Distribution of M-Wave and H-Reflex in Hand Muscles Evoked via Transcutaneous Nerve Stimulation: A Preliminary Report

Neuromuscular electrical stimulation (NMES) targeting the muscle belly is commonly used to restore muscle strength in individuals with neurological disorders. However, early onset of muscle fatigue is a major limiting factor. Transcutaneous nerve stimulation (TNS) can delay muscle fatigue compared with traditional NMES techniques. However, the recruitment of Ia afferent fibers has not be specifically targeted to maximize muscle activation through the reflex pathway, which can lead to more orderly recruitment of motor units, further delaying fatigue. This preliminary study assessed the distribution of M-wave and H-reflex of intrinsic and extrinsic finger muscles. TNS was delivered using an electrode array placed along the medial side of the upper arm. Selective electrode pairs targeted the median and ulnar nerves innervating the finger flexors. High-density electromyography (HD EMG) was utilized to quantify the spatial distribution of the elicited activation of finger intrinsic and extrinsic muscles along the hand and forearm. The spatial patterns were characterized through isolation of the M-wave and H-reflex across various stimulation levels and EMG channels. Our preliminary results showed that, by altering the stimulation amplitude, distinct M-wave and H-reflex responses were evoked across EMG channels. In addition, distinct stimulation locations appeared to result in varied levels of reflex recruitment. Our findings indicate that it is possible to adjust stimulation parameters to maximize reflex activation, which can potentially facilitate physiological recruitment order of motoneurons.