Appearance of reciprocal facilitation of ankle extensors from ankle flexors in patients with stroke or spinal cord injury

The purpose of the present study was to investigate the pathophysiological role of reciprocal facilitation between antagonistic motoneuron pools in spasticity. The soleus H-reflex was conditioned by prior stimulation of the peroneal nerve in 15 healthy subjects, six hemiplegic patients and 11 spinal cord injured (SCI) patients. The hemiplegic patients were tested from soon after the onset of hemiplegia and up to 2 years later. Whereas stimulation of the peroneal nerve produced short-latency inhibition of the soleus H-reflex in healthy subjects, it produced facilitation in spastic SCI and hemiplegic patients. This facilitation was demonstrated to have a low threshold compatible with activation of group I afferents and was most likely mediated by an oligosynaptic (reciprocal) excitatory pathway. The facilitation appeared in parallel with the development of hyperactive Achilles tendon reflexes, which was the only clinical finding that could be correlated positively with the facilitation. It is suggested that the appearance of reciprocal excitation plays a role in the pathophysiology of spasticity.