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322
323
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34
Mech
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On
EMG
Results
Phases of central excitability during clonus
The first question asked was whether the silent
period between two beats of clonus was due to
unloading the spindles or to a central refractory
period. In these experiments clonus was
maintained by continual stretch of the triceps
surae while the excitability of the motoneurons
performing clonus was examined by putting in
three kinds of test stimuli with different delays
after the preceding clonic burst. These added
stimuli were afferent volleys elicited by tendon
taps, H-reflex stimulation, and vibration of the
tendon at 80 Hz with 3 mm displacement. The
experiments were done on a patient wi,th
hemiplegia following a vascular lesion of the
internal capsule and on 3 patients with lesions of
the cervical cord. The sequence of mechanical
and electrical events during clonus is shown in
fiR I. It is an excerpt of a continuous recording
of sustained clonus maintained by constant
stretch on the foot. The times between clonic
bursts have been numbered so that they can be
referred to. This numbering is mainly based on
the recordings in man of Hagbarth, Wallin and
Lofstedt8 and Hagbarth et al.2 Particularly
relevant are their recordings of ankle clonus,
shown in fig 4 of their second paper.
Point 1 marks the beginning of plantar flexion
in response to the contraction of the triceps
surae. Between points 1 and 2, the muscle
spindles will be unloaded and their afferents will
be silent. At point 2, the limit of plantar flexion
is reached. The foot is maintained in plantar
flexion between 2 and 3. After point 3, the foot
dorsiflexes in response to the steady force
maintained by the examiner. Between points 1
and 3. the muscle is contracting. The spindles
cease to fire after the next point I is reached. In
the case illustrated, in which ankle clonus was at
a rate of 6 Hz, the duration of muscle relaxation
lasted about 65 ms. Among all patients, the
range of this period was 50 to 75 ms. In this
case, the subsequent EMG burst lasts about 50
ms; the range among all patients was 40 to 70 ms.
The silent period in this case was 120 ms; the
50
100
150
200
324
EMG ]
Vibr
,,,,
lum
1Orms
40ms
E MG
Vibr
X
60ms
......
130ms
5mV1 EMG
JVibr
9Oms
140ms
lOOms
Fig 3 A vailability of motor units to vibration on
tendo Achillis. The times shown are the times after
the onset of the previous clonic EMG burst.
]0
40
80
120
160
200
2mV
325
2 mV
40
Fig 4 A vailability of
80
120
160
200
are
three superimposed
records.
326
W 50
0a
z
0
4
2
0
Rate of tapping (Hz)
10
Fig
response3,
stretch.
With tapping rates above that of clonus, two
kinds of response were seen: a poorly synchronised low amplitude response to each
stimulus; or a large synchronised response to
alternate taps. There is a 40-50% response at
a tapping rate of 10 Hz, which is twice the rate
of tapping of the 95-lCO% response at 5 Hz.
That peripheral factors were not playing a role
is seen by examination of the maximum responsiveness possible from a single motor unit. Fig 6
shows single motor unit responses to tapping rates
327
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Mech
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6
Tendon tap frequency (Hz)
10
12
14
16
EMG
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328
rate.
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Gastroc
Gonio ankle
Accel tendon
lo I
Tib ant
Soleus
Gastroc
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Accel tendon
150,V
329
Discussion
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References
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doi: 10.1136/jnnp.43.4.321
Updated information and services can be found at:
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Notes