Search Results (22)

The human spinal cord is increasingly recognized as an active and adaptable component of sensorimotor function, contributing to motor control, pain modulation, and recovery after neurological injury. Within this framework, the Hoffmann reflex (H-reflex) has evolved from a classical electrophysiological phenomenon into a useful probe of spinal circuit function. Rather than reflecting motoneuron excitability alone, H-reflex amplitude and modulation arise from the interaction of Ia afferent transmission, presynaptic inhibition, homosynaptic depression, and interneuronal networks that regulate sensorimotor gain in a state-dependent manner. This review synthesizes classical and contemporary evidence to position the H-reflex as an indirect measure of spinal inhibitory function in humans. We integrate physiological mechanisms with findings from studies in chronic pain syndromes, spasticity, Parkinson’s disease, and recovery after central nervous system injury, where alterations in spinal inhibitory processes have been described. We further discuss methodological and conceptual challenges that limit clinical translation, including state dependence, protocol heterogeneity, and the lack of normative reference frameworks. Finally, we outline directions for integrating H-reflex paradigms with complementary approaches to improve the interpretation of spinal circuit function and its relation to clinical phenomena. Framed in this context, the H-reflex can be considered a valuable experimental and translational tool, whose utility depends on careful methodological implementation and physiologically informed interpretation. Full article

Background/Objectives: Visual motion is a powerful contributor to postural control, yet its influence on modulation of the Ia afferent pathway remains to be confirmed. This study investigated whether optic-flow simulating self-motion modulates the soleus Hoffmann (H) reflex recorded in the soleus during upright stance in immersive virtual reality. Methods: Fourteen healthy adults completed two experimental sessions, each comprising four visual conditions of increasing optic-flow complexity. In one session, participants stood freely on a force platform (free standing) whereas in the other, postural sways were restricted (supported standing). Surface EMG, posterior tibial nerve stimulation, and force-platform recordings were collected. Results: During free standing, optic flow substantially increased postural sway [F(3,13) = 15.7, p < 0.001, η² = 0.55], with higher sway in all optic-flow conditions (~13 mm/s) compared with static viewing (~10 mm/s). In contrast, soleus H-reflex amplitude was not modulated by optic flow [F(3,13) = 0.2, p = 0.57], remaining stable across conditions (~44% M_max). Background EMG and CoP position preceding stimulation were similar across conditions. In supported standing, used to isolate the effect of optic flow independently to postural control, H-reflex amplitude again showed no condition effect [F(3,13) = 0.2, p = 0.86]. Conclusions: These findings indicate that postural perturbation induced by optic flow was not accompanied by a modulation of the Ia afferent-motoneuron transmission of the soleus under the used experimental conditions. The results suggest that postural control under virtual optic flow is mediated predominantly by supraspinal sensory-integration mechanisms, rather than by modulation of the Ia-monosynaptic reflex pathway. Full article

Background/Objectives: Accurate assessment of neuromuscular reflexes, such as the Hoffmann reflex (H-reflex), plays a critical role in sports science, rehabilitation, and clinical neurology. Conventional interpretation of H-reflex electromyography (EMG) waveforms is subject to inter-rater variability and interpretive bias, limiting reliability and standardization. This study aims to develop an automated, interpretable, and robust agentic AI–driven framework for H-reflex waveform analysis. Methods: We propose a fine-tuned Vision–Language Model (VLM) consortium combined with a reasoning Large Language Model (LLM)–enabled decision support system for automated H-reflex interpretation. Multiple VLMs were fine-tuned on curated datasets of H-reflex EMG waveform images annotated with expert clinical observations, recovery timelines, and athlete metadata. The VLM outputs were aggregated using a consensus-based strategy and further refined by a specialized reasoning LLM to ensure coherent, transparent, and explainable diagnostic assessments. Model fine-tuning employed Low-Rank Adaptation (LoRA) and 4-bit quantization to enable efficient deployment on consumer-grade hardware. Results: Experimental evaluation demonstrated that the proposed hybrid system delivers accurate, consistent, and clinically interpretable assessments of neuromuscular states, including fatigue, injury, and recovery, directly from EMG waveform images and contextual metadata. Compared with baseline models, the fine-tuned VLM consortium exhibited substantially improved precision, consistency, and contextual awareness, while the reasoning LLM enhanced diagnostic coherence through cross-model consensus and structured reasoning, thereby supporting responsible and explainable AI-driven decision making. Conclusions: This work presents, to the authors’ knowledge, the first integration of a responsible and explainable AI-driven decision support system for H-reflex analysis. The proposed framework advances the automation and standardization of neuromuscular diagnostics and establishes a foundation for next-generation AI-assisted decision support systems in sports performance monitoring, rehabilitation, and clinical neurophysiology. Full article

