn and i n the
d i r e c t i o n of the e f f e c t s of s p e c i f i c agents.
In f u r t h e r work, a more e labora te experimental design could
be used to i n v e s t i g a t e the =e<s of these experiments and
to use a wide range of doses for each agent. Probably the most
i n t e r e s t i n g direction fur further work i s i n the use of t h i s
VI . CONCLUSIONS 1
The H-ref lex changes o b t a i n e d by t h e - u s e o f t h e d r u g s i n
t h i s s t u d y i n d i c a t e t h a t t h e r e f l e x can n o t o n l y b e a n e f f e c t i v e
t o o l i n t e s t i n g t h e : e x c i t a b i l i t y o f t h e n e r v o u s sys t em b u t c a n
a l s o d e t e r m i n e t h e a c t i o n and e f f e c t i v e n e s s o f some d r u g s .
Q u a n t i f i c a t i o n i s p o s s i b l e i n t h e H- re f l ex s t u d i e s and t h i s
w a d d be an asset i n its d i a g n o s t i c u s e , I n a d d i t i o n t o t h e s e
g e n e r a l c o n c l u s i o n s , t h i s s t -udy h a s a l s o g i v e n new o r
c o n f i r m a t o r y e v i d e n c e of t h e c t i o n bf c e r t a i n a g e n t s on s p i n a l 1 r e f l e x e s . S p e c i f i c a l l y , a l c o h o l (0 .012 p e r c e n t b lood
c o n c e n t r a t i o n ) p o t e n t i a t e d t h e H-ref,lex and i n c r e a s e d t h e s i z e
of t h e musc le r e s p o n s e , c a f f e i n e ( 1 . 3 g c o f f e e ) p o t e n t i a t e d t h e
r e f 3 . e ~ and t h e d i r e c t auscle r e s p o n s e w h i l e a s p i r i n f f 8 grf
d e p r e s s e d bo th t h e r e f l g x and musc le r e s p o n s e . I t was a l s o
suggested t h a t e a r l i e r e x p f q n a t i o n s o f fatigue i n s u s t a i n e d /d
': B c o n t r a c t i o n s need t o be re-examined.
MEDICAL HISTORY a
Name :
Weigh t :
D a t e :
. Check ( x ) i f a n s w e r i s y e s :
' P a s t B i s t o r y :
Have you ever 'had2
R h e u m a t i c ' f e v e r
Heart murmur
H i g h b l o o d p r e s s u r e
Any. h e a 2 t t r o u b l e
Diseas'es o f a r t e r i e s
Var i c o s e v e i n s
P r e s e n t Symptons : . ' Have you r e c e n t l y had?
C h e s t p a i n s
S h o r t n e s s o f b r e a t h
H e a r t p a l p i t a t i o n s
Cough o n e x q r t i o n
Goughing, o f b l o o d h
Back p a i n
Lung d i s e a s e - S w o l l e n , s t i f f , o r
O p e r a t i o n s p a i n f u l j o i n t s I .u
I n j u r i e s to b a c k , e t c . Muscle or t e n d o n i n j u r y
E p i l e p s y
S p e l l s o f severe d i z z i n e s s
E x p l a i n :
Age:
Height:
Is t h e r e a good phys ica l reason n o t mentioned here why you
s h o u l d not p a r t i c i p a t e i n c e r t a i n types of physical activity, r h
even i f you wanted to? ,
Subject's. signature: -- --
P e a k H-Amplitudes -
Subject A l c o h o l ( A )
H a 1
2
\
-4 *
4
5
Mean Ratios
Aspirin f As) Caffeine (Ca)
S u b j e c t
No. 1
2
3
- 4
5
H e a n R a t i o s
Alcohol ( A ) Aspirin ( A s )
Third to the Peak 8-Amplitude ---
Caffeine ( C a )
Subject Alcohol (A) . Aspirin ( A s ) C a f f e i n e ( C a ) /
Mean R a t i o s
Mean R a t i o s (X ,Y ,Z )
C a t e g o r y A l c o h o l X 1 . 3 7 Y 1 . 4 7 Z 1 . 4 8 T o t a l 4 . 2 4 Mean 1 . 4 1
A s p i r i n 8 . 9 4 8 .95 0 . 9 1 2 . 8 0 8 . 9 3
C a f f e i n e 1 . 2 5 1 . 2 8 1 . 3 8 3 . 8 3 1 . 2 8
BIBLIOGRAPHY
Abe K, ( 1 9 7 8 ) : A s t u d y o f s e n s o r y p r o j e c t i o n f rom jaw m u s c l e s t o t h e c e r e b r a l c o r t e x i n t h e r a t , J a p . J. P h y s i o l . 28:309-322.
Angel R . H . and Hoffmann W . W . ( 1 9 6 3 ) : .H r e f l e x i n no rma l , s p a s t i c and r i g i d s u b j e c t s . Arch. Neu ro l . 8: 591-596.
Asmussen E. and Haz in B. ( 1 9 7 8 ) : A c e n t r a l n e r v o u s component i n l o c a l muscu l a r f a t i g u e , Europ. J. Appl. P h y s i o l . 38: 9-15.
B i s h o p B., Machova S. , J o h n s t o n R , , and Anderson M , , ( 1 9 6 8 ) : A q u a n t i t a t i v e a s s e s s m e n t o f gamma motoneuron c o n t r i b u t i o n t o t h e A c h i l l e s t e n d o n r e f l e x i n normal s u b j e c t s . Arch. Phys . Med. 49': 145-154.
B i s h o p B., Machova S . , J o h n s t o n R . , Wash W . , and Anderson M . ( 1 9 6 8 ) : R o l e o f t h e gamma motor s y s t e m i n t h e A c h i l l e s t e n d o n r e f l e x o f h e m i p l e g i c p a t i e n t s . Arch. Phys . Med. Rehab. 49:698-707.
/ I
Bishop, B., J o h n s t o n R.M. and Wash W . ( 1 9 7 0 ) : Changes i n a l p h a and gamma motoneuron e x c i t a b i l i t y w i t h r e s p i r a t i o n s . Arch. Phys . Med. R e h a b i l . 51: 383-390.
B l a c k s t o c k E. , Rushwort G. and Ga th D. ( 1 9 7 2 ) : E l e c t r o p h y s i o l o g i c a l s t u d i e s i n a l c o h o l i s m . J. N e u r o l , Neurosurg . P s y c h i a t . 35:326-334.
Blom S . , Hagba r th K.E . and Skoglund S. ( 1 9 6 4 ) : P o s t t e t a n i c p o t e n t i a t i o n o f H - r e f l e x e s i n humaq i n f a n t s . Exp. Neu ro l . 9:198-211.
Braddom R.L. and J o h n s o n E.W. ( 1 9 7 4 ) : S t a n d a r d i z a t i o n o f H r e f l e x and d i a g n o s t i c u s e o f S 1 r a d i c u l o p a t h y . Arch. Phys . Med. R e h a b i l . 55: 161166.
