Patellar tendon vibration reduces the increased facilitation from quadriceps to soleus in post-stroke hemiparetic individuals

Ann Phys Rehabil Med. 2017 Sep;60(5):319-328. doi: 10.1016/j.rehab.2017.03.008. Epub 2017 May 18.

Abstract

Background: Stimulation of the femoral nerve in healthy people can facilitate soleus H-reflex and electromyography (EMG) activity. In stroke patients, such facilitation of transmission in spinal pathways linking the quadriceps and soleus muscles is enhanced and related to co-activation of knee and ankle extensors while sitting and walking. Soleus H-reflex facilitation can be depressed by vibration of the quadriceps in healthy people, but the effects of such vibration have never been studied on the abnormal soleus facilitation observed in people after stroke.

Objectives: To determine whether vibration of the quadriceps can modify the enhanced heteronymous facilitation of the soleus muscle observed in people with spastic stroke after femoral nerve stimulation and compare post-vibration effects on soleus facilitation in control and stroke individuals.

Methods: Modulation of voluntary soleus EMG activity induced by femoral nerve stimulation (2×motor threshold) was assessed before, during and after vibration of the patellar tendon in 10 healthy controls and 17 stroke participants.

Results: Voluntary soleus EMG activity was facilitated by femoral nerve stimulation in 4/10 (40%) controls and 11/17 (65%) stroke participants. The level of facilitation was greater in the stroke than control group. Vibration significantly reduced early heteronymous facilitation in both groups (50% of pre-vibration values). However, the delay in recovery of soleus facilitation after vibration was shorter for the stroke than control group. The control condition with the vibrator turned off had no effect on the modulation.

Conclusions: Patellar tendon vibration can reduce the facilitation between knee and ankle extensors, which suggests effective presynaptic inhibition but decreased post-activation depression in the lower limb of people after chronic hemiparetic stroke. Further studies are warranted to determine whether such vibration could be used to reduce the abnormal extension synergy of knee and ankle extensors in people after hemiparetic stroke.

Keywords: Coactivation; Hemiparesis; Heteronymous facilitation; Spasticity; Stroke; Vibration.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Electric Stimulation Therapy / methods*
  • Female
  • Femoral Nerve
  • H-Reflex / physiology
  • Humans
  • Male
  • Middle Aged
  • Muscle, Skeletal / physiopathology
  • Paresis / etiology
  • Paresis / physiopathology
  • Paresis / rehabilitation*
  • Patellar Ligament
  • Quadriceps Muscle / physiopathology
  • Stroke / complications
  • Stroke / physiopathology*
  • Stroke Rehabilitation / methods*
  • Vibration / therapeutic use*