QUANTIFIED DEEP TENDON REFLEX DEVICE FOR RESPONSE AND LATENCY, THIRD GENERATION

2008 ◽  
Vol 08 (04) ◽  
pp. 491-506 ◽  
Author(s):  
ROBERT LEMOYNE ◽  
CRISTIAN COROIAN ◽  
TIMOTHY MASTROIANNI ◽  
WARREN GRUNDFEST
Keyword(s):  
Neurological Examination ◽  
Evaluation System ◽  
Microelectromechanical Systems ◽  
Deep Tendon Reflex ◽  
Three Dimensional ◽  
Reflex Response ◽  
Electrodiagnostic Testing ◽  
Test And Evaluation ◽  
Tendon Reflex ◽  
Mems Accelerometers

Deep tendon reflex is fundamental for a neurological examination. A hyperactive reflex response is correlated with spasticity, which can also be associated with the degree of damage to the supraspinal input, essentially assessing the severity of traumatic brain injury. Clinical evaluation of the myotatic stretch reflex is provided by the National Institute of Neurological Disorders and Stroke (NINDS) Myotatic Reflex Scale (0 to 4); however, the results of the NINDS Myotatic Reflex Scale vary in terms of interpretation and lack temporal data. Deep tendon reflex can assess the severity and degree of peripheral neuropathy. Subsequent to the neurological examination, suspect patients are often referred to a specialist for definitive electrodiagnostic testing. A study by Cocito found that 28% of the prescriptions for testing were considered to be inappropriate. Therefore, the solution is a fully quantified tendon reflex evaluation system. The input force of the reflex hammer is derived from a predetermined potential energy setting. Tandem wireless three-dimensional (3D) microelectromechanical systems (MEMS) accelerometers quantify the output and latency time of the reflex. The wireless 3D MEMS accelerometers are positioned to a standard anchor point near the ankle and reflex hammer swing arm. Reflex response is quantified by the maximum and minimum components of the acceleration profile. The temporal disparity between hammer strike and response defines the latency of the reflex loop. The quantified data collected from wireless 3D MEMS accelerometers are conveyed to a portable computer. Enclosed are the initial test and evaluation and the description of such a device, which quantitatively evaluates the reflex response and latency using wireless 3D MEMS accelerometers, while demonstrating precision for reproducibility.

WIRELESS THREE DIMENSIONAL ACCELEROMETER REFLEX QUANTIFICATION DEVICE WITH ARTIFICIAL REFLEX SYSTEM

2010 ◽  
Vol 10 (03) ◽  
pp. 401-415 ◽  
Author(s):  
ROBERT LEMOYNE ◽  
TIMOTHY MASTROIANNI ◽  
CRISTIAN COROIAN ◽  
WARREN GRUNDFEST
Keyword(s):  
Deep Tendon Reflex ◽  
Three Dimensional ◽  
Reflex Response ◽  
Electrodiagnostic Testing ◽  
Tendon Reflex ◽  
Margin Of Error ◽  
Mems Technology ◽  
Latency Response ◽  
The Mean ◽  
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.

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

2011 ◽  
Vol 11 (03) ◽  
pp. 471-513 ◽  
Author(s):  
ROBERT LEMOYNE ◽  
TIMOTHY MASTROIANNI ◽  
CRISTIAN COROIAN ◽  
WARREN GRUNDFEST
Keyword(s):  
Longitudinal Study ◽  
Patellar Tendon ◽  
Neurological Examination ◽  
Deep Tendon Reflex ◽  
Reflex Response ◽  
Fundamental Aspect ◽  
Tendon Reflex ◽  
Reflex System ◽  
Wireless Accelerometer ◽  
Tendon Reflexes

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.