' Braddom R.L. and J o h n s o n E.W. (1974 ) : H r e f l e x : r e v i e w and c l a s s i f i c a t i o n w i t h s u g g e s t e d c l i n i c a l u s e s . Arch. Phys . Xed, R e h a b i l . 55:412-417.
Braddom R.L. ( 1976 ) : H r e f l e x . Arch. Phys. Med. R e h a b i l . 57:407. - -- - -
Brooks C . HcC. and E c c l e s J.C. ( 1 9 4 7 ) : A s t u d y o f t h e e f f e c t s o f a n a e s t B e s r b - & - - a ~ ~ 4 + o n t k t t t w & i ; e +x&hway-kBnx~g h -
t h e s p i n a l c o r d . 3 . N e u r o p h y s i o l . 10:349-360.
- -
Brough ton R . , Vera C., Heir -Ewer t K . , ~ b e M. a n d Andermann F. (1968) : B r e f l e x s t u d i e s and t h e e f f e c t s o f i v . d i azepam ( v a l i u m ) i n s u b a c u t e s c l e r o s i n g l e u c o e n c e p h a l i t i s . F l e c t r o e n c e p h . C l i n . Neurophys io l . 24: 288.
B u c h t h a l F. and Schmalbruch H. (1978) : C o n t r a c t i o n times o f t w i t c h e s evoked by H r e f l e x e s . Acta . P h y s i o l o g i c a S c a n d i n a v i c a , 88: 378-382.
Burg D . , Szumski A , , S t r u p p l e r A . and Velho F . ( 1 9 7 4 ) : Asses smen t o f f u s i m o t a r c o n t r i b u t i o n t o r e f l e x r e i n f o r c e m e n t i n humans. J . Neuro l . Neurosurg . and P s y c h i a t r y . 37: 1012-1021,
Burger A . (1970) : M e d i c i n a l C h e m i s t r y , T h i r d E d i t i o n , P a r t 11. E d i t e d by Burger A . , W i l e y - I n t e r s c i e n c e N e w York. p. 1273.
Burke D. , Andrews C . J . and Lance J . W . ( 1972) : T o n i c v i b r a t i o n r e f l e x i n s p a s t i c i t y , P a r k i n s o n ' s d i s e a s e and normal s u b j e c t s . J . N e u r a l . Neurosurg . P s y c h i a t . 35:477-486.
Burke E.R., Lev ine D.N., Z a j a c E.F., T s a i r i s P. and Engel K , W . ( 1971) : Mammalian motor u n i t s : P h y s i o l o g i c a l h i s t o c h e m i c a l c o r r e l a t i o n i n t h r e e t y p e s i n c a t g a s t r o c n e m i u s . S c i e n c e . 174:709-712.
B u s s e l B, , Morin C. and P i e r r o t - D e s e i l l i g n y E. ( 1 9 7 8 ) : Mechanisms o f monosynap t i c r e f l e x r e i n f o r c e m e n t d u r i n g J e n d r a s s i k manoeuvre i n man. J. Neuro l . Neurosu r . and P s y c h i a t . B l tB0-44-.-
C a d i l h a c J . , Georgesco M . , Benezech J . , Duday H. and Dapres G . ( 1 9 7 7 ) : Soma tosenso ry c e r e b r a l p o t e n t i a l and H r e f l e x a f t e r a c u t e s p i n a l c o r d les ions , ~ l e c t r o e n k e p h , C l i n . N e u r o p h y s i o l . 43:160-167.
Campbel l E.D. and Green E. (1964) : A n a t t e m p t t o measu re musc l e s p a s t i c i t y by H wave c h a n g e s and t h e e f f e c t on t h e s e measurements u f a s k e l e t a l m u s c l e r e l a x a n t ( c a r i s o p r o d o l ) . E l e c t r o e n c e p h . Clin. Neurophys io l . 17:705-706.
Casey , E.B., LeQuesne P.M. ( 1 9 7 2 ) : E l e c t r o p h y s i o l o g i c a l e v i d e n c e f o r a d i s t a l l e s i o n i n a l c o h o l i c n e u r o p a t h y . J . Neuro l . Neurosu rg , P s y c h i a t . 35:624-630. 4-
- -
Chu N . , S q u i r e s K. and S t a r r (1978) : A u d i t o r y b r a i n s t e m p o t e n t i a l s i n c h r o n i c a l c o h o l i n t o x i c a t i o n and a l c o h o l
- -
w i t h d r a w a l .-arch. We u r o l . 3 5 3 963682. ---
t i a n c t r e t t i C b flW5T: Soleus tf sef'lex and a f f e r e n t d i s c h a r g e s f rom a n t a g o n i s t i c m u s c l e s . An e l e c t r o p h y s i o l o g i c a l method o f e v a l u a t i o n . E f e c t r o e n c e p h . C l i n . N e u r o p h y s i o f , 39:425-427.
Cohen S . ( 1 9 6 6 ) : Me tabo l i sm and pharmacology, Alcoho l i sm . E d i t e d by Max Hayman. C h a r l e s C. Thomas P u b l i s h e r 1966, p ' 17 -25 .
Cook W.A. J n r . ( 1 9 6 8 ) : E f f e c t s o f low f r e q u e n c y s t i m u l a t i o n on m o n o s y n a p t i c reflex (B r e f l e x ) i n man.- ~ e u i o l o ~ ~ (R inneap ) . 18:47-51.
Cooper S. ( 1 9 6 6 ) : n u s c l e s p i n d l e s and motor u n i t s , I n Andrew c o n t r o l and I n n e r v a t i o n o f ske le ta l musc l e . U n i v e r s i t y o f S t . Andrews Press, Aberdeen 1966. p. 15 .
C o r r i e W.S. and H a r d i n W.B. ( 1 9 7 4 ) : P o s t - t e t a n i c p o t e n t i a t i o n o f H r e f l e x i n normal man. Q u a n t i t a t i v e s t u d y . Arch. Neu ro l . ( c h i c ) 11: 317-323.
---
Decand ia M . , P r o v i n i L. and T a b o r i k o v a H. ( l 9 6 7 b ) : P r e s y n a p t i c i n h i b i t i o n o f t h e m o n o s y n a p t i c r e f l e x f o l l o w i n g t h e s t i m u l a t i o n o f n e r v e t o e x t e n s o r m u s c l e s o f t h e a n k l e . Exp. B r a i n Res. 4:34-42.
d e l C a s t i l l o J . and Ka tz B. ( 1 9 5 4 ) : S t a t i s t i c a l f a c t o r s i n v o l v e d i n neu romuscu l a r f a c i l i t a t i o n and d e p r e s s i o n . J. P h y s i o l . 124: 574-585.
