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Claudia Angeli, Victor R. Edgerton, Yury Gerasimenko, Susan Harkema, Reply: No dawn yet of a new age in spinal cord rehabilitation, Brain, Volume 138, Issue 7, July 2015, Page e363, https://doi.org/10.1093/brain/awu376
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Sir,
We agree with Dr Wernig that enhancement of activity after spinal cord injury can be obtained by mechanical stimulation, electrical stimulation of the skin, reduction of body weight support and enhanced excitability including Jendrassik manoeuvres. Therefore in our study we assessed this excitability continuously. In all four of our research participants with repeated Jendrassik manoeuvres there was no detectable EMG activity below the level of lesion [Supplementary Fig. 2 in Angeli et al. (2014): neck flexion with resistance]. Neck flexion with resistance is one way to induce the Jendrassik manoeuvre and in many individuals with cervical level injury may be the only way because grasping their fingers bilaterally and pulling is not possible due to the severity and level of injury. In addition, when we provided repetitive sensory cues within categories of mechanical stimulation and reduction of body weight support, no increase in EMG activity was observed as was reported by Angeli et. al. (2014). Dr Wernig refers to Supplementary Videos 3 and 4 concluding that these are because of the Jendrassik manoeuvre mechanisms because of their significant exertion. However, when the stimulator is off these same exertions (Fig. 3), as quantified by the EMG activity of the intercostal muscles above the lesion, demonstrate that the Jendrassik manoeuvre alone cannot elicit motor activity below the lesion. Dr Wernig appears to make his conclusions from the video alone. The EMG activity in the figures show discrete movements of the toe and ankle without the ‘seemingly all-or-none multi-joint flexion mass’. In addition, in the flexion and extension leg movements there is alternation of flexor and extensor activity, a feature not observed in Jendrassik manoeuvres as we reported previously with Dr Wernig and thus are very aware of this phenomenon (Maegele et al., 2002).
