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Fulltext Influence of age on patellar tendon reflex response

Chandrasekhar A, Abu Osman NA, Tham LK, Lim KS, Wan Abas WA

PLoS One, 2013;8(11):e80799.
PMID: 24260483 DOI: 10.1371/journal.pone.0080799

BACKGROUND: A clinical parameter commonly used to assess the neurological status of an individual is the tendon reflex response. However, the clinical method of evaluation often leads to subjective conclusions that may differ between examiners. Moreover, attempts to quantify the reflex response, especially in older age groups, have produced inconsistent results. This study aims to examine the influence of age on the magnitude of the patellar tendon reflex response.
METHODOLOGY/PRINCIPAL FINDINGS: This study was conducted using the motion analysis technique with the reflex responses measured in terms of knee angles. Forty healthy subjects were selected and categorized into three different age groups. Patellar reflexes were elicited from both the left and right patellar tendons of each subject at three different tapping angles and using the Jendrassik maneuver. The findings suggested that age has a significant effect on the magnitude of the reflex response. An angle of 45° may be the ideal tapping angle at which the reflex can be elicited to detect age-related differences in reflex response. The reflex responses were also not influenced by gender and were observed to be fairly symmetrical.
CONCLUSIONS/SIGNIFICANCE: Neurologically normal individuals will experience an age-dependent decline in patellar reflex response.
Fulltext The validity and reliability of motion analysis in patellar tendon reflex assessment

Tham LK, Abu Osman NA, Wan Abas WA, Lim KS

PLoS One, 2013;8(2):e55702.
PMID: 23409022 DOI: 10.1371/journal.pone.0055702

The deep tendon reflex assessments that are essential to the accurate diagnosis of neurological or neuromuscular disorders are conducted subjectively in clinical neurology. Our aim was to assess deep tendon reflexes objectively with a new reflex quantification method.
Investigation to predict patellar tendon reflex using motion analysis technique

Tham LK, Osman NA, Lim KS, Pingguan-Murphy B, Abas WA, Zain NM

Med Eng Phys, 2011 May;33(4):407-10.
PMID: 21146440 DOI: 10.1016/j.medengphy.2010.11.002

The investigation of patellar tendon reflex involves development of a reflex hammer holder, kinematic data collection and analysis of patellar reflex responses using motion analysis techniques. The main aim of this research is to explore alternative means of assessing reflexes as a part of routine clinical diagnosis. The motion analysis system was applied to provide quantitative data which is a more objective measure of the patellar tendon reflex. Kinematic data was collected from 28 males and 22 females whilst subjected to a knee jerk test. Further analysis of kinematic data was performed to predict relationships which might affect the patellar tendon reflex. All subjects were seated on a high stool with their legs hanging freely within the capture volume of the motion analysis system. Knee jerk tests were applied to all subjects, on both sides of the leg, by eliciting hypo, hyper, and normal reflexes. An additional reinforcement technique called the Jendrassik manoeuvre was also performed under the same conditions to elicit a normal patellar tendon reflex. The comparison of reflex response between genders showed that female subjects generally had a greater response compared to males. However, the difference in reflex response between the left leg and the right leg was not significant. Tapping strength to elicit a hyper-reflex produced greater knee-jerk compared to the normal clinical tapping strength. All results were in agreement with clinical findings and results found by some early researchers.
Fulltext Estimation of body segmental orientation for prosthetic gait using a nonlinear autoregressive neural network with exogenous inputs

Tham LK, Al Kouzbary M, Al Kouzbary H, Liu J, Abu Osman NA

Phys Eng Sci Med, 2023 Dec;46(4):1723-1739.
PMID: 37870729 DOI: 10.1007/s13246-023-01332-6

Assessment of the prosthetic gait is an important clinical approach to evaluate the quality and functionality of the prescribed lower limb prosthesis as well as to monitor rehabilitation progresses following limb amputation. Limited access to quantitative assessment tools generally affects the repeatability and consistency of prosthetic gait assessments in clinical practice. The rapidly developing wearable technology industry provides an alternative to objectively quantify prosthetic gait in the unconstrained environment. This study employs a neural network-based model in estimating three-dimensional body segmental orientation of the lower limb amputees during gait. Using a wearable system with inertial sensors attached to the lower limb segments, thirteen individuals with lower limb amputation performed two-minute walk tests on a robotic foot and a passive foot. The proposed model replicates features of a complementary filter to estimate drift free three-dimensional orientation of the intact and prosthetic limbs. The results indicate minimal estimation biases and high correlation, validating the ability of the proposed model to reproduce the properties of a complementary filter while avoiding the drawbacks, most notably in the transverse plane due to gravitational acceleration and magnetic disturbance. Results of this study also demonstrates the capability of the well-trained model to accurately estimate segmental orientation, regardless of amputation level, in different types of locomotion task.