Delwaide P. and De lbecq P. ( 1973 ) : V e s t i b u l a r i n f l u e n c e s on p r o p r i o c e p t i v e reflexes of the l ower 1 imb i n normal man. N e w Dev. i n EMG and C l i n , N e u r o p h y s i o l . E d i t e d by Desmedt J. 3: 336-341 (Ka rge r Base1 1 9 7 3 ) .
De lwaide P . J . , C o r d o n n i e r M . and Charlier M. ( 1 9 7 6 ) : F u n c t i o n a l r e l a t i o n s h i p s be tween r n y o t a t i c r e f l h a rcs o f t h e lower l i m b s i n man: I n v e s t i g a t i o n by e x c i t a b i l i t y c u r v e s . J. Neuro l . Neu rosu rg . and P s y c h i a t . 39:545-554.
De lwa ide P. , C o r d o n n i e r M . and G a d e a c i r i a M, ( 1 9 7 8 ) : - E x c i t a b i l i t y r e l a t i o n s h i p be tween l o w e r l i m b m y o t a t i c a r c s
i n s p a s t i c i t y . J. N e u r o l . Neu rosu rg . and P s y c h i a t . 41:636-641.
Denny-Brown D. (19681: C i t e d i n : T a b o r i k o v a •’3. and Sax D.S. ( 1 9 6 9 ) : C o n d i t i o n i n g o f H r e f l e x e s by a p r e c e d i n g s u b t h r e s h o l d B r e f l e x %t imulus . B r a i n . 92: 283-212,
- - - - -
B e GbkZ P. , Lance J.W. ~t r i~smY.I3 . (1966) : p i i f e r m X e f f e c _ t s o n t o n i c and p h a s i c r e f l e x mechanisms p roduced by
v i b r a t i o n . o f muscles i n man. J. Neurol. Neurosurg. Pgychiat . 29:l-10,
Deschuytere J. and ~ o s s e l l -N. (1973) : Diagnos t ic use of monosynaptic r e f l e x e s i n L5 and S1 r o o t compression, I n : Xew Dev. i n E K and Clin . Neurophysiol. Edi ted by Desmedt J . E . (Basel Kargerl 1973. 3:360-366.
=, Deschuytere J. and Rosse l l e N. (la : I d e n t i f i c a t i o n of c e r t a i n E M ~ ' ~ a t t e r n s of s p i n a l cord r e f l e x i v e a c t i v i t y i n man. E lec t rophys io log ica l s tudy of d i scha rges f r o m s p i n a l o r i g i n i n fdrearm f l e x o r s i n normal a d u l t s . ~ l e c t r 6 m y o -
'g raph . C l in . Neurophysiol. 14:497-511. rn
Diamantopoulos E . and Gassel M. (1965): E l e c t r i c a l l y induced monosynaptic r e f l e x e s i n man. J. Neurol. Neurosurg. Psych ia t , 2%t$9+fff2.
Diamantopoulos E. and Zander Olsen 0. (1967) : E x c i t a b i l i t y of motorneurons i n s p i n a l shock i n m a n . J. Neurol. Neurosurg. Psychia t . 30 : 427-431,
Dietz V. (1978) : Analysis of t h e e l e c t r i c a l -muscle a c t i v i t y dur ing maximal c o n t r a c t i o n and i n f l u e n c e of ischaemia. J. Neurological Sciences . 37:187-197.
Drechs le r B., Lastovka M. and Kalvodova E. (1966) :i Elec t rophys io log ica l s tudy of p a t i e n t s with h e r n i a t e d i n t e r v e r t e b r a l d i s c . Electromyography. 6:187.
Edwards R. and Lippold C. (1956): The r e l a t i o n between f o r c e and i n t e g r a t e d EMG i n f a t i g u e d muscle. J. Phys io l . l32:677-681.
Ekholm J. and Skoglund S. (1964) : Poss ib l e f a c t o r s i n f luenc ing t h e demonstra t ion of p o s t - t e t a n i c p o t e n t i a t i o n of t h e H r e f l e x a s s t u d i e d i n the c a t . Exp. Neurol. 9:x83-197.
Erokhina L . G . , Rekhtman M.B. and Chekneva N.S. (1976) : I n t e r a c t i o n between p e r i p h e r a l motoneurons of a n t a g o n i s t muscles i n normal s u b j e c t s and s p a s t i c hemipares i s s t u d i e d by t h e H r e f l e x method. Neuroscience and Behaviora l Physiology. 7: 232-235,
- - -- -- -
F e r r a r i E . , Sanna G. and Bravaccio F. (1966): E f f e c t s of - J9ffdrassiLIE----M-pI--jref1wL-In---- -
s u b j e c t s with f u n c t i o n a l and w r a m i d a l hype r r e f l ex i a . 5, Electroenceph. Cl in . Neurophysiol. 21:90.
F i s h e s H. and Penn R. (1978): Evidence f o r changes i n segmental aotoneurone poo l s by ch ron ic c e r e b e l l a r s t i m u l a t i o n and its c l i n i c a l s i g n i f i c a n c e . J. Neurol. l3eurosurg:and Psych ia t . 41:630-635. . -..
Fisher M., Shashani B , and Young R. (1979) : Elec t rophys io- l o g i c a n a l y s i s o f t h e motor system a f t e r s t r o k e : The r suppres s ive ' e f f e c t s o f v i b r a t i o n . Arch. Phys. Med. Rehabil . 60: 11-13,
F r a L, and Briognol io F. (1968): F and H responses e l i c i t e d f r ~ ~ t ef--fewer Liz& in normel subjects; J r Henrok. - - - - - Science. 7:251-261,
F u j i t a S, and cooper I.S. (1971): E f f e c t s of L-dopa on H r e f l e x i n Parkinsonism. J, Am. G e r i a t r i c Soc.. 19:289-295'.
- - - -- - - - --- - - - - - - - - - - - -
G a g e P , W, (1965b) : The e f f e c t o f methyl, e t h y l and n-propyl a l c o h o l on neurornuscular t ransmiss ion .in t h e rat. J. Pharmacol. E x p t l . Ther. 150: 236-243.
G a s s e l M, (1970): A cri t ical review of evidence concerning long loop r e f l e x e s e x c i t e d by muscle a f f e r e n t s i n man. J. Neurol. Neurosurg. Psych ia t , 33:358-362,
Gassel M. M. (1973): An o b j e c t i v e technique f o r t h e a n a l y s i s of the c l i n i c a l e f f e c t i v e n e s s and physiology of a c t i o n of drugs i n man. In: New Developments i n EMG and C l i n i c a l Neurophysiology, Edited by J.E. Desmedt. V o l . 3 ( ~ a r g e r B a s e l 1973). p . 342-359.
Garcia-Mullin R. and Mayer R. F. (1972) : H reflexes i n a c u t e and ch ron ic hemiplegia. B r a n , 95:559-572.
Ger i lovsky L o , Radichera N . , Gydikov A, (1977) : he shape of a e A c h i l l e s tendon r e f l e x p o t e n t i a l s . Electromyogra. Cl in . Neurophysiol, 17:143-153.
