Contralateral influences on patellar tendon reflexes in young and old adults

Assessing neuromuscular system via patellar tendon reflex analysis using EMG in healthy individuals

Patellar tendon reflex tests are essential for evaluating neuromuscular function and identifying abnormalities in nerve conduction and muscle response. This study explored how age, height, weight, and gender influence reflex response times in healthy individuals, providing a reference for future research on different neuromuscular conditions. We analyzed reflex onset, endpoint, and total duration of reflexes using electromyography (EMG) recordings from 40 healthy participants. Reflexes were elicited by striking the patellar tendon, and participants were grouped based on age, height, weight, and gender. We investigated both the individual and combined effects of these factors on reflex response times. Additionally, height and weight-normalized data were analyzed to clarify their roles in influencing reflexes across age groups. Gender-specific analyses were conducted as well to assess potential differences between males and females. Our findings indicated that reflex onset was significantly delayed in elderly individuals, particularly in taller and heavier individuals, and in males compared to females. Even with height normalization, elderly participants showed slower reflexes. Weight-normalized data revealed that younger participants exhibited longer total reflex durations, likely due to their greater height, which impacted nerve conduction time. This trend was consistent across genders, with males generally exhibiting longer duration of reflex response times. These findings provide insights into how different demographic factors, particularly aging, affect neuromuscular reflexes and could serve as a reference for diagnosing and monitoring neuromuscular disorders.

CLASSIFICATION OF SOFTWARE CONTROL ARCHITECTURES FOR A POWERED PROSTHESIS THROUGH CONVENTIONAL GAIT ANALYSIS USING MACHINE LEARNING APPLICATIONS

The powered prosthesis for people with transtibial amputation offers the opportunity to more appropriately restore gait functionality with benefits, such as powered plantar flexion. In particular, various software control architectures provide unique capabilities for regulating the powered prosthesis during gait. One highly novel approach applies the winding filament hypothesis, which enables an advanced modeling of muscle characteristics, such as through introducing the attributes of titin into the muscle model. The objective of the research is to contrast the conventional control architecture of the BiOM-powered prosthesis compared with the winding filament hypothesis control architecture through machine learning classification. Four machine learning algorithms are applied through the Waikato Environment for Knowledge Analysis (WEKA): J48 decision tree, [Formula: see text]-nearest neighbors, logistic regression, and the support vector machine. The feature set is derived from the force signal acquired from a force plate, which is a conventional gait analysis system. The feature set applied five attributes representing temporal and kinetic aspects of the stance phase of gait. The [Formula: see text]-nearest neighbors algorithm achieves the best machine learning classification accuracy of 95%. The preliminary research establishes the foundation for more sophisticated endeavors respective of the powered prosthesis, such as determining the appropriateness of modifying the software control architecture to best accommodate the progressive lifestyle evolutions and adaptations of the person with amputation.

Implementation of an iPod wireless accelerometer application using machine learning to classify disparity of hemiplegic and healthy patellar tendon reflex pair

The characteristics of the patellar tendon reflex provide fundamental insight regarding the diagnosis of neurological status. Based on the features of the tendon reflex response, a clinician may establish preliminary perspective regarding the global condition of the nervous system. Current techniques for quantifying the observations of the reflex response involve the application of ordinal scales, requiring the expertise of a highly skilled clinician. However, the reliability of the ordinal scale approach is debatable. Highly skilled clinicians have even disputed the presence of asymmetric reflex pairs. An alternative strategy was the implementation of an iPod wireless accelerometer application to quantify the reflex response acceleration waveform. An application enabled the recording of the acceleration waveform and later wireless transmission as an email attachment by connectivity to the Internet. A potential energy impact pendulum enabled the patellar tendon reflex to be evoked in a predetermined and targeted manner. Three feature categories of the reflex response acceleration waveform (global parameters, temporal organization, and spectral features) were incorporated into machine learning to distinguish a subject's hemiplegic and healthy reflex pair. Machine learning attained perfect classification of the hemiplegic and healthy reflex pair. The research findings implicate the promise of machine learning for providing increased diagnostic acuity regarding the acceleration waveform of the tendon reflex response.

