H-reflex and Its Role in EMG Laboratory and Clinical Practice

Česká verzia

Authors: Z. Kadaňka Jr.
Authors place of work: Neurologická klinika LF MU a FN Brno
Published in the journal: Cesk Slov Neurol N 2017; 80(6): 641-646
Category: Review Article
doi: https://doi.org/10.14735/amcsnn2017641

Summary

H-reflex is the most extensively studied reflex in the electrophysiological literature. It is no longer considered to be strictly monosynaptic since it has been shown to contain a shorter monosynaptic and longer oligosynaptic component. It is widely used in EMG laboratories. The relative ease with which the H-reflex can be elicited makes it an attractive clinical tool. However, we must take into account the limitations to H-reflex examination in neurophysiology. This concerns the choice of appropriate methods used to elicit the H-reflex (correct location of stimulating and recording electrodes) and correct evaluation of amplitude and latency, which are influenced by many factors (including the phenomenon presynaptic of inhibition and post-activating depression). The H-reflex is not exclusively monosynaptic, it consists of monosynaptic and oligosynaptic pathways. This reflex is not an equivalent of tendon jerk reflex because it bypasses muscle spindle mechanisms. With correct interpretation, the H-reflex is a useful tool for diagnosing sensorimotor polyneuropathy, plexopathy, radiculopathy S1 and static nerve lesions. It has been used in sports medicine research to evaluate musculoskeletal injuries and can be used as a tool to assess the neurophysiologic mechanism underlying the recovery of walking after spinal cord injuries. H-reflex modulation is also used to monitor the degree of hypertonia in the study of spasticity.

Key words:
H-reflex – electromyography – presynaptic inhibition – post-activation depression – polyneuropathy – radiculopathy S1 – lumbar plexopathy

The author declares he has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Zdroje

1. Misiaszek JE. The H-reflex as a tool in neurophysiology: its limitations and uses in understanding nervous system function. Muscle Nerve 2003;28(2):144– 60. doi: 10.1002/ mus.10372.

2. Burke D, Gandevia SC, McKeon B. The afferent volleys responsible for spinal proprioceptive reflexes in man. J Physiol 1983;339(6):535– 52.

3. Magladery JW, Porter WE, Park AM, et al. Electrophysiological studies of nerve and reflex activity in normal man. IV. The two-neurone reflex and identification of certain action potentials from spinal roots and cord. Bull Johns Hopkins Hosp 1951;88(6):499– 519.

4. Burke D, Gandevia SC, McKeon B. Monosynaptic and oligosynaptic contributions to human ankle jerk and H-reflex. J Neurophysiol 1984;52(3):435– 48.

5. Jankowska E, Johannisson T, Lipski J. Common interneurones in reflex pathways from group 1a and 1b afferents of ankle extensors in the cat. J Physiol 1981;310:381– 402.

6. Lin CS, Chan JH, Pierrot-Deseilligny E, et al. Excitability of human muscle afferents studied using threshold tracking of the H reflex. J. Physiol 2002;545(2):661– 9. doi: 10.1113/ jphysiol.2002.026526.

7. Zehr EP. Considerations for use of the Hoffmann reflex in exercise studies. Eur J Appl Physiol 2002;86(6):455– 68. doi 10.1007/ s00421-002-0577-5.

8. Eccles JC, Schmidt RF, Willis WD. Presynaptic inhibition of the spinal monosynaptic reflex pathway. J Physiol 1962;161:282– 97.

9. Iles JF. Evidence for cutaneous and corticospinal modulation of presynaptic inhibition of Ia afferents from the human lower limb. J Physiol 1996; 491(1):197– 207.

10. McIlroy WE, Collins DF, Brooke JD. Movement features and H reflex modulation. II. Passive rotation, movement velocity and single leg movement. Brain Res 1992;582(1):85– 93.

11. Misiaszek JE, Brooke JD, Lafferty KB, et al. Long-lasting inhibition of the human soleus H reflex pathway after passive movement. Brain Res 1995;677(1):69– 81.

12. Cheng J, Brooke JD, Misiaszek JE, et al. Crossed inhibition of the soleus H reflex during passive pedalling movement. Brain Res 1998; 779(1– 2):280– 4.

13. Hiraoka K. Phase-dependent modulation of the soleus H-reflex during rhythmical arm swing in humans. Electromyogr Clin Neurophysiol 2001;41(1):43– 7.

14. Chen XY, Wang Y, Chen Y, et al. Ablation of the inferior olive prevents H-reflex down-conditioning in rats. J Neurophysiol 2016;115(3): 1630– 6. doi: 10.1152/ jn.01069.2015.

15. Rudomin P, Schmidt RF. Presynaptic inhibition in the vertebrate spinal cord revisited. Exp Brain Res 1999;129(1):1– 37.

16. Bonnet M, Decety J, Jeannerod M, et al. Mental simulation of an action modulates the excitability of spinal reflex pathways in man. Brain Res Cogn Brain Res 1997;5(3):221– 8.

17. Hultborn H, Illert M, Nielsen J, et al. On the mechanism of the post-activation depression of the H-reflex in human subjects. Exp Brain Res 1996;108(3):450– 62.

18. Magladery JW, McDougal DB Jr. Electrophysiological studies of nerve and reflex activity in normal man. I. Identification of certain reflexes in the electromyogram and the conduction velocity of peripheral nerve fibres. Bull Johns Hopkins Hosp 1950;86(5):265– 90.

