Marquette University e-Publications@Marquette Master's Theses (2009 -) Dissertations, Theses, and Professional Projects Role of tendon vibration in multijoint reflex coupling in the hemiparetic arm post stroke Bani Gadhoke Marquette University Recommended Citation Gadhoke, Bani, "Role of tendon vibration in multijoint reflex ouc pling in the hemiparetic arm post stroke" (2011). Master's Theses (2009 -). Paper 101. http://epublications.marquette.edu/theses_open/101 ROLE OF TENDON VIBRATION IN MULTIJOINT REFLEX COUPLING IN THE HEMIPARETIC ARM POST STROKE By Bani Gadhoke, B.Tech. A Thesis submitted to the Faculty of the Graduate School, Marquette University, in Partial Fulfillment of the Requirements for the Degree of Master of Science Milwaukee, Wisconsin August 2011 ABSTRACT ROLE OF TENDON VIBRATION IN MULTIJOINT REFLEX COUPLING IN THE HEMIPARETIC ARM POST STROKE Bani Gadhoke, B.Tech. Marquette University, 2011 Post stroke hemiparesis causes reflex coupling in multiple muscles of the arm, leading to atypical movements that hamper motor control. In particular, people post- stroke can become unstable while holding the arm at the end of a planar motion. Recently, we have found that tendon vibration of the wrist flexors improves the stability of the arm during a hold task. The objective of the current study was to identify the effects of vibration applied to the wrist flexors on the biceps and triceps stretch reflexes, generated using a tendon tapper. In people post-stroke, tendon tap perturbations of the biceps and triceps elicit heteronymous spinal reflexes in muscles of the wrist, elbow and shoulder. We hypothesized that if tendon vibration improved stabilization of the arm through spinal reflex pathways, then heteronymous tendon tap reflexes would be modified by wrist vibration. Ten chronic stroke survivors and 5 age-matched controls participated in this study. Subjects were seated in a high-back chair, force/torque measurements were made from the 6 axis load cells at the elbow and wrist and EMG signals were recorded from 8 muscles. Isometric maximum voluntary contractions (MVCs) were performed for wrist and elbow flexion/extension and shoulder abduction/adduction. The test protocol consisted of 6 active tasks and 3 relaxed conditions in a randomized order, each consisting of 30 taps, with vibration applied during the middle 10 taps. The active tasks consisted of the same task types as the MVCs; however, the subjects maintained their primary force/torque between 10% and 30% of their MVCs. Peak-to-peak amplitude of the reflexes showed negligible changes in amplitude during vibration compared to the non vibration trials. These results showed that tendon vibration did not affect the multi-joint reflex coupling of muscles across the arm. Thus, the effects of tendon vibration as a sensory intervention, as seen in previous studies on arm stability do not appear to occur at the spinal level. These results imply that the effects of vibration on arm stability likely occur in supraspinal structures, suggesting a change in supraspinal sensorimotor integration underlies the effects. i ACKNOWLEDGMENTS Bani Gadhoke, B.Tech. I would like to sincerely thank my advisor, Dr. Brian Schmit, for trusting in me and giving me an opportunity to do research under his guidance. He has been very encouraging and supportive throughout the project. I am thankful to him for instilling a high degree of professionalism in me. I am grateful to my committee members Dr. Scott Beardsley and Dr. Allison Hyngstrom for their time and guidance during the thesis project. They have been very helpful despite their busy schedules and have provided useful insights for the completion of this multidisciplinary project. I am very thankful to Dr. Megan Conrad and Dr. Samir Sangani for providing the results of their studies to fuel the desire to carry out my research project. I would also like to thank the funding source NINDS R01-NS525. I am thankful to the INERL lab members for their assistance and useful discussions. I would particularly like to thank Ryan McKindles for making my transition from Bioinformatics to Biomedical Engineering easier. I would also like to thank my other lab members and friends from the department Tanya Onushko, Eric Walker, Robin Mottackel, Benjamin Kalinosky, Michael Jirjis, Matthew Chua, Kakanand Srungboonmee, Joseph Lee and Nutta-On for being friends along with being lab-mates. I am also thankful to my friends in the Biomedical engineering department: Priyanka Kanade, Dr. Lior Brotz, Jon Wieser, and especially Ronak Dholakia for uplifting my spirits and humoring me during the course of my project. ii I am very thankful to the stroke survivors who happily participated in this study and provided valuable data. Their contribution in the field of neurorehabilitation is very valuable. Last but not the least, I would like to dedicate my thesis to my grandparents Sardar Diwan Singh and Mrs. Bimla Kaur and parents Dr. Gurcharan Singh and Mrs. Sonya Gadhoke. They have provided extreme support, love and encouragement to me to successfully complete this project. iii TABLE OF CONTENTS ACKNOWLEDGEMENTS……………………………………………………………… i LIST OF TABLES………….