Implementation of a smartphone as a wireless gyroscope application for the quantification of reflex response

The patellar tendon reflex constitutes a fundamental aspect of the conventional neurological evaluation. Dysfunctional characteristics of the reflex response can augment the diagnostic acuity of a clinician for subsequent referral to more advanced medical resources. The capacity to quantify the reflex response while alleviating the growing strain on specialized medical resources is a topic of interest. The quantification of the tendon reflex response has been successfully demonstrated with considerable accuracy and consistency through using a potential energy impact pendulum attached to a reflex hammer for evoking the tendon reflex with a smartphone, such as an iPhone, application representing a wireless accelerometer platform to quantify reflex response. Another sensor integrated into the smartphone, such as an iPhone, is the gyroscope, which measures rate of angular rotation. A smartphone application enables wireless transmission through Internet connectivity of the gyroscope signal recording of the reflex response as an email attachment. The smartphone wireless gyroscope application demonstrates considerable accuracy and consistency for the quantification of the tendon reflex response.

Influence of age on patellar tendon reflex response

Background

A clinical parameter commonly used to assess the neurological status of an individual is the tendon reflex response. However, the clinical method of evaluation often leads to subjective conclusions that may differ between examiners. Moreover, attempts to quantify the reflex response, especially in older age groups, have produced inconsistent results. This study aims to examine the influence of age on the magnitude of the patellar tendon reflex response.

Methodology/Principal Findings

This study was conducted using the motion analysis technique with the reflex responses measured in terms of knee angles. Forty healthy subjects were selected and categorized into three different age groups. Patellar reflexes were elicited from both the left and right patellar tendons of each subject at three different tapping angles and using the Jendrassik maneuver. The findings suggested that age has a significant effect on the magnitude of the reflex response. An angle of 45° may be the ideal tapping angle at which the reflex can be elicited to detect age-related differences in reflex response. The reflex responses were also not influenced by gender and were observed to be fairly symmetrical.

Conclusions/Significance

Neurologically normal individuals will experience an age-dependent decline in patellar reflex response.

Implementation of an iPhone wireless accelerometer application for the quantification of reflex response

The patellar tendon reflex represents an inherent aspect of the standard neurological evaluation. The features of the reflex response provide initial perspective regarding the status of the nervous system. An iPhone wireless accelerometer application integrated with a potential energy impact pendulum attached to a reflex hammer has been successfully developed, tested, and evaluated for quantifying the patellar tendon reflex. The iPhone functions as a wireless accelerometer platform. The wide coverage range of the iPhone enables the quantification of reflex response samples in rural and remote settings. The iPhone has the capacity to transmit the reflex response acceleration waveform by wireless transmission through email. Automated post-processing of the acceleration waveform provides feature extraction of the maximum acceleration of the reflex response ascertained after evoking the patellar tendon reflex. The iPhone wireless accelerometer application demonstrated the utility of the smartphone as a biomedical device, while providing accurate and consistent quantification of the reflex response.

WIRELESS THREE DIMENSIONAL ACCELEROMETER REFLEX QUANTIFICATION DEVICE WITH ARTIFICIAL REFLEX SYSTEM

Fundamental to the neurological examination is the deep tendon reflex. Two important tendon reflex parameters are response and latency. Response can be quantified by the NINDS Myotatic Reflex Scale; however, controversy exists with respect to the accuracy of the scale. Electrodiagnostic testing may derive parameters, similar to the validity of the reflex latency; however, such tests require highly specialized resources. Attempts have been made to develop quantified reflex devices. Two wireless three-dimensional (3D) accelerometers incorporating MEMS technology have been integrated into a device for quantifying reflex response and latency. The device is tested and evaluated using an artificial reflex system. The reflex quantification device obtained reflex response and latency parameters based on the artificial reflex device, which were bounded by a 98% confidence level with a 2% margin of error about the mean.