G i l l i e s J, Do, Lance J, W,, Neilson P. Do and T a s s i n a r i C, A. (1969): P re syaap t i c i n h i b i t i o n ' o f t h e monosynaptic r e f l e x by v i b r a t i o n , J, Phys io l . (Lond) . 205: 329-339.
G l a s s A- and Smolen A, (1976) : H r e f l e x recovery curves i n klx-evaLua*ion of-42wtrofee &iwt &-Ek&zepam- -Brcfr;- - - -
.Phys. Med. Rehabif. 5 7 ~ 5 9 8 .
Gfylys J. A, and T i l s o n H, A, (1975) : ~ h a r m a c o l o g i c a l approaches t o main ta in ing and imp'roving walking func t ion .
. Annual Rep. bfed. Chart, Vol, 10. ~ c a d e m i c P re s s , New York,
- -- - - - - - - -----
\
1975. p , 21-26. I
Godaux E. and Desmedt J. E. (1975) : Human masse t e r muscle: I
H and tendon r e f l e x e s , Arch. Neurol. 32:229-234,
Goodgold J: and E b e r s t e i n A. (1971): E l ec t rud iagnos i s of Neuromuscular d i s eases . Balt imore, Williams and Wilkins P. p. 170-171.
Goodwill C. J. and O'Tuand I,. (1968): The normal j a w r e f l e x : - Measurement o f the action p o t e n t i a l i n t h e masseter muscles. -- Phys, Med, 9 :183-188,
A - - -
G o t t l i e b G. L . , Agarwal G . C . and S t a r k L. (1970) : I n t e r a c t i o n s between voluntary and p o s t u r a l mechanisms of t h e human motor system. J. Neurophysiol. 33:365-381,
G O t t l l ' i G, L. -arG$ Agamal. G. C. TI9761 : Extinmion of Hoffmann r e f l e x by an t id romic conduction. Elect roenceph,
'% Clin . ~ e u r o p h y s i o l . 41:19-24.
G o t t l i e b G. L. and Agarwal C. G . ' (1971): E f f e c t s of i n i t i a l cond i t i ons on Hoffma~1 r e f l e x . J. Neurol. Neurosurg. Psychiat . 34:226-230,
G o t t l i e b G. L; and Agarwal G. C. ( lb72) : The r o l e of t h e rnyotatic r e f l e x i n t h e vo lun ta ry c o n t r o l of movements. Bra in R e s . 40 : 139-143.
-
Gran i t R. and Burke R. E. (1973): Control of movement and pos ture . Bra in R e s . 53 : 1-2 8.
Guiheneuc P. and Ginet J. (1973): The Hoffmann r e f l e x i n lumbosacral root i n u r i e s . .Electroenceph. Cl in . Neurophy- siol. 34:814,
Guiheneuc P. and Ginet J, (1974): Etude r e f l e x e d e Hoffmann obtenu au n iveau du muscle quadr iceps d e s u j e t s h w i n s normaux. Electroenceph. C l in , Neurophysiol. ' 36:225-231,
/
Guiheneuc E, and B a t h i e n N, (1976) : Two p a t t e r n s of r e s u l t s i n polyneurophathies i n v e s t i g a t e d with t h e H r e f l e x . J. Neurol. Science. 30:83-94.
- - - - - - - - - - - - -
Gyaik6v A,, C k i l o v s k y L, &dDimitoE G , V, (1916) : Dependence of the H r e f l e x p o t e n t i a l shape on e x t r a t e r r i t o r i a l
-- - -- - - - -- p o t e n t i a l s of trxCep-iae =tor u n i t s . Electramyograph C l in , Neurophysiol. 16:555-567.
- - - - - -- --- C
Grylys 5. and and TiLson H. A. (1975): Pharmacological approaches to main ta in ing and improving walking func t ions . In: Ann. Reports i n Med. Chem. Vol, 10. Edi ted by Eeinzelman R , V,, Academic Press, N.Y. , Lond. 1975. pp. 21- 26.
Hagbath K. " (1962) : P o s t - t e t a n i c p o t e n t i a t i o n of myo ta t i c +
r e f l e x e s i n man, - J, Neurology Neurosurg. and Psychia t . 25 : 1-10.
Hayes K, C, (1972): J e n d r a s s i k ' s manoeuvre f a c i l i t a t i o n and + - f r a c t i o n e d patella- r e f l e x times, 3. Applied Phys_iol. - -
32 :290-295. L
Hayes K, C. (1975): E f f e c t s o f f a t i g u i n g isometric exercise upon A c h i l l e s tendon r e f l e x and p l a n t a r f l e x i o n r e a c t i o n time componen+erin man. Europ. J. Appl. Phys io l . 34:
- - - -- - - - - -p - - - - - - - - - - - - -- - - -- -- - - - -
69-79.
Hayes K, C, and S-rsflivax J. (1976): Tonic neck r e f l e x i n f l u e n c e ,on tendoB and Eof fmann r e f l e x e s i n man - Electromyogr. C l in . Neurophysiol. 16:251-261.
Herbison G, J. (1973): H r e f l e x i n p a t i e n t s w i th Parkinsonism: E f f e c t of L-D=6pa, Arch. Phys. Med. Rehabil. 54:291-295.
Herman R. (1969) : Rela t ionsh ip between t h e H. r e f l e x and t h e tendon j e rk response. Electromyogr. 9:359-370,
- -
Hades R. and Gr ibe t z I. (1963): Normal e l e c t r i c a l l y induced r e f l e x e s ( 'H r e f l e x e s t ) i n a Z-week-old i n f a n t w i t h a c r a n i a and c e r e b r a l dysgenesis . Electroenceph. Cl in . Neurophysiol, 15:1033-1036.
H d e s R, and Dement W. (1964) : Depression of e l e c t r i c a l l y induced r e f l e x e s ( 'H- re f l exes t ) i n man du r ing l o w voLtage EEG ' s l e e p , ' Elect renceph, Cl in . Neurophysiol. 17:617- 629.
Hof fmann P. 9 8 : Uber die Beziehungen d e r Sehnenef l e x e z u r Wi l lku r l i chen Bewegung und zum Tonus. 2. Biol . 68: 351,
=a
- Hogfmann-P, 11922): C5ted-in: Gottlieb G A , and Agarwal G - C , (1976): E x t i n c t i o n of the Hoffman r e f l e x by an t id romic
--- conduction, E lec tmenceph . C l i n , Neurophysiol. 41:19-24,
9
Hoffmann Von P. (1952): Kurzer W r b l i c k Uber d i e Beziehungen - de ref lexversuche mit der e l e k t r i s c h e n methodik b e i mensch
9 i
I 94 P
urrd t i e r , E x p e t i e n t i a . 8: 371-375.
Homma 8, and K a n o M. (1962) : E l e c t r i c a l properties of the, '
t o n i c r e f l e x arc i n the human propr iocep t ive r e f l e x . Sympos5um on Muscle Receptors. Edited by David Barker. Hong Kong .UniversitTPress. 1962. pp. 167-374.