19. Hugon M. Methodology of the Hoffmann reflex in man. In: Desmedt JE (ed). New Developments in Electromyography and Clinical Neurophysiology. Basel: Karger 1973: 277– 93.

20. Dumitru D, Amato AA, Zwartz MJ. Nerve conduction studies. In: Dumitru D, Amato AA, Zwarts M. (eds.) Electrodiagnostic Medicine. 2nd ed. Philadelphia: Hanley & Belfus 2001: 159– 223.

21. Panizza M, Nilsson J, Roth BJ, et al. The time constants of motor and sensory peripheral nerve fibers measured with the method of latent addition. Electroencephalogr Clin Neurophysiol 1994;93(2):147– 54.

22. Lachman T, Shahani BT, Young RR. Late responses as aids to diagnosis in peripheral neuropathy. J Neurol Neurosurg Psychiatry 1980;43(2):156– 62.

23. Sabbahi MA, Khalil M. Segmental H-reflex studies in upper and lower limbs of patients with radiculopathy. Arch Phys Med Rehabil 1990;71(3):223– 7.

24. Buschbacher RM. Normal range for H-reflex recording from the calf muscles. Am J Phys Med Rehabil 1999;78(Suppl 6):S75– 9.

25. Denys EH. M wave changes with temperature in amyotrophic lateral sclerosis and disorders of neuromuscular transmission. Muscle Nerve 1990;13(7):613– 7.

26. Hicks A, Fenton J, Garner S, et al. M wave potentiation during and after muscle activity. J Appl Physiol 1989;66(6):2606– 10.

27. Mayo M, DeForest BA, Castellanos M, et al. Characterization of involuntary contractions after spinal cord injury reveals associations between physiological and self-reported measures of spasticity. Front Integr Neurosci 2017;11:2. doi: 10.3389/ fnint.2017.00002.

28. Millán-Guerrero R, Trujillo-Hernández B, Isais-Millán S, et al. H-reflex and clinical examination in the diagnosis of diabetic polyneuropathy. J Int Med Res 2012;40(2):694– 700. doi: 10.1177/ 147323001204000233.

29. Nishida T, Kompoliti A. Janssen I, et al. H reflex in S-1 radiculopathy: latency versus amplitude controversy revisited. Muscle Nerve 1996;19(7):915– 7. doi: 10.1002/ (SICI)1097-4598(199607)19:7<915::AID-MUS19>3.0.CO;2-H.

30. Cho SC, Ferrante MA, Levin KH, et al. Utility of electrodiagnostic testing in evaluating patients with lumbosacral radiculopathy: An evidence-based review. Muscle Nerve 2010;42(2):276– 82. doi: 10.1002/ mus.21759.

31. Jankus WR, Robinson LR, Little JW. Normal limits of side-to-side H-reflex amplitude variability. Arch Phys Med Rehabil 1994;75(1):3– 7.

32. Kreiner DS, Shaffer WO, Baisden JL, et al. An evidence based clinical guideline for the diagnosis and treatment of degenerative lumbarspinal stenosis (update). Spine J 2013;13(7):734– 43. doi: 10.1016/ j.spinee.2012.11.059.

33. Sudulagunta SR, Sodalagunta MB, Sepehrar M, et al. Guillain-Barré syndrome: clinical profile and management. Ger Med Sci 2015;21;13. doi: 10.3205/ 000220.

34. Dachy B, Deltenre P, Deconinck N, et al. The H reflex as a diagnostic tool for Miller Fisher syndrome in pediatric patients. J Clin Neurosci 2010;17(3):410– 1. doi: 10.1016/ j.jocn.2009.06.014.

35. Kim KM, Hart JM, Saliba SA, et al. Relationships between self-reported ankle function and modulation of Hoffmann reflex in patients with chronic ankle instability. Phys Ther Sport 2016;17:63– 8. doi: 10.1016/ j.ptsp.2015.05.003.

36. Karakoyun A, Boyraz İ, Gunduz R, et al. Electrophysiological and clinical evaluation of the effects of transcutaneous electrical nerve stimulation on the spasticity in the hemiplegic stroke patients. J Phys Ther Sci 2015;27(11):3407– 11. doi: 10.1589/ jpts.27.3407.

37. Stetkarova I, Kofler M. Differential effect of baclofen on cortical and spinal inhibitory circuits. Clin Neurophysiol 2013;124(2): 339– 45. doi: 10.1016/ j.clinph.2012.07.005.

38. Bonouvrié LA, Becher JG, Vles JS, el al. Intrathecal baclofen treatment in dystonic cerebral palsy: a randomized clinical trial: the IDYS trial. BMC Pediatr 2013;13:175. doi: 10.1186/ 1471-2431-13-175.

39. Chen XY, Wolpaw JR. Dorsal column but not lateral column transection prevents down-conditioning of H reflex in rats. J Neurophysiol 1997;78(3):1730– 4.

40. Nielsen J, Crone C, Hultborn H. H-reflexes are smaller in dancers from The Royal Danish Ballet than in well-trained athletes. Eur J Appl Physiol Occup Physiol 1993;66(2):116– 21.

41. Thompson AK, Wolpaw JR. Restoring walking after spinal cord injury: operant conditioning of spinal reflexes can help. Neuroscientist 2015;21(2):203– 15. doi: 10.1177/ 1073858414