Quantified reflex strategy using an iPod as a wireless accelerometer application

A primary aspect of a neurological evaluation is the deep tendon reflex, frequently observed through the patellar tendon reflex. The reflex response provides preliminary insight as to the status of the nervous system. A quantified reflex strategy has been developed, tested, and evaluated though the use of an iPod as a wireless accelerometer application integrated with a potential energy device to evoke the patellar tendon reflex. The iPod functions as a wireless accelerometer equipped with robust software, data storage, and the capacity to transmit the recorded accelerometer waveform of the reflex response wirelessly through email for post-processing. The primary feature of the reflex response acceleration waveform is the maximum acceleration achieved subsequent to evoking the patellar tendon reflex. The quantified reflex strategy using an iPod as a wireless accelerometer application yields accurate and consistent quantification of the reflex response.

TENDON REFLEX AND STRATEGIES FOR QUANTIFICATION, WITH NOVEL METHODS INCORPORATING WIRELESS ACCELEROMETER REFLEX QUANTIFICATION DEVICES, A PERSPECTIVE REVIEW

The deep tendon reflex is a fundamental aspect of a neurological examination. The two major parameters of the tendon reflex are response and latency, which are presently evaluated qualitatively during a neurological examination. The reflex loop is capable of providing insight into the status and therapy response of both upper and lower motor neuron syndromes. Attempts have been made to ascertain reflex response and latency; however, these systems are relatively complex, resource intensive, with issues of consistent and reliable accuracy. The solution presented is a wireless quantified reflex device using tandem three-dimensional (3D) wireless accelerometers to obtain response based on acceleration waveform amplitude and latency derived from temporal acceleration waveform disparity. Three specific aims have been established for the proposed wireless quantified reflex device:

(1) Demonstrate the wireless quantified reflex device is reliably capable of ascertaining quantified reflex response and latency using a quantified input.

(2) Evaluate the precision of the device using an artificial reflex system.

(3) Conduct a longitudinal study respective of subjects with healthy patellar tendon reflexes, using the wireless quantified reflex evaluation device to obtain quantified reflex response and latency.

Aim 1 has led to a steady evolution of the wireless quantified reflex device from a singular 2D wireless accelerometer capable of measuring reflex response to a tandem 3D wireless accelerometer capable of reliably measuring reflex response and latency. The hypothesis for aim 1 is that a reflex quantification device can be established for reliably measuring reflex response and latency for the patellar tendon reflex, comprised of an integrated system of wireless 3D MEMS accelerometers. Aim 2 further emphasized the reliability of the wireless quantified reflex device by evaluating an artificial reflex system. The hypothesis for aim 2 is that the wireless quantified reflex device can obtain reliable reflex parameters (response and latency) from an artificial reflex device. Aim 3 synthesizes the findings relevant to aim 1 and 2, while applying the wireless accelerometer reflex quantification device to a longitudinal study of healthy patellar tendon reflexes. The hypothesis for aim 3 is that during a longitudinal evaluation of the deep tendon reflex the parameters for reflex response and latency can be measured with a considerable degree of accuracy, reliability, and reproducibility. Enclosed is a detailed description of a wireless quantified reflex device with research findings and potential utility of the system, inclusive of a comprehensive description of tendon reflexes, prior reflex quantification systems, and correlated applications.

