Direct and reflex motor effects of conventional and catch-like electrical stimulation for dropped foot correction

Abstract

Electrical stimulation applied to the common peroneal nerve during the swing phase of gait is an established clinical technique for the correction of dropped foot following upper motor neuron injury. The catch-like effect of skeletal muscle refers to force augmentation resulting from the inclusion of an initial high frequency burst of two or more stimuli prior to conventional low frequency electrical stimulation. There is interest in clinical utilisation of catch-like stimulation during functional applications; however the mechanism of the effect is not fully understood. The purpose of this research was to determine if the catch-like effect is a property of the muscle alone or related to spinal reflex mediated activation. In order to investigate this, direct and reflex motor effects of conventional and catch-like stimulation during dropped foot correction and other controlled conditions were assessed in unimpaired (n=12) and stroke (n=13) populations through use of electromyography. A system was developed to enable analysis of electromyography activity shortly after the application of configurable stimulation patterns. Innovative design minimised effects of stimulation artefact such that electromyography of the tibialis anterior and soleus muscles during dropped foot correction could be assessed. This system was utilised and further refined during exploratory investigations prior to structured use with study participants. Both direct and reflex motor effects of conventional stimulation were found to vary with muscle length. At typical stimulation intensities and frequencies used during dropped foot correction, direct (orthodromic) motor activation dominates voluntary or reflex mediated activation of the tibialis anterior. Enhanced contractile force when utilising catch-like stimulation with human participants, appears an effect solely inherent to muscle with no excitatory or inhibitory spinal reflex contribution. Facilitation of reflected antidromic motor activation (F-waves) with voluntary effort, observed only within the unimpaired participant group, may be an indicator of normal neuroplasticity at the spinal cord. Findings highlight the need to consider antidromic motor effects of electrical stimulation when combining its use with voluntary function during future clinical development.

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