Hugon M. (19731 : Yethodology of the Hoffmann r e f l e x i n m a n . New Dev. in EMG & C l i n . Neuruphysiol. 3:277-293,
- - - - - - - -- -- -- - --
Ioku M, , Ribera V, A., &per I. S. and ~ a t s u o k a S . (1965) : Parkinsonism: Electromyographic s t u d i e s of monosynaptic reflex, Science. l50:1472-1475.
* d"
Ioku M. (1968) : 3 r e f l e x e l i c i t e d by t e t a n i z a t i o n ' i n hand -- - - - -
musk le, ElectrOioqr-. - 8 3 5-333. - - ,
Ioku M., Nakatani S. and Oku Y. f 1969) : H r e f I&- study 'with + high frequency s t i m u l a t i o n , Electromyogr. 9:219-227. . J
Ioku M., Ogawa M. and Jinnai D. (1971) : S t u d i e s on fac i l i - t a t i o n of the H r e f l e x i n s p a s t i c i t y and r i g i d i t y . Efectromyography. 11:Il-23.
.- Isaacs E . R., Szumski A. J. and Sute r C. (1968) : Central
and p e r i p h e r a l influences on t h e H r e f l e x i n nonnal man. Neurology ( M i n n e a p ) , 18: 907- 914. - - -
Ishikawa K . w V t t K,, P o r t e r R. W. and S t u a r t D. (2966): Low frequency depres s ion -o f the H-wave in normal and spinal man. Exp. Neurology. 15:140-156.
J e f f e r s o n A. and Benson A. (1953): Some e f f e c t s of post- t e t a n i c p o t e n t i a t i o n of monosynaptic response of s p i n a l '
I cord o f cat. 3. Neuraphysiof. 16:381-396.
Johns R,, Grob D, and harvey M. (1957): Electromyographic study of a spinal co rd reflex i n the normal human arm. B u l l , Jokns Eopkins Eosp. 101:232-239.
s-
-, J5- W * ? - --
I P, L, an Paulson G , W, 419771 - . - Huntington Disease : Ear ly i d e n t i f i c a t i o n by E reflex testing. Arch- Phys, Xed, Rehabil. 58:162-166.
Johnson 3. L., Sax D. S. and Fe ldhan R. G. (1974) : A technique for feature e x t r a c t i o n and i n t e ~ a t i e n t cconparison of R r e f l e x c o n d i t i o n i n g c u r v e s . E l e c t r o - enceph . C l i n . Neurophys io l . 37:188-190.
Jun Tanji and Kota ro T. (1976) : P r e s e t t i n g of e x c i t a b i l i t y of the s p i n a l l a inhibitby pathway i n r e l a t i o n t o t h e d i r e c t i o n o f an i n t e n d e d movement. ~ e u r o s c i e n c e s L e t t e r s . 3:321-327. -
Ralow W . (19731 : p+nes c o n t r ~ l l i n g d rug a c t i o n i n m a n : Ptramacolcsgy an& t&e future ' of man. P r o c . 5 t h Pn t . CongI Pharmacology, San F r a n c i s c o , 19 72, 1972. 3 :2-16. (Karger and Base l 1 9 7 3 ) .
Kaneko Z . , Matsumoto K . , Shimizu A . and S u m i t s u j i N . ( 1 9 6 6 ) : 33 wr-effex s t e y GE q~irpkospazm. E3ectrornyogr. 6 r e - 5 3 .
Xatz R * , Morin C . , P i e r r o t - D e s e i L l i y n y E; and H i b i n o R* (1977): C o n d i t i o n i n g o f H r e f l e x b y a p r e c e d i n g sub- t h r e s h o l d t endon r e f l e x s t i m u l u s . J. Neurol . Neurosurg. and Psychiatr. 4 0 : 575-580.
Xidokoro Y . , Kubota K. and Shuto S . (1968) : R e f l e x o r g a n i z a t i o n o f c a t m a s t i c a t o r y musc les , 2 . Neurophys io l . 31:695-708.
I tnutsson E. (1961) : E f f e c t s o f e t h a n o l on t h e membrane p o t e n t i a l and membrane r e s i s t a n c e of f r o g muscle f i b e r s . A c t a P h y s i o l . Scan. 52:242-253.
Krnjevic K. and .%ledi R . (1958) : F a i l u r e o f neuromuscu la r p r o p a g a t i o n i n rats . J. P h y s i o l . 140:440-461.
X u r i h a r a T. and Brooks 3 . (1975) : The mechanism o f neuro- muscular f a t i g u e . Arch. Neurof.. 32:168.
Landau W. M . ff953): Aut-tic r e s p o n s e s med ica ted via the c o r t i c o s p i n a l tract-. 2. Neurophys io l . 16:299-311.
Landau W . and C l a r e H. (1964) : fusimotor funct ion vi: B reflex, t endon jerk and reinf o r a x t e n t i n h d p l e g i a . Arch. Neural, {Chic.) lO:1.28-134.
- - - - - - - - - - - - - - - - - - - -
Lartguth B . W . , T e a s d a l f R. D. and,rfagladery 3 . W. (1952) : - - ---
. . a C t ~ * v * l t Y ILL
p a t i e n t s with lesions of the nervous system: Motoneurone e x c i t a b i l i t y f o l l a v i n g a f f e r e n t n e r v e v o l l e y s i n p a t i e n t w i t h rostrally adjacent s p i n a l cord damage. B u l l . Johns Hopkins Hasp, 91~257-255-
Liberson W . T. (1962): Monosynaptic r e f l e x e s and t h e i r c l i n i c a l s i g n i f i c a n c e . Electroenceph. C l in . Neurophysiol. Suppl. 22 : 79-89.
F --------- I (1965): Experiment concerning r e c e i p r o c a l i n h i b i t i o n
of a n t a g o n i s t s e x c i t p d by e l e ~ t r i c a l ~ s t i m u l a t i o n of a g o n i s t s i n a normal i n d i v i d u a l . Am. J. Phys. Med. 44:306-308.
------ I Chen L. Y . I Fuk S . X. I P a t e l K. K., Yu G . H. and F r i e d P. (1975): H r e f l e x e s and F waves i n hemiplegics . Arch. Phys. Med. Rehabil. 56:551.
Lloyd P. C . , Hunt C. C. and Mcintyre A . K. (1955) : Trans- mission i n f r a c t i o n a t e d monosynaptic s p i n a l r e f l e x systems, J . Gen. Physiol . 38:307-317.
Low bl. D . , Basmajian J. V. and Lyons G. M. (1962) : Conduction v e l o c i t y and r e s i d u a l l a t ency i n human u l n a r nervq and e f f e c t s on them of e t h y l a l coho l . Am. J, Med. S c i . 244:720-730.