QUANTIFIED DEEP TENDON REFLEX DEVICE, SECOND GENERATION

2008 ◽  
Vol 08 (01) ◽  
pp. 75-85 ◽  
Author(s):  
ROBERT LEMOYNE ◽  
FOAD DABIRI ◽  
ROOZBEH JAFARI
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Stretch Reflex ◽  
Evaluation System ◽  
Deep Tendon Reflex ◽  
Reflex Response ◽  
Fundamental Aspect ◽  
Maximum Acceleration ◽  
Mems Accelerometer ◽  
Tendon Reflex

The deep tendon reflex is a fundamental aspect of neurological examinations. The severity of and degree of recovery from a traumatic brain injury can be assessed by the myotatic stretch reflex. A hyperactive reflex response is correlated with spasticity, which can also be correlated with the degree of damage to the supraspinal input, in essence assessing the severity of traumatic brain injury. The myotatic stretch reflex is clinically evaluated by the National Institute of Neurological Disorders and Stroke (NINDS) reflex scale (0–4); however, this scale lacks temporal data and may also vary in interpretation. The solution is a fully quantified evaluation system of the myotatic stretch reflex, whereby a patellar hammer's force input is based on original potential energy and a microelectromechanical system (MEMS) accelerometer quantifies the output. The MEMS accelerometer is attached to a set anchor point near the ankle. The reflex amplitude is based on the maximum acceleration of the reflex response. The quantified data collected from MEMS accelerometers are transmitted by a portable computer (i.e. a Pocket PC). This paper describes a device that quantitatively evaluates the reflex response using accelerometers and that demonstrates precision for reproducibility.

VIRTUAL PROPRIOCEPTION

2008 ◽  
Vol 08 (03) ◽  
pp. 317-338 ◽  
Author(s):  
ROBERT LEMOYNE ◽  
CRISTIAN COROIAN ◽  
TIMOTHY MASTROIANNI ◽  
WARREN GRUNDFEST
Keyword(s):  
Real Time ◽  
Microelectromechanical Systems ◽  
Three Dimensional ◽  
Cortical Reorganization ◽  
Alternative Strategies ◽  
Lateral Epicondyle ◽  
Hemiparetic Gait ◽  
Acceleration Data ◽  
Mems Accelerometers ◽  
Technology Advance

Virtual proprioception represents a novel means of developing cortical reorganization of alternative strategies for hemiparetic gait. Fundamentals of the device are motor control plasticity, aftereffect, and visual-based biofeedback. Two wireless three-dimensional (3D) microelectromechanical systems (MEMS) accelerometers are placed on the femur (upper leg) of both the affected and unaffected limbs above the lateral epicondyle next to the knee joint. The acceleration data from the two wireless 3D MEMS accelerometers are fed back to the user in real time by visual output from a portable laptop PC. Given the virtual proprioception feedback, the user can then adjust the original gait while walking to an improved alternative gait strategy. First, hemiparetic gait is comprehensively discussed. The inherent roles of proprioception with locomotion and issues with traumatic brain injury are considered. Then, the technology advance of accelerometers and gait analysis is detailed. Virtual proprioception is tested and evaluated, while demonstrating the capacity to improve disparities in hemiparetic gait during real time.

scholarly journals Deep Tendon Reflex: The Tools and Techniques. What Surgical Neurology Residents Should Know

2021 ◽  
Vol 28 (2) ◽  
pp. 48-62
Author(s):  
Ooi Lin-Wei ◽  
Leonard Leong Sang Xian ◽  
Vincent Tee Wei Shen ◽  
Chee Yong Chuan ◽  
Sanihah Abdul Halim ◽  
...  
Keyword(s):  
Deep Tendon Reflex ◽  
Reflex Response ◽  
Reflex Responses ◽  
Contraction Duration ◽  
Tendon Reflex ◽  
History Of ◽  
Key Features ◽  
Contraction And Relaxation ◽  
Tools And Techniques

