To establish a correlation between the modified Ashworth scale (MAS) and amplitude and latency of T-reflex and to demonstrate inter-rater and intra-rater reliability of the T-reflex of the biceps muscle for assessing spasticity after stroke.
A total of 21 patients with hemiplegia and spasticity after ischemic stroke were enrolled for this study. The spasticity of biceps muscle was evaluated by an occupational therapist using the MAS. The mean value of manual muscle test of biceps muscles was 2.3±0.79. Latency and amplitude of T-reflex were recorded from biceps muscles by two physicians. The onset latency and peak to peak amplitude of the mean of 5 big T-reflex were measured. The examinations were carried out by two physicians at the same time to evaluate the inter-rater reliability. Further, one of the physicians performed the examination again after one week to evaluate the intra-rater reliability. The correlations between MAS and T-reflex, and the intra- and inter-rater reliability of biceps T-reflex were established by calculating the Spearman correlation coefficients and the intra-class correlation coefficients (ICCs).
Amplitude of the biceps T-reflex increased with increasing level of MAS (
Biceps T-reflex demonstrates a good quantitative measurement and correlation tool with MAS for spasticity, and also shows acceptable inter- and intra-rater reliability, which can be used for patients with spasticity after stroke.
Citations
When recovery of specific reflexes after acute spinal cord injury are delayed or absent, we should consider an acute local complication or other factors that influence reflex function. We observed three spinal cord injury cases with a long-standing delayed plantar reflex and no evolution of Babinski sign despite enough recovery time had passed for the flexor spasm and all deep tendon reflexes of the lower extremities. In these cases we confirmed common peroneal nerve neuropathy at the fibular head by the nerve conduction study and electromyography. Long-standing delayed plantar reflex without evolution of Babinski sign, beyond expected recovery period, would be considered as a sign of local complication such as common peroneal nerve injury.
Object: The purpose of this study was to establish the normal values of sternocleidomastoid (SCM) tendon reflex in normal Korean adults.
Method: The study for SCM tendon reflex was performed in 41 normal adults using electric reflex hammer. The compound muscle action potentials (CMAP) of SCM muscle were obtained by SCM tendon tapping. From 5 repeated trials of each subject, the shortest latency and the largest peak-to-peak amplitude of CMAP were chosen for the representative value.
Results: Mean values of latency and amplitude were 2.19⁑0.27 msec and 0.70⁑0.38 mV for SCM tendon reflex. There was no significant difference in the latency and amplitude regardless of side or sex (p＞0.05). The age and height showed no signifiant correlation with latency and amplitude of SCM tendon reflex (p＞0.05).
Conclusion: We believe that our results can be used as an evaluation method of upper cervical spinal cord.
Objective: There has been some existing problems with the electrical reflex hammer. The occurrence of pressure build up with percussion and change of hammering points is one example. In order to make improvements on this device, we conducted studies with a newly designed percussion instrumental stimulator.
Method: The data collected from the first group was based on the manual percussion of electrical reflex hammer on the patella ligament. The data collected from the second group by usage of a newly designed instrumental stimulator maintained steady pressure and time and target position on the electrical reflex hammer. Comparisons were made between the two group.
Results: Our single measure of latency and amplitude on the manual and instrumental percussion group resulted in the reliability of 84.67%, 91.23%, 73.63%, and 83.29%. The 10 repeated measure of latency and amplitude on the manual and instrumental percussion group resulted in the reliability of 99.95%, 99.97%, 99.90%, and 99.94%.
Conclusion: From our experiment on the tendon reflex, we found out that it is important to have an instrumental stimulator that can maintain steady pressure while it is applying percussion to accurate data. On manual percussion, it is important to obtain data based on mean value of repeated measurements.
Objective: The purpose of this study was to establish the normal values of tendon reflexes (T-reflex) in upper extremities of normal Korean adults.
Method: T-reflex responses were recorded in 30 normal volunteers by delivering tendon taps with a hand operated electric reflex hammer. From 5 repeated trials of each subject, the shortest onset latency and duration, the largest peak to peak amplitude of compound muscle action potentials were chosen for representative values.
Results:
1) There was no significance in the side-to-side differences for all values.
2) Mean values of latency were 13.8⁑1.1 msec in males, 12.4⁑0.9 msec in females for biceps T-reflex and 13.0⁑1.1 msec in males, 11.3⁑1.0 msec in females for triceps T-reflex and there were significant differences between males and females.
3) Height and upper arm length showed a significant positive correlation with biceps and triceps T-reflex latency (p＜0.001).
