Zhang L Q, Wang G, Nishida T, Xu D, Sliwa J A, Rymer W Z
Rehabilitation Institute of Chicago, and Department of Physical Medicine and Rehabilitation, Northwestern University, IL, USA.
Arch Phys Med Rehabil. 2000 Jul;81(7):901-9. doi: 10.1053/apmr.2000.5582.
To develop new measures of tendon reflexes and evaluate hyperactive reflexes in patients with spastic multiple sclerosis (MS).
With the subject relaxed, a hand-held instrumented hammer was used to tap the patellar tendon and record the tapping force, while knee extension torque and quadriceps EMG were recorded isometrically as measures of the reflex response.
Research laboratory in a rehabilitation hospital.
Ten spastic MS and 14 healthy subjects.
Tendon tapping force (designated as system input), reflex torque (as output), their dynamic relationship (characterized as system parameters tendon reflex gain, contraction rate, and reflex loop delay), Ashworth scale, and tendon reflex scale.
The system parameters provide more repeatable measures than do input or output parameters alone because they quantify the input and output simultaneously and dynamically. Compared with control subjects, MS patients had a significantly lower threshold in tapping force (p = .026), yet their evoked reflex torque was significantly higher (p = .033). Despite significant quadriceps weakness (p < .0001), MS patients had a significantly higher reflex gain (p = .0002) and contraction rate (p = .0002), and shorter reflex loop delay (p = .0046), indicating hyperexcitability of motoneurons and peripheral receptors, and indicating that relatively more of the muscle was activated reflexively, with greater recruitment of larger fast-twitch fibers. Both the reflex gain and rate measures correlated more closely with the Ashworth scale and tendon reflex scale than did the output measures, indicating their potential clinical value.
With appropriate simplification, the method may be used in clinical practice to quantify more precisely the tendon jerk than is currently feasible with standard clinical tests.
开发肌腱反射的新测量方法，并评估痉挛性多发性硬化症（MS）患者的反射亢进情况。
在受试者放松状态下，使用手持式仪器化锤子轻敲髌腱并记录敲击力，同时等长记录膝关节伸展扭矩和股四头肌肌电图，作为反射反应的测量指标。
一家康复医院的研究实验室。
10名痉挛性MS患者和14名健康受试者。
肌腱敲击力（指定为系统输入）、反射扭矩（作为输出）、它们的动态关系（表征为系统参数肌腱反射增益、收缩率和反射环延迟）、Ashworth量表和肌腱反射量表。
系统参数比单独的输入或输出参数提供了更可重复的测量方法，因为它们能同时动态地量化输入和输出。与对照组相比，MS患者的敲击力阈值显著更低（p = 0.026），但其诱发的反射扭矩显著更高（p = 0.033）。尽管股四头肌明显无力（p < 0.0001），但MS患者的反射增益显著更高（p = 0.0002）和收缩率显著更高（p = 0.0002），且反射环延迟更短（p = 0.0046），这表明运动神经元和外周感受器兴奋性过高，且表明相对更多的肌肉被反射性激活，更多地募集了较大的快肌纤维。反射增益和速率测量指标与Ashworth量表和肌腱反射量表的相关性比输出测量指标更紧密，表明它们具有潜在的临床价值。
经过适当简化，该方法可用于临床实践，比目前标准临床测试更精确地量化肌腱反射。