FOURTH GENERATION WIRELESS REFLEX QUANTIFICATION SYSTEM FOR ACQUIRING TENDON REFLEX RESPONSE AND LATENCY

An intrinsic aspect of the standard neurological examination is the deep tendon reflex. A clinician is tasked with qualitatively evaluating reflex parameters, such as reflex response and latency. The tendon reflex is capable of providing preliminary insight with respect to dysfunction of the central and peripheral nervous systems. The qualitative assessment of the tendon reflex can be classified through the implementation of an ordinal scale, such as the NINDS scale which spans five ordinal components from 0 to 4. The reliability and accuracy of the ordinal-scale method for classifying reflex characteristics have been demonstrated to be an issue of controversy. Ordinal scales lack the capacity to properly classify the temporal features of the tendon reflex. Electrodiagnostic testing traditionally provides higher fidelity evaluation of peripheral neuropathy; however, a study by Cocito et al., has discovered 28% of the prescriptions were inappropriate. The fourth-generation wireless reflex quantification system provides a less resource intensive, highly accurate, reliable, and reproducible alternative. The patellar tendon reflex is evoked through a predetermined potential energy derived swing arm attached to a standard reflex hammer. Tandem wireless 3D MEMS accelerometers quantify reflex response and latency. The reflex response maximum and minimum are acquired from the wireless 3D MEMS accelerometer positioned above the ankle joint. The latencies derived from the maximum and minimum of the reflex responses are derived from the temporal disparity relative to the acceleration waveforms of the reflex response and swing arm evoking the tendon reflex. The fourth-generation wireless reflex quantification system has been evolved with a more user-convenient wirelessly activated datalogger mode, which is subsequently downloaded to a local PC wirelessly. The wireless datalogger mode enables sampling at a greater rate relative to the real-time streaming data mode. An automated MATLAB software program is implemented for acquiring reflex parameters. Enclosed is the longitudinal study of the fourth-generation wireless reflex quantification system that demonstrates considerable precision for accuracy, reliability, and reproducibility. As a supplement to the research, a brief reflex modulation study is amended to the longitudinal study.

Wireless accelerometer reflex quantification system characterizing response and latency

The evaluation of the deep tendon reflex is a standard aspect of a neurological evaluation, which is frequently evoked through the patellar tendon reflex. Important features of the reflex are response and latency, providing insight to status for peripheral neuropathy and upper motor neuron syndrome. A wireless accelerometer reflex quantification system has been developed, tested, and evaluated. The reflex input is derived from a potential energy setting. Wireless accelerometers characterize the reflex hammer strike and reflex response acceleration waveforms, enabling the quantification of reflex response and latency. Spectral analysis of the reflex response acceleration waveform elucidates the frequency domain, opening the potential for new reflex classification metrics. The wireless accelerometer reflex quantification system yields accurate and consistent quantification of reflex response and latency.

Aging-related neuromuscular changes characterized by tendon reflex system properties

OBJECTIVE

To quantitatively evaluate changes in neuromuscular reflex system properties that are associated with aging.

DESIGN

Controlled, experimental.

SETTING

Research laboratory in a rehabilitation hospital.

PARTICIPANTS

Fourteen elderly (age, 69.4+/-7.1 y) and 18 young (age, 29.9+/-6.5 y) healthy subjects.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

With the subject relaxed, an instrumented reflex hammer was used to tap the Achilles tendon and record the tapping force, whereas the ankle plantarflexion torque and plantarflexor muscle electromyographic activity were recorded isometrically as measures of the reflex responses. Tendon reflex system properties were evaluated by using system identification techniques. Tendon tapping force was designated as system input and reflex-mediated torque and electromyographic activity as outputs. The dynamic relations between input and output were characterized by the system parameters of reflex-mediated torque and electromyographic gains, contraction and excitation rate, reflex-mediated torque and electromyographic delays, and electromechanic delay.

RESULTS

Various aging-related changes were found in the tendon reflex system properties, including decreased tendon reflex gain ( P =.029), slower contraction and half-relaxation rates ( P </=.018), and longer electromyographic activation delay, electromechanical delay and overall torque reflex delay ( P </=.025). In contrast, changes in the electromyographic properties were not significant, except for the longer electromyographic activation delay.

CONCLUSIONS

Aging is associated with significant changes in the neuromuscular reflex system properties. The changes were mainly associated with weaker and slower muscle force generation but not with significant decrease in motoneuronal excitability.

The Consequences of Resistance Training for Movement Control in Older Adults

Older adults who undertake resistance training are typically seeking to maintain or increase their muscular strength with the goal of preserving or improving their functional capabilities. The extent to which resistance training adaptations lead to improved performance on tasks of everyday living is not particularly well understood. Indeed, studies examining changes in functional task performance experienced by older adults following periods of resistance training have produced equivocal findings. A clear understanding of the principles governing the transfer of resistance training adaptations is therefore critical in seeking to optimize the prescription of training regimes that have as their aim the maintenance and improvement of functional movement capacities in older adults. The degenerative processes that occur in the aging motor system are likely to influence heavily any adaptations to resistance training and the subsequent transfer to functional task performance. The resulting characteristics of motor behavior, such as the substantial decline in the rate of force development and the decreased steadiness of force production, may entail that specialized resistance training strategies are necessary to maximize the benefits for older adults. In this review, we summarize the alterations in the neuromuscular system that are responsible for the declines in strength, power, and force control, and the subsequent deterioration in the everyday movement capabilities of older adults. We examine the literature concerning the neural adaptations that older adults experience in response to resistance training, and consider the readiness with which these adaptations will improve the functional movement capabilities of older adults.

