A Smart Tendon Hammer System for Remote Neurological Examination

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.

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

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519410003733 ◽

2011 ◽

Vol 11 (03) ◽

pp. 471-513 ◽

Cited By ~ 25

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.

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

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519408002772 ◽

2008 ◽

Vol 08 (04) ◽

pp. 491-506 ◽

Cited By ~ 22

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.

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IMU-Based Recurrence Quantification Analysis of the Signal Dampening Effect of a Thumb Protector in Deep Tendon Reflex Tests

2021 10th International IEEE/EMBS Conference on Neural Engineering (NER) ◽

10.1109/ner49283.2021.9441186 ◽

2021 ◽

Author(s):

Gerald P. Otoide ◽

Blake A. Hoppe ◽

Nicole P. Ackley ◽

Richard Matovu ◽

Ariana Aliasso ◽

...

Keyword(s):

Deep Tendon Reflex ◽

Recurrence Quantification Analysis ◽

Tendon Reflex ◽

Recurrence Quantification ◽

Quantification Analysis ◽

Signal Dampening

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Remote monitoring in heart failure: current and emerging technologies in the context of the pandemic

Heart ◽

10.1136/heartjnl-2020-318062 ◽

2021 ◽

Vol 107 (5) ◽

pp. 366-372

Author(s):

Donya Mohebali ◽

Michelle M Kittleson

Keyword(s):

Heart Failure ◽

At Risk ◽

Remote Monitoring ◽

Reliable Method ◽

Healthcare Delivery ◽

Rapid Expansion ◽

Monitoring Technology ◽

Remote Healthcare ◽

Monitoring Technologies

The incidence of heart failure (HF) remains high and patients with HF are at risk for frequent hospitalisations. Remote monitoring technologies may provide early indications of HF decompensation and potentially allow for optimisation of therapy to prevent HF hospitalisations. The need for reliable remote monitoring technology has never been greater as the COVID-19 pandemic has led to the rapid expansion of a new mode of healthcare delivery: the virtual visit. With the convergence of remote monitoring technologies and reliable method of remote healthcare delivery, an understanding of the role of both in the management of patients with HF is critical. In this review, we outline the evidence on current remote monitoring technologies in patients with HF and highlight how these advances may benefit patients in the context of the current pandemic.

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Ontology-driven Approach to Health Data Management for Remote Healthcare Delivery

Proceedings of the 7th ACM Workshop on ACM Mobile Health 2017 - MobileHealth'17 ◽

10.1145/3084035.3084039 ◽

2017 ◽

Cited By ~ 2

Author(s):

Poly Sil Sen ◽

Shabnam Banerjee ◽

Nandini Mukherjee

Keyword(s):

Data Management ◽

Healthcare Delivery ◽

Health Data ◽

Remote Healthcare

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Deep Tendon Reflex in Eaton-Lambert Syndrome

Psychiatry and Clinical Neurosciences ◽

10.1111/j.1440-1819.1978.tb02784.x ◽

1978 ◽

Vol 32 (1) ◽

pp. 109-113

Author(s):

Hitoka Doi ◽

Yoshiyuki Murai ◽

Yoshigoro Kuroiwa

Keyword(s):

Deep Tendon Reflex ◽

Tendon Reflex

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QUANTIFIED DEEP TENDON REFLEX DEVICE, SECOND GENERATION

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519408002462 ◽

2008 ◽

Vol 08 (01) ◽

pp. 75-85 ◽

Cited By ~ 22

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.

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Early Neurological Assessment in Infants with Hypoxic Ischemic Encephalopathy Treated with Therapeutic Hypothermia

Journal of Clinical Medicine ◽

10.3390/jcm8081247 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1247

Author(s):

Domenico M. Romeo ◽

Sarah Bompard ◽

Francesca Serrao ◽

Giuseppina Leo ◽

Gianpaolo Cicala ◽

...

Keyword(s):

Neurological Examination ◽

Motor Impairment ◽

Hypoxic Ischemic Encephalopathy ◽

Neurological Assessment ◽

Neurodevelopmental Outcomes ◽

Good Tool ◽

Motor Disabilities ◽

High Risk Infants ◽

Ischemic Encephalopathy

Early neurological assessment in infants with hypoxic ischemic encephalopathy (HIE) treated with hypothermia has not been systematically explored. The aims of the present study were to assess whether the Hammersmith Infant Neurological Examination (HINE) is a good tool to predict later neurodevelopmental outcomes at 2 year from birth in this population of infants. A total of 41 term born infants with HIE treated with hypothermia performed the HINE at 12 months and a neurodevelopmental assessment at 24 months. All the infants who had a global HINE score between 67 and 78 were able to walk independently at 2 years and reported a normal developmental quotient; language disorders were observed in a limited number of infants. HINE scores <67 were always associated with motor impairment. In conclusion, the HINE confirms its role as one of the early neurological examination tools for the diagnosis of high risk infants, even in infants with HIE treated with hypothermia. These results can be useful for clinicians involved in the follow up of these infants for early identification of motor disabilities and in planning appropriate intervention.

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