Background: Rate-dependent depression of the Hoffmann reflex (RDD-HR) is a neurophysiological marker of spinal inhibition altered in several neurological conditions, yet no consensus exists on optimal stimulation frequency, number of stimuli, or the feasibility of upper limb recordings. This study aimed to define practical, standardized parameters for reliable RDD-HR assessment in upper and lower limbs of healthy adults, as a first step toward clinical application. Methods: In this observational study, bilateral Hoffmann reflexes were recorded from the flexor carpi radialis and soleus muscles in 21 healthy adults. Stimulation was delivered using three 10-pulse trains at seven frequencies (0.1–5 Hz). RDD-HR was quantified as the median H-reflex area, expressed as a percentage of the first response (lower values indicate greater depression). Optimal frequencies and minimal stimuli were identified by sigmoid fitting and confidence analyses, with train and stimulus effects tested by two-way ANOVA. Results: RDD-HR displayed a sigmoidal frequency–response across all limbs. Maximal depression occurred at 1–5 Hz, with no significant differences between these frequencies, supporting 1 Hz as optimal. Depression was greater in lower limbs (~30%) than upper limbs (~47%). Reliable estimates were obtained using a single train of seven stimuli, with no benefit from averaging across trains. Upper limb recordings required lower stimulation intensities. Conclusions: RDD-HR can be reliably assessed using a simplified protocol based on a single seven-pulse train at two key frequencies. This standardized approach provides a methodological foundation for future clinical validation of RDD-HR as a biomarker of spinal inhibitory dysfunction. Full article

Calcium (Ca²⁺) release from the sarcoplasmic reticulum is central to excitation–contraction coupling and plays a critical role in the development of skeletal muscle fatigue. Altered Ca²⁺ dynamics may affect not only contractile function but also neuromuscular excitability. This study examined the effects of pharmacological modulation of Ca²⁺ channels on fatigue development and spinal reflex activity in rats. Using the Hoffmann reflex (H-reflex) as an indicator of motoneuron excitability, we evaluated the effects of Ca²⁺ channel blockers (Amiloride, Nifedipine) and an activator ((−)-Bay K8644) on the reflex responses of the plantar muscle before and after fatigue induction. The ratio of the maximum H-reflex to maximum M-wave (H_max/M_max) was used to assess alterations in spinal excitability. Compared with the control, both Amiloride and Nifedipine markedly reduce the H_max/M_max ratio (77% and 60%, respectively), whereas (−)-Bay K8644 elicited a robust 129% increase. These findings demonstrate that pharmacological modulation of Ca²⁺ channels has distinct and divergent effects on spinal excitability during fatigue. These results highlight the close interaction between intramuscular Ca²⁺ regulation and reflex pathways and suggest potential strategies for enhancing muscle performance through targeted Ca²⁺ channel modulation. Full article

Background/Objectives: Acute lateral ankle sprain (ALAS) affects balance, often assessed by changes in traditional center of pressure (COP) parameters. Spatiotemporal measures of COP and time-to-boundary (TTB) analysis may offer improved sensitivity in detecting postural deviations associated with ALAS. However, the neurophysiological mechanism underlying these changes remains unknown. This study aimed to explore the effects of ALAS on spinal reflex excitability in the fibularis longus (FL) during single-leg balance and TTB parameters following ALAS. Methods: Fourteen participants with and without ALAS were recruited within 14 days from the onset of the injury. We assessed FL spinal reflex excitability and postural control during a single-leg stance. The primary outcomes included the H/M ratio, H-latency, and TTB parameters. For H-reflex testing, the peripheral electrical stimulation was delivered at the sciatic nerve before bifurcating into the tibial and common fibular nerve while participants maintained a single-leg balance position with the involved side of the limb. The TTB parameters of the medial–lateral (ML) and anterior–posterior (AP) directions of the mean, SD, and minimum were assessed, which indicate postural correction and strategies. Results: Patients with ALAS had a significantly lower AP-TTB minimum compared with healthy uninjured controls, with a moderate effect size (p = 0.039; d = −0.83). However, there was no significant difference in the H/M ratio (ALAS: 0.29 ± 0.16 vs. CON: 0.24 ± 0.10; p = 0.258) and H-reflex latency (ALAS: 34.6 ± 1.92 vs. CON: 33.8 ± 1.75 ms; p = 0.277); Conclusions: These results indicate that reflex control at the spinal level may have a minimal role in response to balance deficits following ALAS. Full article