The effect of quadriceps-electrocutaneous stimulation on the T-reflex and the H-reflex of the soleus muscle

OBJECTIVE

To investigate the effect of ipsilateral quadriceps-electrocutaneous stimulation on the T-reflex and the H-reflex of the soleus muscle, and to examine the interactions in human cutaneous sensation - the soleus motoneuron pathway.

METHODS

The T-reflex and H-reflex tests were performed bilaterally on 50 able-bodied adults with a standardized technique using the soleus muscle. The reflexes were conditioned by electrocutaneous stimuli applied to the ipsilateral quadriceps using the optimal transcutaneous electrical nerve stimulation (TENS) machine (3 x perception, intensity 15-30 mA). The conditioning stimuli were followed by reflex tests by 30-50 ms (conditioning A) and 80-100 ms (conditioning B). The latency and amplitude of the T-reflex and H-reflex were measured before (control) and after conditioning stimuli (A and B) and at sham (placebo).

RESULTS

There were no significant differences between the right and left sides and between the control and placebo in both T-reflex and H-reflex. There were significant differences in both latency and amplitude of the T-reflex only between control and conditioning A. There were no significant differences between control and conditioning tests in the H-reflex.

CONCLUSIONS

The above results suggest that supraspinal center and cutaneous fusimotor reflexes, which increase the sensitivity of the soleus muscle spindle, mediate the observed motoneuron excitability changes.

Contralateral activity in a homologous hand muscle during voluntary contractions is greater in old adults

This study compared the amount of contralateral activity produced in a homologous muscle by young (18-32 yr) and old (66-80 yr) adults when they performed unilateral isometric and anisometric contractions with a hand muscle. The subjects were not aware that the focus of the study was the contralateral activity. The tasks involved the performance of brief isometric contractions to six target forces, slowly lifting and lowering six inertial loads, and completing a set of 10 repetitions with a heavy load. The unintended force exerted by the contralateral muscle during the isometric contractions increased with target force, but the average force was greater for the old adults (means +/- SD; 12.6 +/- 15.3%) compared with the young adults (6.91 +/- 11.1%). The contralateral activity also increased with load during the anisometric contractions, and the average contralateral force was greater for the old subjects (5.28 +/- 6.29%) compared with the young subjects (2.10 +/- 3.19%). Furthermore, the average contralateral force for both groups of subjects was greater during the eccentric contractions (4.17 +/- 5.24%) compared with the concentric contractions (3.20 +/- 5.20%). The rate of change in contralateral activity during the fatigue task also differed between the two groups of subjects. The results indicate that old subjects have a reduced ability to suppress unintended contralateral activity during the performance of goal-directed, unilateral tasks.

Decline in motor functions in aging is related to the loss of NMDA receptors

The aim of the study was to assess the contribution of central dopaminergic and glutamatergic systems to the age-dependent loss of motor functions in rats. Rats of three age groups were compared: young (3-5-month-old), middle-aged (20-21-month-old) and old (29-31-month-old). The obtained results showed an age-dependent decline in the electromyographic (EMG) resting and reflex activities in the gastrocnemius and tibialis anterior muscles, as well as in the T-maze performance. Although these disturbances were accompanied with significant age-dependent decreases in the binding to NMDA, AMPA and dopamine D2 receptors, and a decline in the number of nigral dopamine neurons, they were significantly correlated with the loss of the binding to NMDA receptors only. The reduction in T-maze performance with aging was additionally correlated with a decrease in motor functions (EMG activity). The study suggests a crucial role of the loss of NMDA receptors in age-dependent motor disabilities, as well as in disturbances measured in the T-maze.

