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	Opponens pollicis long latency reflex during the ipsilateral sustained knee torque maintenance.

*Shinichi Daikuya, PT, Ph.D., Yumi Okayama, PT, MSc, Kyonosuke Yabe, Ph.D.
*M3 Doctor Support, Inc., Value-up promotion Dept., Director in rehabilitation charge.
 1-1-7 2F, Higashi-Nihonbashi, Chuo-ku, Tokyo 103-0004 JAPAN
 TEL: +81-3-5835-5180, FAX: +81-3-5835-5181, e-mail: s-daikuya@m3ds.co.jp














Brief Report
Long latency reflex recorded from opponens pollicis muscle during the ipsilateral sustained torque maintenance of the knee extension by different feedback methods

*Shinichi Daikuya, PT, Ph.D., **Yumi Okayama, PT, MSc., ***Kyonosuke Yabe, Ph.D.
*: M3 Doctor support Inc.
**: Osaka University of Human Sciences.
***: Nagoya University.

key words: long latency reflex, neuro-muscular coordination, feedback 










Abstract
Objective: As a preliminary study to clarify the excitability of central nervous system function during motor control, the aspect of long latency reflex in the upper limbs, which is an indicator of excitability of upper central nervous system function, while maintaining knee extension torque with constant strength.
Methods: Long latency reflex was recorded from opponens pollicis muscle during the ipsilateral sustained torque demonstration of the knee extension by different feedback methods in healthy subjects with maintaining the 25% of individual peak torque by the visual feedback and the verbal instruction. From the acquired waveform, the appearance characteristic of long latency reflex between each task was visually examined.
Results: In 8 out of 10 subjects, the aspect of the long latency reflex was changed according to the difference in task.
Discussion and Conclusion: It was suggested that excitability of higher level of cortex might be enhanced if the degree of difficulty becomes higher even if motion control of lower limbs. In the requirement of fine adjustment of motor control, even if the task of lower extremity, it was suggested that the excitability of the cerebral cortex function associated with the upper limb might increase.
     Because it is not possible to refer to the individual difficulty level of tasks and the skill of lower limbs for each subject in this experiment, follow-up study is needed under the clear conditions of the task, especially individual difficulty and skill.
Introduction
     In the rehabilitation process for the return to play after sports injury, there is the case who sports activity can not be acquired smoothly despite no problem in physical findings such as muscular strength, range of joint motion, performance battery test and so on. On the other hand, some people can smoothly return to competition despite the insufficient physical findings.
     In our previous case study (Daikuya et al., 2008 and 2013), there are cases in which hyperactivation of the long latency reflex during sports performance acquisition process or at the immediately after injury. We pay attention to the importance of the involvement of central nervous system function in the acquisition process of sports motion and the healing process of the injury. Particularly, it was thought that the consciousness and unconsciousness in the sports performance are involved in the result of the sports performance acquisition process. In other words, we emphasize the ability to control the posture and movement under unconsciousness in smooth operation of the sports performance.
     The purpose of this study is to investigate the excitability of central nervous system function during motor control. As a preliminary study we examined the aspect of long latency reflex in the upper limbs, which is an indicator of excitability of upper central nervous system function, while maintaining knee extension torque with constant strength.

Subjects and Methods
     Subjects were 10 healthy adults (5 males and 5 females) who did not show any abnormality in the neurological function and musculoskeletal system. Prior to the experiment, all of the subjects were informed the purpose of this study based on the descriptions, and their agreement for participation was obtained from all of the subjects.
     The experimental situation is shown in Figure 1. Using the BIODEX SYSTEM 3 (Biodex medical system, inc.), the knee extension torque was maintained of 25% of their individual peak torque of voluntary isometric contraction at the 60 degrees flexed position of knee joint. Two feedback methods concerning torque maintenance were set. The first is visual feedback (Task A). In the Task A, subjects gazed at the torque curve on the screen of BIODEX and sustained torque maintenance due to subject's own visual feedback. The second is guidance by the examiner's verbal instruction (Task B). In Task B, subjects kept constant output with blindfolded only by verbal guidance of the examiner with monitoring the torque curve on the screen. 
     Long latency reflex was recorded from the opponens pollicis muscle during the ipsilateral sustained torque demonstration of the knee extension in the order of Task A-B-A. As a stimulus condition for recording the long latency reflex, a constant current rectangular wave with a frequency of 0.5 Hz and a duration of 0.2 ms was added 16 times in the median nerve at the wrist with the intensity at which the maximum M wave is evoked (Hirose, et al., 1995). In order to evoke the long latency reflex, sustained contraction of the recording muscle is needed. So, in this experiment, as the contraction condition, we chose to gently hold the rubber ball. From the acquired waveform, the appearance characteristic of long latency reflex between each task was visually examined.