Background/Objective: Short hamstring syndrome is common in the general population and can lead to impaired balance, function, and posture, and increased risk of injuries. Local treatments have obtained controversial results, so it is necessary to evaluate the effectiveness of other types of therapy such as osteopathic treatment. To evaluate the efficacy of osteopathic techniques in increasing the elasticity of the hamstring musculature in short hamstring syndrome. Methods: A systematic review of randomised controlled trials was conducted in PubMed, Medline, Cinhal, Scopus, WOS, SPORTDiscuss, and PEDro. The PEDro scale was used to evaluate the methodological quality and the RoB2 for the evaluation of biases. Results: A total of eight articles were selected. Most of the participants were assessed with the Active Knee Extension or Straight Leg Raise tests. The osteopathic techniques used were the muscle energy technique, suboccipital inhibition, and vertebral mobilisations. As for the control interventions, they mainly included passive stretching and placebo. Conclusions: The results suggest that osteopathic techniques are more effective than placebo or other interventions in increasing flexibility in adult patients with short hamstring syndrome. This effect can be explained by neurophysiological (Golgi apparatus, neuromuscular spindle activity, and Hoffmann reflex) and structural factors (dura mater, posture, and myofascial chains). Nevertheless, the evidence suggests that it would be beneficial to incorporate this type of treatment into flexibility improvement programmes. Full article

(1) Background: Neuromuscular electrical stimulation (NMES) has beneficial effects on physical functions in Multiple sclerosis (MS) patients. However, the neurophysiological mechanisms underlying these functional improvements are still unclear. This study aims at comparing acute responses in spinal excitability, as measured by soleus Hoffmann reflex (H-reflex), between MS patients and healthy individuals, under three experimental conditions involving the ankle planta flexor muscles: (1) passive NMES (pNMES); (2) NMES superimposed onto isometric voluntary contraction (NMES+); and (3) isometric voluntary contraction (ISO). (2) Methods: In total, 20 MS patients (MS) and 20 healthy individuals as the control group (CG) took part in a single experimental session. Under each condition, participants performed 15 repetitions of 6 s at 20% of maximal voluntary isometric contraction, with 6 s of recovery between repetitions. Before and after each condition, H-reflex amplitudes were recorded. (3) Results: In MS, H-reflex amplitude did not change under any experimental condition (ISO: p = 0.506; pNMES: p = 0.068; NMES+: p = 0.126). In CG, H-reflex amplitude significantly increased under NMES+ (p = 0.01), decreased under pNMES (p < 0.000) and was unaltered under ISO (p = 0.829). (4) Conclusions: The different H-reflex responses between MS and CG might reflect a reduced ability of MS patients in modulating spinal excitability. Full article

In chronic shoulder pain, adaptations in the nervous system such as in motoneuron excitability, could contribute to impairments in scapular muscles, perpetuation and recurrence of pain and reduced improvements during rehabilitation. The present cross-sectional study aims to compare trapezius neural excitability between symptomatic and asymptomatic subjects. In 12 participants with chronic shoulder pain (symptomatic group) and 12 without shoulder pain (asymptomatic group), the H reflex was evoked in all trapezius muscle parts, through C3/4 nerve stimulation, and the M-wave through accessory nerve stimulation. The current intensity to evoke the maximum H reflex, the latency and the maximum peak-to-peak amplitude of both the H reflex and M-wave, as well as the ratio between these two variables, were calculated. The percentage of responses was considered. Overall, M-waves were elicited in most participants, while the H reflex was elicited only in 58–75% or in 42–58% of the asymptomatic and symptomatic participants, respectively. A comparison between groups revealed that the symptomatic group presented a smaller maximum H reflex as a percentage of M-wave from upper trapezius and longer maximal H reflex latency from the lower trapezius (p < 0.05). Subjects with chronic shoulder pain present changes in trapezius H reflex parameters, highlighting the need to consider trapezius neuromuscular control in these individuals’ rehabilitation. Full article

