PATHOLOGICAL STRETCH REFLEXES ON THE GOOD SIDE OF HEMIPARETIC PATIENTS

The reflex EMG responses from a tendon tap or an imposed, medium amplitude (30°), stretch at a range of stretch velocities have been recorded from the triceps and biceps muscles of normal human subjects and in both the affected and 'unaffected' arms of hemiparetic patients under relaxed conditions. In the hemiparetic arm, exaggerated tendon jerks were, as expected, observed in both muscles. The response of the biceps to elbow extension was also exaggerated compared with normal values and displayed both an additional, earlier component and a much reduced velocity threshold. The triceps, in contrast, showed depressed responses to elbow flexion, with a much higher velocity threshold than normal subjects. Furthermore, on the supposedly 'unaffected' side of the hemiparetic subjects, the reciprocal pattern was seen, with depression of the biceps response and a raising of its threshold, along with considerably exaggerated responses in the triceps including earlier components not seen in the normal subjects. The increased excitability of the flexor musculature on the spastic side may be paralleled by increases in activity in the segmental pathways responsible for modulation of agonist/antagonist activity in the ipsi and contralateral limb, leading to an inhibition of the ipsilateral extensors and contralateral flexors and excitatory input to the contralateral extensors. Thus the 'good' side of hemiparetic patients also receives pathological changes, and studies of the mechanisms of spasticity should avoid the use of the 'unaffected' side of hemiparetic subjects as a control for monitoring pathological reflexes.