Conclusion: We believe that our results can be used as a guideline researching the tendon reflexes in upper extremities.
Objective: To investigate the role of tendon reflex test in the diagnosis of diabetic peripheral neuropathy.
Method: Patellar tendon reflex (PTR) and achilles tendon reflex (ATR) were recorded in forty six diabetic patients and thirty seven normal adults by delivering tendon taps with an electric reflex hammer. Forty six diabetic patients were divided into two groups based on nerve conduction study and diabetic neuropathy score: group 1 consisted of nineteen patients with peripheral neuropathy, group 2 consisted of twenty seven patients without peripheral neuropathy. Multiple regression equations using latency as a variable dependent on age and height were used and upper crossing of the 3 standard deviation level with regression on height and age was considered abnormal.
Results: Mean latencies of PTR and ATR were prolonged in the diabetic patients in comparison with the controls (p＜0.01) and were prolonged in group 1 compared to group 2. In group 1, PTR was abnormal in 14 cases (sensitivity: 73.6%, specifity: 88%) and ATR was abnormal in 13 cases (sensitivity: 68.4%, specifity: 85.1%). In group 2, PTR was abnormal in 3 cases and ATR was abnormal in 4 cases.
Conclusion: Tendon reflex test would be a valuable supplement to conventional nerve conduction studies for detection of diabetic peripheral neuropathy, especially in the proximal segment.
Objective: To determine the differences of the tendon reflex responses (TRR) between medial and lateral heads of gastrocnemius muscles in healthy subject and spastic patients.
Method: The TRR of medial and lateral heads were evaluated in 20 healthy subjects and 20 spastic hemiplegic patients. From 5 repeated trials on each subject, the shortest latency and duration, and the largest peak-to-peak amplitude of TRR were chosen for the representative value.
Results: 1. The evoked potentials by tendon reflex in medial head of gastrocnemius demonstrated significantly higher amplitude than in the lateral head of gastrocnemius in patients (P＜0.05) and the evoked potentials in lateral head of gastrocnemius demonstrated significantly higher amplitude than in the medial head of gastrocnemius in healthy patients (P＜0.05). 2. Mean latency of the evoked potentials by a tendon reflex in both heads of gastrocnemius in the spastic patients and healthy subjects were not significantly different (P＞0.05). 3. Mean duration of the evoked potentials by a tendon reflex in both heads of gastrocnemius in spastic patients and healthy subjects were not significantly different (P＞0.05).
Conclusion: These results indicate that the medial head of gastrocnemius is activated more than the lateral head of gastrocnemius by a tendon reflex in recording evoked potentials of the spastic patients.
Early onset cerebellar ataxia with retained tendon reflexes is distinctive clinical syndrome characterized by progressive cerebellar ataxia of unknown etiology with an onset within the first two decades. This disorder was distinguished from Friedreich's ataxia by the preservation of the deep tendon reflexes. There is 22-year-old male with 13 year history of slowly progressive cerebellar ataxia and dysarthria. His elder brother, also, has milder clinical manifestations, electrophysiological and radiological abnormalities. We experienced two cases of early onset cerebellar ataxia with retained tendon reflexes developed in brothers which was diagnosed by clinical manifestations, electrophysiologic, radiologic studies and report with brief review of related literatures.
The purpose of this study was to establish the normal values of tendon reflex in normal Korean adults. Ankle tendon reflex(ATR), patellar tendon reflex(PTR) and medial hamstring tendon reflex (MHTR) responses were recorded in 96 limbs of 48 normal Korean adults by delivering tendon taps with an electric reflex hammer.
Latency to the onset of the triggered response, peak to peak amplitude and duration of the wave were measured after several repetitions. Minimum latency and duration of the elicited response were chosen to calculate normal means. Side differences were also evaluated. As amplitude showed a marked interindividual variation and side to side variation, lowest recorded value was selected to represent the lower limit of normal.
Mean values of latency, duration and amplitude were 30.27⁑3.18 msec, 11.05⁑1.08 msec and 1.98⁑0.89 mV for ATR, 16.37⁑1.58 msec, 20.63⁑1.68 msec and 1.56⁑0.76 mV for PTR and 20.25⁑2.14 msec, 10.95⁑1.57 msec and 0.71⁑0.56 mV for MHTR. Age, height, and leg length showed significant correlation with the latency of ATR, PTR and MHTR latency(P<0.001).
We believe our results can be used as guideline researches in clinical practice.
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