The aim of the study was to determine the relationship between changes in physiological tremor after exercise and changes in the traction properties of the stretch reflex indirectly assessed using the Hoffmann reflex test. The research involved 19 young men practicing canoe sprint (age 16.4 ± 0.7 years, body mass 74.4 ± 6.7 kg, body height 182.1 ± 4.3 cm, training experience 4.8 ± 1.6 years). During resting tests, Hoffmann reflex measurements were performed from the soleus muscle, physiological tremor of the lower limb, and the blood lactate concentration was determined. Then, a graded test was carried out on the kayak/canoe ergometer. Immediately after the exercise and in the 10th and 25th minute following the exercise, Hoffmann’s reflex of the soleus muscle was measured. The physiological tremor was measured at 5, 15 and 30 min after exercise. Blood lactate concentrations were determined immediately after physiological tremor. Both the parameters of Hoffmann’s reflex and physiological tremor changed significantly after exercise. There were no significant interrelationships between Hoffmann reflex measurements and physiological tremor in resting and post-exercise conditions. No significant correlation was detected between changes in physiological tremor and changes in Hoffmann reflex parameters. It is to be assumed that there is no connection between a stretch reflex and a physiological tremor. Full article

In people with peripheral neuropathy (PN), impaired plantar sensation can cause adaptive changes in the central nervous system (CNS), resulting in changes in the standing postural control, which is reflected in the variability of standing output signals. Standard deviation (SD) and entropy are reliable indicators of system variability, especially since entropy is highly sensitive to diseased populations. The relation between SD and entropy, CNS and center of pressure (COP) variability is unclear for people with severe PN. The purpose of this study was to explore the adaptability of the CNS to the severe of PN and its effect on the degree and complexity of COP variability. Here, people with PN were divided into less affected (LA) and more affected (MA) groups based on plantar pressure sensitivity. We studied Hoffmann reflex (H-reflex) and standing balance performance with the control group (n = 8), LA group (n = 10), and MA group (n = 9), recording a 30 s COP time series (30,000 samples) of double-leg standing with eyes open. We observed that the more affected group had less COP complexity than people without PN. There is a significant negative correlation between the SD and sample entropy in people without PN, less affected and more affected. The COP complexity in people without PN was inversely correlated with H-reflex. We concluded that: (1) The complexity of COP variability in patients with severe plantar sensory impairment is changed, which will not affect the degree of COP variability; (2) The independence of the COP entropy in the AP and ML directions decreased, and the interdependence increased in people with PN; (3) Although the CNS of people with PN has a greater contribution to standing balance, its modulation of standing postural control is decreased. Full article

Recent literature has highlighted altered spinal-reflex excitability following acute lateral ankle sprain (ALAS), yet there is little information on the conduction velocity of spinal reflex pathways (CV-SRP) in these patients. Therefore, we aimed to investigate the effects of ALAS on the CV-SRP. We employed a cross-sectional study with two groups: ALAS (n = 30) and healthy controls (n = 30). The CV-SRP of the soleus, fibularis longus, and tibialis anterior was assessed using the H-index method. As secondary outcomes, H-reflex and M-wave latencies were assessed as well as acute symptoms including ankle swelling, pain, and self-reported ankle function. Separate group-by-limb ANOVA with repeated measures revealed a significant interaction for soleus CV-SRP (p < 0.001) and H-reflex latency (p < 0.001), showing significant slower CV-SRP and longer H-reflex latency in the involved limb of the ALAS group compared with both limbs in the control group. However, there was no significant interaction or main effect in any other ankle muscles (p > 0.05). A further correlation analysis showed a significant relationship between CV-SRP and acute symptoms, including ankle swelling (r = −0.37, p = 0.048) and self-reported ankle function (r = 0.44, p = 0.017) in ALAS patients. These results suggest a disrupted functionality of the afferent pathway and/or synaptic transmission following ALAS. Level of Evidence: 4. Full article