Age-related muscle stiffness: predominance of non-reflex factors

This study was aimed at assessing the contribution of reflex and non-reflex factors to the muscle tone of old female Wistar rats. The hind foot of a rat was flexed or extended at the ankle joint by 25 degrees over 250 ms. The resistance of the foot to passive movements (torque, mechanomyogram), as well as the reflex electromyographic activity in the gastrocnemius and tibialis anterior muscles, were recorded simultaneously. Moreover, the impact of the blockade of the reflex activity caused by the local anesthetic lignocaine (1-2 ml of a 2% solution, injected in the vicinity of the sciatic nerve) on the muscle tone was investigated. Additionally, old rats' hind leg muscle samples were analysed using fluorescent microscopy for the expression of fibronectin, which is an early marker of connective tissue formation. It has been shown that old rats are characterized by (i) a substantially increased resistance of flexor muscle stiffness (measured during extension) and unchanged resistance of extensors (measured during flexion), (ii) the loss of a major part of the reflex electromyographic activity and (iii) the increased content of fibronectin in muscles. Moreover, it has been shown that lignocaine, which completely blocked the electromyographic reflex activity in the gastrocnemius and tibialis anterior muscles in young animals, was unable to counteract the resistance of these muscles to passive movements in old rats. The present results suggest that the muscle stiffness seen in old rats is not due to a reflex response, but depends mainly on non-reflex factors--chiefly on a large overgrowth of non-elastic connective tissue replacing degenerated active muscle fibers.

Age-dependent effects of muscle vibration and the Jendrassik maneuver on the patellar tendon reflex response

OBJECTIVE

To explore possible effects of aging on the excitability of spinal reflexes.

DESIGN

Using a cross-sectional design, the influences of muscle vibration and the Jendrassik maneuver on patellar tendon reflex function were compared between 30 young adults and 15 older adults.

SETTING

Motor control research laboratory.

SUBJECTS

The young adults were volunteers of college age. The older adults (74.5 +/- 4.14 yr) were volunteers from the local community. All subjects were free of medications and neurological conditions that would affect normal neuromuscular responses.

MAIN OUTCOME MEASURES

A force-time curve analysis of the patellar tendon reflex response was used to assess the inhibition and facilitation of spinal reflexes. In the experimental protocol to assess spinal reflex inhibition, 100 Hz vibration was applied to the right quadriceps muscle. In another experimental protocol, spinal reflex facilitation was assessed using the Jendrassik maneuver. To perform the Jendrassik maneuver, subjects were instructed to grasp their hands together and to pull as hard as possible while breathing normally. After a 2-second count, the tendon tap was delivered to the right leg and the subject was instructed to relax. In both experimental protocols, control patellar tendon reflexes were collected.

RESULTS

Analysis of variance for reflex peak force revealed a significant 30% reduction in the amount of vibration-induced reflex inhibition with increasing age, and a similar 33% reduction in the amount of Jendrassik maneuver facilitation observed for the older adults as compared with the younger adults.

CONCLUSION

These results support the hypothesis that inhibitory and excitatory influences acting on the alpha motoneuron pool are different in young and older adults.

Contralateral influences on triceps surae motoneuron excitability

In an effort to more fully investigate spinal reflex pathways in humans, we measured the isometric force-time curve of the tibial nerve H-reflex in 12 college age subjects. We also conditioned the reflex with a contralateral H-reflex stimulus or a contralateral tendon-tap, to ascertain the effects of crossed spinal segmental inputs on alpha motoneuron excitability. The conditioning stimulus preceded the test reflex by 10, 25, 40, 55, 70, 85, 100, 115, 130 or 145 msec. The results demonstrate that a conditioning tibial nerve H-reflex produced marked facilitation onto the contralateral triceps surae motoneurons, predominantly at longer-latency intervals. Conversely, a conditioning Achilles tendon-tap produced long-latency inhibition to the triceps surae. These results demonstrate that differential motoneuron excitability changes can be produced by electrical and mechanical conditioning stimuli. Moreover, these excitability changes may be long lasting and only appear after a relatively long latency. Several neurophysiological mechanisms are proposed to contribute to these changes.