Lundberg A. (1975) : Control of s p i n a l mechanisms from t h g b r a i n . 'The Nervous System' - Donald B. Tower. Vol. s: The Bas ic Neurosciences. Raven Press 1975. p . 253-26$,
Lut tgau C. H. (1965) : The e f f e c t o f metabol ic i n h i b i t o r s on t h e f a t i g u e of t h e a c t i o n p o t e n t i a l of s i n g l e muscle f i b e r s . - J. Phys io l . 178:45-67.
Madkour 0. and Jacobsen W. (1967): H and F r e f l e x e s i n man. Xlectroenceph. Cl in . Neurophysiol. 23:391.
Ihg lade ry J., Teasda l l R . , Park A, and Languth H . . (1952): E lec t rophys io log ica l s t u d i e s of r e f l e x a c t i v i t y i n p a t i e n t s wi th l e s i o n s of t h e nervous system. 1. A comparison of s p i n a l motoneurone e x c i t a b i l i t y fol lowing a f f e r e n t nerve v o l l e y s i n normal person and p a t i e n t s w i t h upper motoneurone l e s i o n . Bu l l . Johns Hopk. Hosp. 91:219-244.
and McDougal D. 3. (1950): E lec t rophys io log ica l studies of nerve ref l ex -ac t iv i*y in normal man. 1. ~ d e n t i f i c a t i o n of c e r t a i n r e f l e x e s i n electromyogram and
en ve Inc i t y ~ - f ~ ~ = r i p h e _ x r a 1 ne r ~ e f i b e r ~ , B u l L - Johns Eopkins Eosp. 86:265-290.
Magladery J. W. (1955) : Some observa t ions on s p i n a l r e f l e x e s i n m a n . P f l u g e r s Arch. Ges. Physiol . 261:302-321.
\
b Malcqlm D. S. (1951) : A method of measuring r e f l e x t i m e
a p p l i e d i n s c i a t i c a and other cond i t i ons due t o nerve r o o t ,compression. J. Neurol. Neurosurg. Psych ia t r , 14:15.
Malouin F. and S h a r d T. (1978): Vibra t ion i n f l u e n c e on c o n t r o l o f s i n g l e motor u n i t a c t i v i t y . Arch. Phys. Med. Rehabil . 59 : l44- l5l .
Mark R. F. (1963) : Tonic s t r e t c h r e f l e x e s i n t h e c a l f muscles of normal human s u b j e c t s , Nature (Lond) . 199 : 5 0 ~ 5 2 ,
Marinacci A . (1966): Electromyogram i n t h e e l e v a t i o n of lumbar h e r n i a t e d d i s c . Electromyogram. 6:25.
Martinez A . C . , Conde P. and F e r r e r M. T. (1977): Motor conduction v e l o c i t y and H r e f l e x i n infancy and childhood - s tudy i n newborns, twins and smal l - for-dates . Electromyogr. C l in . Neurophysiol. 17:493-505.
Masland W. S. and Tucson A. (1972): F a c i l i t a t i o n dur ing t h e H r e f l e x recovery cyc le . Arch. Neurol. (Chic.) 26 : 313-319.
Matsuoka S. , Waltz J. MI, Terada C , , Ikeda T. and Cooper I, S, (1966): A computer technique f o r e v a l u a t i o n of recovery c y c l e of t h e H r e f l e x i n t h e abnormal movement d i s o r d e r s . Electroenceph. Cl in . Neurophysiol. 21:496-500.
Matthews P. B. and Rushworth G. (1957a): The s e l e c t i v e e f f e c t of p roca ine on t h e s t r e t c h r e f l e x and,tendon j e rk of s o l e u s muscle when a p p l i e d t o i ts nerve. J. Phys io l . (Lond) . 135:245-262.
Matthews W. B , (1966) : Rat io o f maximum H r e f l e x t o maximum M response as a measure of s p a s t i c i t y . J. Neurol. Neurosurg. Psychia t . 29:201-204.
Matthews W. B. (1968) : In t roduc t ion t o c l i n i c a l Neurology. The W i l l i a m s and Wilkins Company, Balt imore. 1968.
-------- (1970) : Cffn fca f i m p l i c a t i o n s of H r e f l e x and o f o t h e r e l e c t r i c a l l y induced r e f l e x e s . In: Modern Trends i n Neu-lw I--= E L a + W i U i a r n s - ~ U ~ r t h s e - - - - -
Mawdsley C. and Mayer R. F. (1965): Nerve conduction i n a l c o h o l i c neuropathy. , Brain. 88:335-356.
Mayer R. (1963) : Nerve conduction s t u d i e s i n man. Neurology (Minneap) 13:1021-1030.
---------- and Mawdsley C. (1965): S tud ie s i n man and cat o f t h e s i g n i f i c a n c e of the H wave. J. Neurol. Neurosurg. Psychia t . 28:201-211.
---------- and Feldman R. G . (1967) : Observations on n a t u r e of F wave i n man, Neurology. 17:$47-156.
---------- and Mosser R. S , (1973) : Maturation of human r e f l e x e s . New Developments Edi ted by Desmedt J. E, 3:294-307. (Karger, Base1 1973) .
McIntyre A. K, and Robinson R. G. (1959) : Pathway f o r t h e - jaw-jerk i n man. Brain. 82:468-474.
McLeod J.' G. and Van d e r Meulen J. P. (1967) : E f f e c t of c e r e b e l l a r a b l a t i o n on t h e H r e f l e x i n t h e cat. Arch. Neurol. 16:421-432.
---------- (1969) : H r e f l e x s t u d i e s i n p a t i e n t s wi th c e r e b e l l a r d i s o r d e r s , J. Neurol. Neurosurg. Psych ia t r . 32:21-27.
---------- (1972) : H r e f l e x s t u d i e s i n p a t i e n t s w i th Park inson ' s d i s e a s e . J. Neurol. Neurosurg. Psychia t . 35:77-80. .
Meinck H . M. (1976): Occurrence of t h e H r e f l e x and F wave i n t h e r a t . Electroenceph. Cl in . Neurophysiol. 41:530-533.
, *
14erton P. (1954): Voluntary s t r e n g t h and f a t i g u e . J. Physiol . 123:553-564.
Mongia S. K. (1972): S ign i f i cance o f c e r t a i n evoked responses i n neurogenic d i s o r d e r s , Electroenceph. Cl in . Neurophysiol. 33:236.
----------- (1972) : H r e f l e x from quadr iceps and gastocnemius muscles. Electromyography. 12:179-190.
Morin C. and P ie r ro t -Dese i f l igny E. (1977): 43ok a€ la a f f e r e n t s i n t h e so l eus motoneurones i n h i b i t i o n dur ing
- & a s s ~ ~ i l ; ~ - - v o ~ u n t a q - - c O I L t r a ~ n s i n _ man, E x p , -
Brain Res. 27:509-522.