Neural changes in the ankle stabilizing muscles following ankle sprains are thought to be one contributing factor to persistent ankle dysfunction. However, empirical evidence is limited. Therefore, we aimed to examine spinal reflex excitability of lower leg muscles following acute ankle sprains (AAS). We performed a case-control study with 2 groups consisting of 30 young adults with AAS and 30 aged-matched uninjured controls. Hoffmann reflex (H-reflex) testing was performed to estimate spinal reflex excitability of lower leg muscles: soleus, fibularis longus (FL), tibialis anterior (TA). Maximal H-reflex (H_max) and motor responses (M_max) were determined by delivering a series of electrical stimuli at the sciatic nerve. H_max/M_max ratios were calculated to represent normalized spinal reflex excitability. Separate group-by-limb analyses of variance (ANOVA) with repeated measures found there were no significant interactions for any of the muscles (SL: F_1,56 = 0.95, p = 0.33, FL: F_1,51 = 0.65, p = 0.42, TA: F_1,51 = 1.87, p = 0.18), but there was a significant main effect of group in the soleus (F_1,56 = 6.56, p = 0.013), indicating the H_max/M_max ratio of soleus in the AAS group was significantly lower bilaterally (AAS = 0.56 ± 0.19, control = 0.68 ± 0.17, p = 0.013), with no significant group differences in the other muscles (FL: F_1,51 = 0.26, p = 0.61, TA: F_1,51 = 0.93, p = 0.34). The bilateral inhibition of the soleus spinal reflex excitability following AAS may be significant in that it may explain bilateral sensorimotor deficits (postural control deficits) following unilateral injury, and provide insights into additional therapies aimed at the neural change. Full article

Background and Objectives: The Hoffmann’s reflex (H-reflex) is important in electrodiagnostic testing because it improves sensitivity and specificity in diagnosing radiculopathies. Although quantitative electromyography (EMG) measurements for H-reflex amplitudes during the gait cycle have been performed in both hemiplegic and healthy individuals, research on the H-wave latency in these individuals during the gait cycle is lacking. Materials and Methods: The H-reflex latency of the soleus muscle was investigated in hemiplegic stroke patients and healthy elderly persons in this observational analytical study. Two groups of individuals participated in this study: healthy adults (n = 25) and stroke patients with hemiplegia (n = 25) were compared. An MP150 with Ag-Ag/Cl electrodes was utilized to record and analyse electromyography measurements. All individuals could walk independently indoors. Stimuli were administered to elicit the H-reflex in the four gait phases as the participant walked. Results: Stroke patients had a significantly shorter latency than did healthy patients in the mid-swing, mid-stance, and toe-off phases of the gait cycle; heel-strike latency did not significantly differ. Conclusions: These results can be used as diagnostic data to help account for patient characteristics or measure the recovery extent for treatment planning and gait training in hemiplegic individuals. Full article

The state and excitability of pattern generators are attracting the increasing interest of neurophysiologists and clinicians for understanding the mechanisms of the rhythmogenesis and neuromodulation of the human spinal cord. It has been previously shown that tonic sensory stimulation can elicit non-voluntary stepping-like movements in non-injured subjects when their limbs were placed in a gravity-neutral unloading apparatus. However, large individual differences in responsiveness to such stimuli were observed, so that the effects of sensory neuromodulation manifest only in some of the subjects. Given that spinal reflexes are an integral part of the neuronal circuitry, here we investigated the extent to which spinal pattern generation excitability in response to the vibrostimulation of muscle proprioceptors can be related to the H-reflex magnitude, in both the lower and upper limbs. For the H-reflex measurements, three conditions were used: stationary limbs, voluntary limb movement and passive limb movement. The results showed that the H-reflex was considerably higher in the group of participants who demonstrated non-voluntary rhythmic responses than it was in the participants who did not demonstrate them. Our findings are consistent with the idea that spinal reflex measurements play important roles in assessing the rhythmogenesis of the spinal cord. Full article