# Upper limb muscle reflexes in real and virtual environments: Insights into sensorimotor adaptations

## TL;DR

The study explores how upper limb muscle reflexes change in virtual environments, revealing that motion perception in VR suppresses spinal reflexes and affects neuromuscular control.

## Contribution

The novel use of VR to manipulate visual feedback and assess sensorimotor adaptations in upper limb reflexes under altered emotional and visual conditions.

## Key findings

- H-reflex amplitude was suppressed during dynamic VR and persisted after returning to the real environment.
- Sympathetic arousal and motion sickness symptoms increased during VR-C but returned to baseline post-VR.
- Muscle spindle sensitivity (NTV-reflex) remained stable across conditions, suggesting fusimotor adaptations.

## Abstract

The mechanisms influencing neuromuscular adaptations in the upper limb within dynamic environments remain understudied, especially when exposed to altered visual and emotional conditions such as those simulated in virtual reality (VR). Here we utilize VR to manipulate visual feedback, inducing motion sickness and modulating sympathetic arousal, while assessing adaptations in sensorimotor integration in the upper extremity using electrically evoked and muscle stretch reflexes.

Eighteen healthy young adults experienced four experimental conditions while sustaining submaximal activation of their flexor carpi radialis (FCR) muscle by isometrically supporting a weighted load: baseline real-world (Pre-VR), stationary VR (VR-BL), dynamic VR with motion perception via a virtual rollercoaster ride (VR-C), and post-VR following re-entry to the real environment (Post-VR). Muscle activity was monitored via electromyography (EMG), while reflex activity was assessed using electrical (H-reflexes) and mechanically induced (noisy tendon vibration; NTV) reflexes in the FCR. Additionally, electrodermal activity (EDA) and psychosocial indicators of motion sickness (subjective questionnaires) were measured throughout.

H-reflex amplitude was suppressed during VR-C, which persisted into Post-VR; whereas NTV-reflexes were unaffected across conditions. Sympathetic arousal (e.g., EDA) and motion sickness symptoms increased significantly during VR-C compared to Pre-VR, but rapidly returned to baseline Post-VR. EMG within the target muscle (FCR) as well as in the brachioradialis was maintained across conditions, though increased activation was observed in the biceps brachii beginning at the onset of VR immersion (VR-BL).

These findings suggest suppression of spinal excitability (H-reflex) when the perception of motion (VR-C) was added to a stationary VR experience. Meanwhile, muscle spindle sensitivity (NTV-reflex) remained consistent, highlighting potential fusimotor adaptations to maintain sensorimotor function under altered visual and emotional states. Persistent H-reflex suppression post-VR indicates lingering neuromuscular effects of immersive VR, underscoring the need for further exploration of VR’s implications for rehabilitation and virtual training environments.