The Soleus H-Reflex as a Biomarker of Post-Injury Spasticity in Spinal Cord Injury: A Conceptual Pilot Study
Notice bibliographique
Résumé
BackgroundSpinal cord injury (SCI) disrupts neuronal pathways, alters spinal reflexes, and often leads to spasticity-a condition of increased muscle tone and involuntary contractions that interfere with daily function. Spasticity typically emerges progressively after injury; however, its mechanisms remain poorly understood, particularly regarding why it develops in some individuals but not in others. Increased spinal excitability has been implicated, but prospective evidence remains scarce.ObjectiveThis pilot, proof-of-concept study explored whether early electrophysiological markers of spinal excitability, specifically the soleus H-reflex and post-activation depression (PAD), could be linked to the subsequent development of spasticity during intensive functional rehabilitation (IFR).MethodsSeventeen individuals with traumatic SCI were assessed. The Hmax/Mmax ratio and PAD were measured prior to or shortly after IFR admission. At IFR admission and discharge, spasticity (Modified Ashworth Scale and clonus) and motor function (Lower Extremity Motor Score, LEMS) were evaluated. Each lower limb was analyzed separately to account for asymmetry. Correlations between early electrophysiological measures and clinical outcomes were examined.ResultsSpasticity measures tended to increase from IFR admission to discharge, but only LEMS improved significantly, reflecting motor recovery. Several participants did not present spasticity at admission or discharge. A higher Hmax/Mmax ratio and reduced PAD at early IFR were associated with greater clonus at both admission and discharge, whereas no significant associations were found with Ashworth scores. Across injury levels and AIS grades, AIS A participants displayed the lowest Hmax/Mmax ratios and minimal spasticity, while AIS B or D participants with H/M ratios exceeding 0.2 in early IFR developed clonus.ConclusionThese exploratory findings suggest that early signs of spinal hyperexcitability reflect spasticity development, but it does not show that they precedes spasticity development, which would be required to support its prognostic value. Assessment at earlier timepoints, such as in acute care, would be necessary to validate both the Hmax/Mmax ratio and the PAD as predictive measures of spasticity in SCI. While not clinically generalizable due to the small and heterogeneous sample, this proof-of-concept study highlights the feasibility and potential value of H-reflex as early markers of spasticity. Larger, adequately powered studies stratified by injury level and severity are needed to confirm utility and clinical applicability.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».