Involuntary stepping after chronic spinal cord injury : evidence for a central rhythm generator for locomotion in man

We investigated a pattern of involuntary lower extremity stepping-like movements which recently appeared in a subject with a 17-year history of neurologically incomplete injury to the cervical spinal cord. The movements were rhythmic, alternating and forceful, involved all muscles of the lower extre...

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Bibliographic Details
Published in:Brain (London, England : 1878) England : 1878), 1994-10, Vol.117 (5), p.1143-1159
Main Authors: CALANCIE, B, NEEDHAM-SHROPSHIRE, B, JACOBS, P, WILLER, K, ZYCH, G, GREEN, B. A
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Brain - physiopathology
Electromyography
Evoked Potentials
Humans
Injuries of the nervous system and the skull. Diseases due to physical agents
Leg
Locomotion
Male
Medical sciences
Motor Cortex - physiopathology
Muscle Contraction
Muscle, Skeletal - physiopathology
Muscle, Smooth - physiopathology
Spinal Cord Injuries - physiopathology
Traumas. Diseases due to physical agents
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Summary:We investigated a pattern of involuntary lower extremity stepping-like movements which recently appeared in a subject with a 17-year history of neurologically incomplete injury to the cervical spinal cord. The movements were rhythmic, alternating and forceful, involved all muscles of the lower extremities and could be reliably evoked by lying the subject down (supine) and extending his hips. Once in this position, the movements continued spontaneously, in the absence of external sensory perturbations, with a step-cycle duration of approximately 3.5 s (0.3 Hz). This rate could be either increased or temporarily halted by specific sensory inputs. Anaesthetizing the subject's right hip joint, in which we found evidence of pathology, led to a marked attenuation of the stepping movements for a period of approximately 15 min. We believe that a combination of (i) preserved but limited supraspinal tonic facilitation, and (ii) abnormal, perhaps noxious afferent inflow from the subject's right hip to the spinal cord may underlie the appearance of this highly unusual and involuntary movement pattern. The striking similarity between the movement and EMG patterns in this subject and those described in many reports using the surgically reduced cat model suggests that we were witnessing the first well-defined example of a central rhythm generator for stepping in the adult human.
ISSN:0006-8950
1460-2156
DOI:10.1093/brain/117.5.1143