Tendon Reflex and Strategies for Quantification, With Novel Methods Incorporating Wireless Accelerometer Reflex Quantification Devices, a Perspective Review

Abstract

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.

Smartphone and Portable Media Device: A Novel Pathway toward the Diagnostic Characterization of Human Movement

“…As previously disclosed gait and reflex of the lower limb, such as the patellar tendon reflex, are neurologically associated [19,36]. Therefore the portable media device provides a useful means of quantifying the patellar tendon reflex response.…”

“…The ability for even a skilled team of clinicians to conclusively decide upon the presence of a hemiplegic reflex pair is a subject of contention [19,36]. Considerable classification accuracy was attained through the amalgamation of a portable media device as a wireless accelerometer platform, a potential energy impact pendulum, and a machine learning algorithm.…”

Advances Regarding Powered Prosthesis for Transtibial Amputation

“…The temporal resolution of muscle history dependence response time is swifter than the reflex loop. 8,108 However the relatively protracted temporal resolution of the functional mechanical latency of the human patellar tendon reflex circuit is on the scale of 100 ms. [109][110][111] Efferent and afferent representation significantly impacts the plasticity of locomotion. 60 …”

Implementation of an iPod Wireless Accelerometer Application Using Machine Learning to Classify Disparity of Hemiplegic and Healthy Patellar Tendon Reflex Pair

“…Dysfunction to the tendon reflex response may imply trauma to either the central or peripheral nervous system. The observation of an irregular tendon reflex response may support the diagnostic decision process and consequentially treatment and action plan [1,2,3,4]. …”

“…The NINDS Myotatic Reflex Scale entails five ordinal components. The Mayo Clinic scale encompasses nine ordinal components [2,3,4,5,6]. The reliability of the ordinal scale approach for quantitatively classifying reflex response is debatable [3,4,5,6].…”