The accuracy of subjective clinical assessments of the patellar reflex

Dafkin, Chloe; Green, Andrew; Kerr, Samantha; Veliotes, Demetri; McKinon, Warrick

doi:10.1002/mus.23487

Cited by 19 publications

(21 citation statements)

References 16 publications

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“…Inter-rater variability in the clinical examination of the patellar tendon reflex has been resulted from the variability in the way clinicians elicit the reflex and assess the response [25]. In this study, the inter-rater variability was minimized using a standard elicitation method and the aid of an automatic assessment tool.…”

Section: Discussionmentioning

confidence: 99%

The Validity and Reliability of Motion Analysis in Patellar Tendon Reflex Assessment

et al. 2013

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BackgroundThe deep tendon reflex assessments that are essential to the accurate diagnosis of neurological or neuromuscular disorders are conducted subjectively in clinical neurology. Our aim was to assess deep tendon reflexes objectively with a new reflex quantification method.Methodology/Principal FindingsThe present study used a motion analysis technique to collect quantitative measurements for both the input and output of normal patellar tendon reflex. Reflex responses were measured as knee angles. The patellar tendon reflexes of 100 healthy subjects were examined using 6 levels of tendon taps, where all the assessments were captured using motion capture system. A linear relationship was found between the experimental maximum tapping velocity and tapping angle (coefficient of determination = 0.989), which was consistent with the theoretical values. Tapping velocities were predictable according to tapping angles. The findings proved the reproducibility of tapping method in producing consistent input. The reflex amplitude was consistent between two randomly assigned groups, and linearly proportionate to the tapping velocity.Conclusions/SignificanceThe findings on reflex amplitude indicate that motion analysis is a valid and reliable method of assessing and measuring deep tendon reflexes.

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Section: Discussionmentioning

confidence: 99%

The Validity and Reliability of Motion Analysis in Patellar Tendon Reflex Assessment

et al. 2013

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“…Despite the common use and simplicity of DTR tests, however, clinical assessments of DTR responses remain subjective and qualitative [ 1 , 6 ]. Though some studies have evaluated the subjective assessment and concluded strong correlations with biomechanical and electromyographic measures, other studies have demonstrated low interrater reliability when assessing DTR responses [ 7 , 8 ]. Therefore, an opportunity exists to improve the widespread consistency and efficacy of these tests using quantitative methods.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have attempted to identify quantitative measures for improving the assessment of PTR tests, which is the focus of this study. The most common variables used to evaluate PTR responses are the first knee extension angle (FKEA) and the tendon reflex amplitude [ 7 , 9 ] which have both demonstrated to correlate well with subjective ratings of the NINDS and Mayo scales [ 7 ]. Measurements of angular velocity and acceleration, reflex latency, and movement latency have also been used to quantify PTR responses [ 7 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…The most common variables used to evaluate PTR responses are the first knee extension angle (FKEA) and the tendon reflex amplitude [ 7 , 9 ] which have both demonstrated to correlate well with subjective ratings of the NINDS and Mayo scales [ 7 ]. Measurements of angular velocity and acceleration, reflex latency, and movement latency have also been used to quantify PTR responses [ 7 , 10 ]. These studies have been useful for evaluating possible quantified variables of PTR responses; however, little research has been performed to correlate experimental data to theoretical models and incorporate the entirety of the PTR response in the assessment.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Patellar Tendon Reflex Responses Using Second-Order System Characteristics

Steineman

Karra

Park

2016

Applied Bionics and Biomechanics

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Deep tendon reflex tests, such as the patellar tendon reflex (PTR), are widely accepted as simple examinations for detecting neurological disorders. Despite common acceptance, the grading scales remain subjective, creating an opportunity for quantitative measures to improve the reliability and efficacy of these tests. Previous studies have demonstrated the usefulness of quantified measurement variables; however, little work has been done to correlate experimental data with theoretical models using entire PTR responses. In the present study, it is hypothesized that PTR responses may be described by the exponential decay rate and damped natural frequency of a theoretical second-order system. Kinematic data was recorded from both knees of 45 subjects using a motion capture system and correlation analysis found that the mean R2 value was 0.99. Exponential decay rate and damped natural frequency ranges determined from the sample population were −5.61 to −1.42 and 11.73 rad/s to 14.96 rad/s, respectively. This study confirmed that PTR responses strongly correlate to a second-order system and that exponential decay rate and undamped natural frequency are novel measurement variables to accurately measure PTR responses. Therefore, further investigation of these measurement variables and their usefulness in grading PTR responses is warranted.

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“…A reflex response elicited by a tendon tap is usually referred to as a T-reflex (or phasic stretch reflex), while a reflex response obtained from an electrical stimulation to a mixed muscle nerve is known as an H-reflex [ 1 ]. The advantage of T-reflexes over H-reflexes is their routine use in clinical assessments of spinal cord integrity, since a basic mechanical percussion does not require any sophisticated apparatus [ 2 ]. Thus, it is generally easier (and cheaper) to deliver a mechanical percussion as compared to an electrical stimulation if a simple clinical hammer is used.…”

Section: Introductionmentioning

confidence: 99%

Enhanced D1 and D2 Inhibitions Induced by Low-Frequency Trains of Conditioning Stimuli: Differential Effects on H- and T-Reflexes and Possible Mechanisms

et al. 2015

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Mechanically evoked reflexes have been postulated to be less sensitive to presynaptic inhibition (PSI) than the H-reflex. This has implications on investigations of spinal cord neurophysiology that are based on the T-reflex. Preceding studies have shown an enhanced effect of PSI on the H-reflex when a train of ~10 conditioning stimuli at 1 Hz was applied to the nerve of the antagonist muscle. The main questions to be addressed in the present study are if indeed T-reflexes are less sensitive to PSI and whether (and to what extent and by what possible mechanisms) the effect of low frequency conditioning, found previously for the H-reflex, can be reproduced on T-reflexes from the soleus muscle. We explored two different conditioning-to-test (C-T) intervals: 15 and 100 ms (corresponding to D1 and D2 inhibitions, respectively). Test stimuli consisted of either electrical pulses applied to the posterior tibial nerve to elicit H-reflexes or mechanical percussion to the Achilles tendon to elicit T-reflexes. The 1 Hz train of conditioning electrical stimuli delivered to the common peroneal nerve induced a stronger effect of PSI as compared to a single conditioning pulse, for both reflexes (T and H), regardless of C-T-intervals. Moreover, the conditioning train of pulses (with respect to a single conditioning pulse) was proportionally more effective for T-reflexes as compared to H-reflexes (irrespective of the C-T interval), which might be associated with the differential contingent of Ia afferents activated by mechanical and electrical test stimuli. A conceivable explanation for the enhanced PSI effect in response to a train of stimuli is the occurrence of homosynaptic depression at synapses on inhibitory interneurons interposed within the PSI pathway. The present results add to the discussion of the sensitivity of the stretch reflex pathway to PSI and its functional role.

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The accuracy of subjective clinical assessments of the patellar reflex

Abstract: These findings show that subjective assessments of reflexes using reflex rating scales correlate strongly with biomechanical and electromyographic measures.

Cited by 19 publications

References 16 publications

The Validity and Reliability of Motion Analysis in Patellar Tendon Reflex Assessment

The Validity and Reliability of Motion Analysis in Patellar Tendon Reflex Assessment

Assessment of Patellar Tendon Reflex Responses Using Second-Order System Characteristics

Enhanced D1 and D2 Inhibitions Induced by Low-Frequency Trains of Conditioning Stimuli: Differential Effects on H- and T-Reflexes and Possible Mechanisms

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