Results
     As the alteration of the appearance aspect of the long latency reflex between Task A (subjects� own visual feedback) and B (verbal guidance by examiner), the following findings were obtained.
   a: Finding 1 (n=7, Figure 2-1, 2-2) 
In Task B, although the late components of long latency reflex increased in non-dominant side, that of long latency reflex unchanged or decreased in dominant side.
   b: Finding 2 (n=1, Figure 3-1, 3-2)
Long latency reflex decreased in non-dominant side, and increased in dominant side in Task B.
   c: Finding 3 (n=2, Figure 4-1, 4-2)
      There was no difference in results and tendency between tasks.

Discussion
     Recent studies about motion control using long latency stretch reflex as an index of involving the higher nervous system include the followings. In the course of adaptation process for reach activity under the various conditions, the excitability of motor cortex increased as the involvement of sensory feedback control (Ahmadi-Pajouh, et al., 2012). On the other hand, in the study of motor control for perturbation to forearm position (elbow angle), the excitability of the supraspinal structures increased by feed forward strategy than that of feedback in non-dominant arm (Walker and Perreault, 2015). 
     Long latency reflex recorded from finger is affected by the excitability of motor cortex. The reflection path is thought to go through the cerebral cortex, and its late components represent the excitability of higher level of cortex. In our previous case study (Daikuya, et al., 2008), during the acquisition process of sports performance after the reconstruction of anterior cruciate ligament, from one month to five months after the operation, the long latency reflex from soleus muscle in operative side appeared during silent period recording by electrophysiological measurement, normally long latency reflex disappeared, and it became most remarkable in four months after reconstruction of anterior cruciate ligament. In that case, the appearance of long latency reflex were observed when much guidance was required in order to correct motion image in operative side during rehabilitation process. In the period of 4 months after reconstruction of anterior cruciate ligament, various activities has to be acquired; i.e., squatting, jogging, running, splinting, cutting and so on. In that case, it needed to activate various neural functions (i.e., polysynaptic reflex on spinal and/or supra-spinal nervous system). On the other hand, in the case of ankle sprain (Daikuya, et al., 2013), a rhythmical waveform like a long latency reflex was observed after three days injury on injured side. From this finding, on injured side in that case, it was cleared that the excitability of supra-spinal neural function was increased. And, even if a slight injury of remote part like ankle sprain, the alteration of the excitability of the supra-spinal neural function was existed for one month after injury. In those two cases, the hyperactivation of the long latency reflex at the immediately after injury or during sports performance acquisition process were existed. 
     In this study, the late components of long latency reflex increased in non-dominant side in Task B in 8 out of 10 subjects. In the occasion of hypothesis that Task B was more difficult and much proprioception was activated than Task A, even if it was a motor task of lower extremity, if the difficulty level became higher, it was possible that the excitability of the cerebral cortex related to the upper limb might increase. Therefore, it was suggested that excitability of higher level of cortex might be enhanced if the degree of difficulty becomes higher even if motion control of lower limbs. However, because it is not possible to refer to the individual difficulty level of tasks and the skill of lower limbs for each subject in this experiment, follow-up study is needed under the clear conditions of the task, especially individual difficulty in the future.

Conclusion
     In this study, as for the motor control in the state of that activated much proprioceptive sense in the lower limb, in other words, when the degree of difficulty of motor control was high and more adjustment under consciousness was required, it was suggested that the excitability of the cerebral cortex function related to upper extremity might be high.

Reference
Ahmadi-Pajouh MA, Towhidkhah F, Shadmehr R (2012): Preparing to reach: selecting an adaptive long-latency feedback controller. J Neurosci 32: 9537-9545.
Daikuya S, Suzuki T, Yabe K (2008): Neuromuscular function after reconstruction of anterior cruciate ligament -A case study using evoked electromyography-. Electromyogr clin Neurophysiol 48: 131-137.
Daikuya S, Ono A and Yabe K (2013): H reflex from soleus muscle after ankle sprain of a college basketball player. J Trauma Treat 2:4:175.
Hirose H, Suzuki T, Daikuya S, Fujiwara T, Takeda I (1995): Characteristics changes in long-latency reflexes (LLR) during various grades of voluntary isometric contraction (Abstract in English). Rigaku Ryohogaku (The Journal of Japanese Physical Therapy Association), 22: 160-164.
Walker EE, Perreault EJ (2015): Arm dominance affects feedforward strategy more than feedback sensitivity during a postural task. Exp Brain Res 233: 2001-2011.











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