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Reliability of the clinical and electromyographic examination of tendon reflexes

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Summary

The reliability of clinical examination of the tendon reflexes was examined by studying inter-observer agreement. Twenty patients were examined by three neurologists. The briskness of the tendon reflexes in arms and legs was scored on a nine-point scale. In 28% of the 160 examined reflexes the observations disagreed 2 scale units or more. Disagreement on the presence of asymmetry occurred in 45% of the 80 reflex pairs. In 15% one observer judged a reflex pair to be symmetrical while another observer found asymmetry of at least 2 scale units. In a second experiment clinical observation of apparently asymmetrical quadriceps reflexes was compared with measurement by surface electromyography. A significant, semi-logarithmic relationship was found between clinical scores and measured reflex amplitudes. Measured reflex asymmetry always agreed with clinical asymmetry, and the magnitudes of right-left amplitude differences were correlated with the magnitude of clinically observed asymmetry. The bedside examination of tendon reflexes is subject to considerable inter-observer disagreement.

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References

  1. Bartko JJ (1966) The intraclass correlation coefficient as a measure of reliability. Psychol Rep 19:3–11

    Google Scholar 

  2. Bastron JA, Bickford RG, Brown JR, et al (Mayo Clinic Staff) (1956) Clinical examinations in neurology. Saunders, Philadelphia, p 188

    Google Scholar 

  3. Bathien N (1971) Reflexes spinaux chez l'homme et niveaux d'attention. Electroencephalogr Clin Neurophysiol 30:32–37

    Google Scholar 

  4. Clarke AM (1965) Relationship between the electromyogram and the force of the isometric reflex response of normal human subjects. Nature 208:551–552

    Google Scholar 

  5. Davis CM, Beaton R (1968) Facilitation and adaption of the human quadriceps stretch reflex produced by auditory stimulation. J Comp Physiol Psychol 65:483–487

    Google Scholar 

  6. Delwaide P J, Toulouse P (1981) Facilitation of monosynaptic reflexes by voluntary contraction of muscle in remote parts of the body. Mechanisms involved in the Jendrassik manoeuvre. Brain 104:701–719

    Google Scholar 

  7. Dietrichson P, Sorbye R (1971) Clinical method for electrical and mechanical recording of the mechanically and electrically elicited ankle reflex. Acta Neurol Scand 47:1–21

    Google Scholar 

  8. Emery FE (1931) The influence of mental activity on the height of the knee jerk. Am J Physiol 97:658–661

    Google Scholar 

  9. Fearing F (1930) Reflex action, a study in the history of physiological psychology. Williams and Wilkins: reprinted by MIT Press, Massachusetts, 1970

  10. Fleiss JL (1981) Statistical methods for rates and proportions Wiley, New York

    Google Scholar 

  11. Gijn J van, Bonke B (1977) Interpretation of plantar reflexes: biasing effect of other signs and symptoms. J Neurol Neurosurg Psychiatry 40:787–789

    Google Scholar 

  12. Grossmann WI, Weiner H (1966) Some factors affecting the reliability of surface electromyography. Psychosom Med 28:78–83

    Google Scholar 

  13. Hoffmann P (1922) Untersuchungen über die Eigenreflexe (Sehnenreflexe) menschlicher Muskeln. Springer, Berlin

    Google Scholar 

  14. Hugon M (1973) Methodology of the Hoffman reflex in man. In: Desmedt JE (ed) New developments in electromyography and clinical neurophysiology, vol 3. Karger, Basel, pp 277–293

    Google Scholar 

  15. Koran ML (1975) The reliability of clinical methods, data and judgements; parts I and II. N Engl J Med 293:642–646, 695–701

    Google Scholar 

  16. Kramer MS, Feinstein AR (1981) Clinical biostatistics: the biostatistics of concordance. Clin Pharmacol Ther 29:111–123

    Google Scholar 

  17. Simons DG, Dimitrijevic MR (1972) Quantitative variations in the force of quadriceps responses to serial patellar taps in normal man. Am J Phys Med 51:240–263

    Google Scholar 

  18. Stam J, Crevel H van (1989) Measurement of tendon reflexes by surface electromyography in normal subjects. J Neurol 236:231–237

    Google Scholar 

  19. Stam J, Crevel H van (1989) Tendon reflex asymmetry by voluntary mental effort in healthy subjects. Arch Neurol 46:70–73

    Google Scholar 

  20. Stam J, Leeuwen JR van (1984) A simple measurement hammer for quantitative reflex studies. Electroencephalogr Clin Neurophysiol 58:282–284

    Google Scholar 

  21. Stam J, Tan KM (1987) Tendon reflex variability and method of stimulation. Electroencephalogr Clin Neurophysiol 67:463–467

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Academic Medical Centre, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands

    J. Stam & H. van Crevel

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  1. J. Stam
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  2. H. van Crevel
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Stam, J., van Crevel, H. Reliability of the clinical and electromyographic examination of tendon reflexes. J Neurol 237, 427–431 (1990). https://doi.org/10.1007/BF00314735

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  • DOI: https://doi.org/10.1007/BF00314735

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