Morris F . , Penn R. D. (1978): Evidence f o r changes i n segmental motoneurone pools by chronic c e r e b e l l a r stimu- l a t i o n and i ts c l i n i c a l s i g n i f i c a n c e . J. Neurol. Neurosurg. Psych ia t r . 41:630-633.
Mountcast le V. B. (1968): Pain and temperature s e n s i b i l i t i e s . I n : Medical Physiology Vol. 11. 1 2 t h Ed i t i on . Edi ted by Mountcast le V: B. The C. V. Mosby Company. p. 1424- 1460.
~ u r a k a m i E. (1971) : Evoked EPlG (M and H wave) i n r a t . C i t ed In: Meinck H. M. (1976): Occurrence of t h e H r e f l e x and t h e F wave i n the r a t . Electroenceph. Cl in . Neurophysiol. 41:530-533.
Na=anson J. A. (1 977) : Cycf i c nuc leo t ides and nervous system func t ion . Phys io l . Reviews. 57:157-265.
Notermans 6. L. and Vingerhoets H . M. (1974) : The importance of t h e Hoffmann r e f l e x i n t h e d i agnos i s of t h e lumbar r o o t l e s i o n s . Cl in . Neurol. and Neurosurg. 77:54-65.
Okada K. and Adachi M. (1962): E f f e c t s of e t h y l a l coho l on t h e endp la t e p o t e n t i a l . J. Physiol . Soc. Japan. 23:255-664. 4
Oku Y. (1973) : S t u d i e s on the H r e f l e x induced from human hand-muscles. Electromyogr. Clin. Neurophysiol. 13:403-431.
Otsuka M. , Endo PI. and Monomura Y,. (1962): P re synap t i c n a t u r e of neuromuscular depress ion. Jap . J. Phys io l . 12:573-584. ..
P a i l l a r d J. (1955) : Ci ted In: ~ o s s i g n o l S. and Jones , M. G. (1976). Elect roenceph. Cl in . Neurophysiol. 41:83-92.
-mu------ (1959) : Funct iona l o rgah iza t ion 0.f a f f e r e n t i n n e r v a t i o n of muscle s t u d i e d i n man by monosynaptic t e s t i n g . Amer. J. Phys. Med. 38:239-247.
P e i r i s 0. A . , Miles D. W. and Anderson W. N. (1966) : The a c t i o n of e t h y l a l coho l on t h e p e r i p h e r a l n e r v e s . Am. J. Med. S c i . 251:207-210.
- - -
Pie r ro t -Dese i l l i gny E . , Bussel B , , Held J. P. and Katz R. (1976): E x c i t a b i l i t y of human motoneurones a f t e r d i scharge i n a cond i t i on ing r e f l e x . Electroenceph. Cl in . Neurophysiol. 40 : 279-287.
Rabending G. and Koch R. D. (1962) : In f luence o f ampli tude o f monosynaptic r e f l e x e s on the du ra t ion of t h e s i l e n t per iod . In: Progress i n EMG E l e c t r o e n c e p h ~ and Cl in . Neurophysiol. Suppl No. 22:120-121.
Rabending G. (1967) : V a r i a t i o n s of p rop r iocep t ive r e f l e x e x c i t a b i l i t y dur ing c l i n i c a l ,absences ( s e i z u r e s ) and a t t h e beginning o f pho tosens i t i ve cen t r encepha l i c grand m a l . Electroenceph. Cl in . Neurophysiol. 23:387-388.
Renshaw (1941) : Cited In : G o t t l i e b G. L. and Agarwal G. C. (1976): Ext inc t ion of t h e Hoffmann r e f l e x by an t id romic conduction. Electroenceph. Cl in . Neurophysiol. 41:19-24.
Romanul F. C , (1965) : C a p i l l a r y supply and metabolism of muscle f i b e r s . Arch. Neurol. 12:497-509.
0
Rossignol S. and Jones G. M, (1976): Audiospinal i n f l u e n c e i n man s t u d i e d by t h e H r e f l e x and i t s p o s s i b l e r o l e on rhythmic movements synchronised t o sound. Electroenceph. C l in . Neurophysiol. 41:83-92.
Roth G, and Baer S. (1975) : Reflex H Heteronyme e t u n i d i r e c t i o n n e l Thenarien Chez L'Homme. Electromyogr. Cl in . Neurophysiol. 15:503-521.
Sachdev K . S., Rana P. K . , Dave K. C. and Joseph A, D. (1964): A s tudy of the-mechanism of a c t i o n of t h e p o t e n t i a t i o n by a l i p h a t i c a l c & o l s of t h e ace ty l - cho l ine response on t h e f r o g ' s r e c t u s hbdominis. Arch. Intern.. Pharmacodyn. he rag. 152 :408-415.
Sax D. S . , Johnson T. L. and Feldman R. G. (1976) : Computerized s tudy of H r e f l e x recovery curves i n Park inson ' s d i s e a s e : E f f e c t of L-Dopa. Arch. Phys. Med. Rehabil . 57:604.
Schuchmann J. A. (1976): B r e f l e x l a t ency i n the eva lua t ion of rad icu lopa thy . Arch. Phys. Med. Rehabil . 57:560.
Schuchmann J. A. (1978) : H r e f l e x l a t ency i n rad icu lopa thy . Arch. Phys. Med. Rehabil . 59:185-187.
S i ~ a , R. E . , Comas A . J. and Upton A. R. (1971): Impaired p o t e n t i a t i o n of H r e f l e x e s in p a t i e n t s w i t h upper motoneurone l e s i o n s . J. Neurol. Neurosurg. Psychia t . 3 L 7 1 2 - Z l L - -- -
Simoyama M. and Tanaka R. (1974): Reciprocal l a i n h i b i t i o n a t t h e o n s e t of vo lun ta ry movements i n man. Brain R e s . 82:334- 337.
Singh N . , Bha t ia H. and Singh B, (1971): Study of H r e f l e x i n muscular dystrophy. Electrornyography. 11:379-387.
Shashami Manik (1977): In f luence of v i s u a l - i n p u t on monosynaptic r e f l e x . Electromyogr. Cl in . Neurophysiol. 17:3-11.
Shea P. A., Woods W , W . and Werden D. H. (1950) : Electromyography i n d i agnos i s of nerve r o o t compression syndrome. Arch. Neurol, Psychia t . 64:93.
Shimizu A . , Yamada Y,, Yaxnoto J., F u j i k i A . and Kaneko Z . (1966): Pathways of descending i n f l u e n c e on H r e f l e x du r ing s l e e p . Elect roenceph. Cl in . Neurophysiol. 20:337,-347.
Sobue I: C i t e d In: K a n e k o Z . , Matsumoto K. , Shimizu A, and Sumi t su j i N. (1966): H r e f l e x s tudy i n graphospasm, Electromyography. 6:45:45-53.
Somervi l le J. and Ashby P. (1978): Hemiplegic s p a s t i c i t y : Neurophysiologic s t u d i e s . Arch. Phys. Med. Rehabil . 59 :592-596.
