Acute Intermittent Hypoxia Increases Motor Unit Discharge Rates And Strength in Persons with SCI

Abstract

<h3>Research Objectives</h3> To determine whether changes in motor unit discharge rates contribute to acute intermittent hypoxia (AIH)-induced improvements in volitional strength in persons with chronic incomplete spinal cord injury (iSCI) at the cervical level. <h3>Design</h3> Repeated-measures crossover study. <h3>Setting</h3> Rehabilitation hospital. <h3>Participants</h3> Seven individuals with iSCI completed two different sessions (AIH and SHAM) in a randomized order. <h3>Interventions</h3> AIH consisted of breathing 15 brief (∼60s) periods of low oxygen (9% O2) interspersed with 60s of normoxia (21% O2), whereas SHAM consisted of repeated exposures to normoxia. <h3>Main Outcome Measures</h3> We recorded high-density surface electromyograms from biceps and triceps brachii during maximal elbow flexion and extension torques, and decomposed these signals into individual motor unit spike trains before and 60 minutes after the interventions. <h3>Results</h3> After AIH, elbow flexion and extension torque increased by 54% (p = 0.0078; g = 0.58) and 59% (p = 0.04, g = 0.63) from baseline, respectively, whereas there was no change (i.e. < 10% change and p > 0.2 in both cases) after SHAM. Across muscles, motor unit discharge rates increased by 3.96 pulses per second (∼38%; p = 0.0015; G = 0.86) during maximal efforts, from pre to post AIH. Using generalized linear mixed models, we found that changes in motor unit discharge rates explained 54% (p = 0.0033) of the variance of changes in volitional torque. <h3>Conclusions</h3> These findings suggest that excitability and/or the activation of spinal motoneurons are augmented after AIH, providing a mechanism to explain AIH-induced increases in voluntary strength. Pending validation, AIH could potentially be used in conjunction with other therapies to enhance rehabilitation outcomes due to these enhancements in motor unit function and strength. <h3>Author(s) Disclosures</h3> The authors have nothing to disclose.