…………………………………………………….……...vii LIST OF FIGURES………….…………………………………………………….……viii CHAPTER 1 – INTRODUCTION……………………………………………………...1 1.1. Stretch reflexes………………………………………………….................2 1.1.1 Tendon tap reflexes………………………………………………..3 1.1.2 Neural coupling of stretch reflexes………………………………..4 1.1.3 Quantitative assessment of stretch reflexes in neurological impairments………………………………………………………..5 1.2. Sensory-motor impairments post-stroke…………………………………..8 1.3. Sensory interventions post-stroke…………………………………..........10 1.4. Effects of tendon vibration on planar motion in hemiparesis post- stroke..........................................................................................................11 1.5. Specific aim……………………………………………………………...15 CHAPTER 2 – ROLE OF TENDON VIBRATION ON MULTIJOINT REFLEX COUPLING IN THE HEMIPARETIC ARM POST STROKE…..16 2.1. Introduction………………….……………………………...……………16 2.2. Research methodologies and materials…………………….….................18 2.2.1 Subject sample…………………………………………………...18 2.2.2 Tendon tapper…………………………………………………....20 2.2.3 Tendon vibrator…………………………………………………..20 iv 2.2.4 EMG, Torque and LVDT recordings…………………………….21 2.2.5 Experimental setup……………………………………………….22 2.2.6 Research protocol………………………………………………...24 2.2.7 Data analysis……………………………………………………..25 2.2.8 Statistical analysis………………………………………………..30 2.3. Results……………………………………………………………………30 2.3.1 Relaxed conditions……………………………………………….30 2.3.2 Active tasks………………………………………………………34 2.3.2.1 Elbow flexion/extension tasks…………………………34 2.3.2.2 Wrist flexion/extension tasks…………………………..39 2.3.2.3 Shoulder abduction/adduction tasks………...................44 2.4. Discussion………………………………………………………………..49 2.4.1 Modulation of Ia afferent feedback at the spinal level in relaxed conditions by tendon vibration ………….…...................49 2.4.2 Modulation of Ia afferent feedback at the spinal level in active tasks by tendon vibration ………………………………...51 2.4.3 Supraspinal structures likely involved in enhancing motor outcomes by tendon vibration…………………………………...54 2.5. Conclusion………………………………………………………...……..56 CHAPTER 3 – FUTURE DIRECTIONS……………...…………...…........................57 REFERENCES………………………………………………………………………….59 APPENDIX A: STATISTICAL ANALYSIS…………………………………………65 A.1 Stroke – Biceps Tendon Tap – Elbow Extension Task…………………..65 A.2 Stroke – Biceps Tendon Tap – Elbow Flexion Task…………………….66 v A.3 Stroke – Biceps Tendon Tap – Wrist Extension Task…………………...67 A.4 Stroke – Biceps Tendon Tap – Wrist Flexion Task……………………...68 A.5 Stroke – Biceps Tendon Tap – Shoulder Abduction Task……………….69 A.6 Stroke – Biceps Tendon Tap – Shoulder Adduction Task……………….70 A.7 Stroke – Biceps Tendon Tap – Passive 1 Task…………………………..71 A.8 Stroke – Biceps Tendon Tap – Passive 2 Task…………………………..72 A.9 Stroke – Biceps Tendon Tap – Passive 3 Task…………………………..73 A.10 Stroke – Triceps Tendon Tap – Elbow Extension Task…………………74 A.11 Stroke – Triceps Tendon Tap – Elbow Flexion Task……………………75 A.12 Stroke – Triceps Tendon Tap – Wrist Extension Task…………………..76 A.13 Stroke – Triceps Tendon Tap – Wrist Flexion Task……………………..77 A.14 Stroke – Triceps Tendon Tap – Shoulder Abduction Task………………78 A.15 Stroke – Triceps Tendon Tap – Shoulder Adduction Task………………79 A.16 Stroke – Triceps Tendon Tap – Passive 1 Task………………………….80 A.17 Stroke – Triceps Tendon Tap – Passive 2 Task………………………….81 A.18 Stroke – Triceps Tendon Tap – Passive 3 Task………………………….82 A.19 Control – Biceps Tendon Tap – Elbow Extension Task…………………83 A.20 Control – Biceps Tendon Tap – Elbow Flexion Task……………………84 A.21 Control – Biceps Tendon Tap – Wrist Extension Task………………….85 A.22 Control – Biceps Tendon Tap – Wrist Flexion Task…………………….86 A.23 Control – Biceps Tendon Tap – Shoulder Abduction Task……………...87 A.24 Control – Biceps Tendon Tap – Shoulder Adduction Task……………..88 A.25 Control – Biceps Tendon Tap – Passive 1 Task…………………………89 vi A.26 Control – Biceps Tendon Tap – Passive 2 Task…………………………90 A.27 Control – Biceps Tendon Tap – Passive 3 Task…………………………91 A.28 Control – Triceps Tendon Tap – Elbow Extension Task………………...92 A.29 Control – Triceps Tendon Tap – Elbow Flexion Task…………………..93 A.30 Control – Triceps Tendon Tap – Wrist Extension Task…………………94 A.31 Control – Triceps Tendon Tap – Wrist Flexion Task……………………95 A.32 Control – Triceps Tendon Tap – Shoulder Abduction Task……………..96 A.33 Control – Triceps Tendon Tap – Shoulder Adduction