Stephens J. A. and Taylor A . (1972): Fa t igue mainta ined vo lun ta ry c o n t r a c t i o n i n man. J. Physiol . (Lond) . 220 : 1-10.
Stephens J. A . , Gerlach R. L., Reinking R. M. and S t u a r t D. G. (1973): F a t i g a b i l i t y o f medial gastrocnemius motor u n i t s i n t h e c a t . In : Cont ro l of Pos ture and Locomotion Vol. 7 Edi ted by S t e i n R. B . , Pearson K. G . , Smith R, S. and Redford J. B. Plenum Press . N.Y. 1973. p , 179-185. O
Stoupe l N. .and Monseu G . (1967) : Hoffman's r e f l e x i n c h i l d r e n wi th c e r e b r a l pa l sy . Electroenceph. Cl in . Neurophysiol. 22:391.
Szentagotha i J. (1948) : Anatomical cons ide ra t ions of monosynaptic r e f l e x arcs. J. Neurophysiol. 11:445-454.
Taborikova H. (1966) : F r a c t i o n of t h e motoneurone pool a c t i v a t e d i n t h e monosynaptic H r e f l e x e s i n man. Nature f L m d ) . 209~286-287, -
- -- -
---------- - -r Proz~ in iL- and X a n d i a fi.p'(19~~6) : Evidence t h a t muscle s t r e t c h evokes long-loop r e f l e x e s from h ighe r c e n t e r s . Bra in R e s , 2:$92-194.
. ------------ and Sax D. S . (1968): Motoneurone pool o f t h e H r e f l e x . J. Neurol. Neurosurg. Psychia t . 31:354-361.
------------ (1969): Condi t ioning of H r e f l e x e s by a preced ing sub threshold H x e f l e x s t imulus . Brain. 92:203-212.
------------ (1973): Suprasp ina l i n f luences on H r e f l e x . New Dev. i n EMG and Cl in . Neurophysiol. 3:328-335. Ed i t ed by Desmedt J. (Karger Base1 1973).
Takamori 14. (1967) : H r e f l e x s tudy i n upper motoneurone d i seases . Neurology. 17:32-40.
Teasda l l R. D. , Park A. M . , Languth H . W. and Magladery W. (1952): ~ l e c t r o ~ h ~ s i o l o ~ i c a l s t u d i e s o f r e f l e x a c t i v i t y i n p a t i e n t s w i t h l e s i o n s of t h e nervous system. Bu l l . Johns Hopk. Hosp. 91:245-256.
Thomas J. E. and Lambert E. W. (1960) : Ulnar nerve conduction v e l o c i t y and H r e f l e x i n i n f a n t s and c h i l d r e n . J. Appl. Physiol . 15 : 1-9.
Tobin W. (1969) : Monosynaptic r e f l e x e s ( H r e f l e x ) and motoneurone e x c i t a b i l i t y i n man. Dev. Med. Chi ld Neurol. 11:193-197.
Top l i s s J. G. (1970) : Xanthines: In : Medical Chemistry. Third Ed i t i on , P a r t 11. Edi ted by Al f red Burger. Wiley I n t e r s c i e n c e , New York. 1970. p . 892.
T r igg le D. J. (19 70) : Adrenergic hormones and drugs. In: Medical Chemistry. Third E d i t i o n , P a r t 11. Edi ted by Al f r ed Burger. Wiley I n t e r s c i e n c e , New York. 1970. p. 1273.
T ron te l J. V. (1968): H r e f l e x of s i n g l e motoneurone i n man. Mature (Lond) . 220: 1043-1044.
------------- (1973) : A s tudy of the H r e f l e x by s i n g l e f i b r e EMG J. Neurol. Neurosurg. Psychia t . 36:951-595.
Upton A. R . , S i c a R. E. and McComas A. J. (1972) : P o t e n t i a t e d H r e f l e x e s i n h e a l t h y and hemiplegi-c s u b j e c t s . Electromyography- 12:63-70. + -
V a n Der Meulen J. P, and Gilman S . (1965) : Recovery o f - - - - - - - ---
muscle s p i n d l e a c t i v i t y i n cats a f t e r c e r e b e l l a r a b l a t i o n . J. Neurophysiol. 28:943-957.
2-4
Vane J. R. (1972) : Pros t ag l and ins and a s p i r i n - l i k e drugs: Pharmacology and t h e f u t u r e of man. Pqoc* 5 t h I n t e r n a t i o n a l Congr. Pharmacology, San Francisco. 5:352- 378. (Karger B a s e l 1973) .
V e a l e J. L. and R e e s S. (1973) : Renshaw cell a c t i v i t y i n man. J. Neurol. Neurosurg. Psych ia t r . 36:674-683.
Wallgren H. and Barry H . I11 (1970): Actions of a lcohol . Vol. I. E l s e v i e r Publ i sh ing Company, New York. p. 209- 273.
Walsh J. and XcLeod J. ( 1 9 70) : ~ l ' c o h o l i c neuropathy - An e l e c t r o p h y s i o l o g i c a l and h i s t o l o g i c a l s tudy . J. Neurol. Science. 10:457-469.
Weber R. J. and e r o D, L. (1978) : F wave e v a l u a t i o n of t d o r a c i c ou P l e t syndrome: Mul t ip le r eg re s s ion de r ived F wave l a t ency p r e d i c t i n g technique. Arch. Phys, Med. Rehabil . 59:464-469.
Weaver R . , Landau W. and Higgins J. (1963): Fusimotor func t ion . P a r t 2 : Evidence of fus imotor depress ion i n human s p i n a l shock. Arch. Neurol. (Chic ) . 9:127-132.
W i l l e r J. C. and Dehen H. (1977): The H r e f l e x i n t h e ex tensor d i g i t o r m b r e v i s muscle: A s tudy i n l a t e n t a l c o h o l i c ne&opathy. Electroenceph. ~ l i n ; Neurophysiol. 42 : 205-212,
Wilson A . , S c h i l d H . , Model1 W. (1975) : ~ p p l i e d pharmacology. 11 th e d i t i o n . c h u r c h i l l Livingstone 1975. pp. 336- 337.
------------- (1977) : - Respect ive importance of d i f f e r e n t e l e c t r o p h y s i o l o g i c a l parameters i n a l c o h o l i c neuropathy. J. Neurological Sciences . 33:387-396.
Yap C. B , (1967): S p i n a l segmental and long loop r e f l e x e s on s p i n a l motoneurone e x c i t a b i l i t y i n s p a s t i c i t y and r i g i d i t y . Brain . 90:887-895.
Zander Olsen P. and Diamantopoulos E. (1967): E x c i t a b i l i t y of spire& neke~ rteerones in rrorma3 subjectszrrd patients wi'tfi s p a s t i c i t y , Parkinsonian r i g i d i t y , and c e r e b e l l a r kyrpotonia. J. Neurol. Neurosurg. Psychia t . 30:325-331.