Mathematical model of patella T-reflex and clinical evaluation with Ashworth scales

Spasticity is one of the major problems that arise in different neurological diseases and seriously affect the quality of human life. Research on the understanding of mechanism of spasticity remains as important as the studies on the spasticity therapy and rehabilitation. In this study, the spasticity mechanism which develops concerning the upper motor neuron lesions is investigated by modelling “Patella tendon reflex triggered patella pendulum”. The mathematical model based on the pendulum phenomenon is developed by solving the curve-fitting problem as finding the curve that best fits a set of data points. Electrophysiological and dynamic measurement data were taken from 76 spastic subjects and 20 healthy participants. The mathematical model is determined by the morphological properties of the goniometric variations. The results denote that the mathematical model containing two clinically relevant parameters –frequency component of the damped oscillatory motion defined as “f0” with the maximum angle of the reflex defined as “a0” ensures to distinguish spasticity from healthy subjects.

An Instrumented Medical Hammer With Diagnostic, Therapeutic and Pedagogical Applications

Medical hammers are a commonly used medical device with both diagnostic and therapeutic uses. Tendon tapping to elicit the T-Reflex is a widely used medical procedure that serves as a high level diagnostic tool for many neurological disorders. Previous work has also suggested the utility of the technique for therapeutic purposes. This work discusses the development and initial testing of an instrumented networked medical hammer. An accompanying scheme for wireless data collection and real-time clinical feedback is proposed and partially implemented. The work represents an important improvement to previous efforts in quantification of tendon reflex responses. Not only is intensity of the full impact measured, a method for determining the location of hammer impact is also presented. Stimulus location classification is done via Support Vector Machine (SVM). Variability between and within clinician tapping methods is confirmed, along with validation of SVM for differentiating between clinicians. The automated determination of impact location provides a foundation for work in both rehabilitation and clinical diagnostics.

Effects of a Dynamic Warm-Up, Static Stretching or Static Stretching with Tendon Vibration on Vertical Jump Performance and EMG Responses

The purpose of this study was to investigate the short-term effects of static stretching, with vibration given directly over Achilles tendon, on electro-myographic (EMG) responses and vertical jump (VJ) performances. Fifteen male, college athletes voluntarily participated in this study (n=15; age: 22±4 years old; body height: 181±10 cm; body mass: 74±11 kg). All stages were completed within 90 minutes for each participant. Tendon vibration bouts lasted 30 seconds at 50 Hz for each volunteer. EMG analysis for peripheral silent period, H-reflex, H-reflex threshold, T-reflex and H/M ratio were completed for each experimental phases. EMG data were obtained from the soleus muscle in response to electro stimulation on the popliteal post tibial nerve. As expected, the dynamic warm-up (DW) increased VJ performances (p=0.004). Increased VJ performances after the DW were not statistically substantiated by the EMG findings. In addition, EMG results did not indicate that either static stretching (SS) or tendon vibration combined with static stretching (TVSS) had any detrimental or facilitation effect on vertical jump performances. In conclusion, using TVSS does not seem to facilitate warm-up effects before explosive performance.

Neuromechanical assessment of lidocaine test block in spastic lower limbs

The objective of this study was to quantify in spastic lower limbs the changes in reflex EMGs and in ankle stiffness after a lidocaine block of the soleus nerve to better understand physiological effects of lidocaine. Twenty patients were prospectively included and assessed before and after lidocaine block of the soleus nerve. We studied clinical and neuromechanical parameters of the triceps surae, including quantification of the maximum Hoffmann’s reflex (Hmax) and tendinous reflex (T) normalized to the maximum direct motor response (Mmax), and passive ankle stiffness assessed by sinusoidal length perturbations. All patients whatever the aetiology of spasticity were improved in clinical parameters of spasticity after the block (62% reduction of the Ashworth score, 85% reduction of stretch reflex scores, increased score on the Physicians’ Rating Scale). All patients presented a reduction of the Hmax–Mmax ratio (mean reduction of 67%) and the T–Mmax ratio (82%). Ankle stiffness was decreased by an average of 23%. Measured stiffness was correlated with the Ashworth score and the T–Mmax ratio. Relatively greater change in the T reflex than in the H reflex suggests that lidocaine block reduces hyperreflexia not only by interfering with generation of afferent volleys in the injected nerve, but also probably by altering generation of the volleys at the level of muscle spindles in the affected spastic muscles, presumably by blocking the transmission along gamma-efferent fibers.

Effects of postural threat on spinal stretch reflexes: evidence for increased muscle spindle sensitivity?

Standing balance is often threatened in everyday life. These threats typically involve scenarios in which either the likelihood or the consequence of falling is higher than normal. When cats are placed in these scenarios they respond by increasing the sensitivity of muscle spindles imbedded in the leg muscles, presumably to increase balance-relevant afferent information available to the nervous system. At present, it is unknown whether humans also respond to such postural threats by altering muscle spindle sensitivity. Here we present two studies that probed the effects of postural threat on spinal stretch reflexes. In study 1 we manipulated the threat associated with an increased consequence of a fall by having subjects stand at the edge of an elevated surface (3.2 m). In study 2 we manipulated the threat by increasing the likelihood of a fall by occasionally tilting the support surface on which subjects stood. In both scenarios we used Hoffmann (H) and tendon stretch (T) reflexes to probe the spinal stretch reflex circuit of the soleus muscle. We observed increased T-reflex amplitudes and unchanged H-reflex amplitudes in both threat scenarios. These results suggest that the synaptic state of the spinal stretch reflex is unaffected by postural threat and that therefore the muscle spindles activated in the T-reflexes must be more sensitive in the threatening conditions. We propose that this increase in sensitivity may function to satisfy the conflicting needs to restrict movement with threat, while maintaining a certain amount of sensory information related to postural control.