The deep tendon reflex (DTR) is a key component of the neurological examination. However, interpretation of the results is a challenge since there is a lack of knowledge on the important features of reflex responses such as the amount of hammer force, the strength of contraction, duration of the contraction and relaxation. The tools used to elicit the reflexes also play a role in the quality of the reflex contraction. Furthermore, improper execution techniques during the DTR assessment may alter the findings and cloud the true assessment of the nervous system. Therefore, understanding the basic principles and the key features of DTR allows for better interpretation of the reflex responses. This paper discusses the brief history of reflexes, the development of the reflex hammer, and also the key features of a reflex response encompassing the amplitude of force needed to elicit a reflex response, the velocity of contraction, the strength of contraction, and the duration of contraction and relaxation phases. The final section encloses the techniques of eliciting DTR in the upper extremities, trunk, and lower extremities, and the interpretation of these reflexes.

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

2011 ◽  
Vol 11 (01) ◽  
pp. 31-54 ◽  
Author(s):  
ROBERT LEMOYNE ◽  
TIMOTHY MASTROIANNI ◽  
HALO KALE ◽  
JORGE LUNA ◽  
JOSHUA STEWART ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Deep Tendon Reflex ◽  
Streaming Data ◽  
Qualitative Assessment ◽  
Reflex Response ◽  
Ordinal Scale ◽  
Fourth Generation ◽  
Reflex Modulation ◽  
Tendon Reflex ◽  
Swing Arm

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.

scholarly journals A Smart Tendon Hammer System for Remote Neurological Examination

2021 ◽  
Vol 8 ◽  
Author(s):  
Waiman Meinhold ◽  
Yoshinori Yamakawa ◽  
Hiroshi Honda ◽  
Takayuki Mori ◽  
Shin-ichi Izumi ◽  
...  
Keyword(s):  
Neurological Examination ◽  
Healthcare Delivery ◽  
Deep Tendon Reflex ◽  
Point Scale ◽  
Neurological Assessment ◽  
Critical Gap ◽  
Mean Error ◽  
Tendon Reflex ◽  
Remote Healthcare ◽  
Survey Results

The deep tendon reflex exam is an important part of neurological assessment of patients consisting of two components, reflex elicitation and reflex grading. While this exam has traditionally been performed in person, with trained clinicians both eliciting and grading the reflex, this work seeks to enable the exam by novices. The COVID-19 pandemic has motivated greater utilization of telemedicine and other remote healthcare delivery tools. A smart tendon hammer capable of streaming acceleration measurements wirelessly allows differentiation of correct and incorrect tapping locations with 91.5% accuracy to provide feedback to users about the appropriateness of stimulation, enabling reflex elicitation by laypeople, while survey results demonstrate that novices are reasonably able to grade reflex responses. Novice reflex grading demonstrates adequate performance with a mean error of 0.2 points on a five point scale. This work shows that by assisting in the reflex elicitation component of the reflex exam via a smart hammer and feedback application, novices should be able to complete the reflex exam remotely, filling a critical gap in neurological care during the COVID-19 pandemic.

Design of Road Test and Evaluation System for Vehicle Handling and Stability

2014 ◽  
Vol 505-506 ◽  
pp. 281-285
Author(s):  
Ming Qiu Gao ◽  
Run Qing Guo ◽  
Rong Liang Liang
Keyword(s):  
Data Processing ◽  
Test Data ◽  
Evaluation System ◽  
Test System ◽  
Stability Test ◽  
Road Test ◽  
Vehicle Handling ◽  
Test And Evaluation ◽  
Test Result

Vehicle handling and stability has effect on positive safety of automotive directly. Test system of handling and stability is built for its road test and the test variables signal can be acquired and stored synchronously. Based on MATLAB GUI, software is developed for the test data processing, so that the stored data is to be analyzed and handling and stability test result is given by the software automatically. Using the test system in paper, handling and stability road test of one domestic sedan is fulfilled and scored, which verifies the applicability of the test system and scoring software in paper.

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