Reliability of the clinical and electromyographic examination of tendon reflexes

SummaryThe 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.

[1]  P. Hoffmann.  Untersuchungen über die Eigenreflexe (Sehnenreflexe) Menschlicher Muskeln , 1922 .

[2]  THE INFLUENCE OF MENTAL ACTIVITY ON THE HEIGHT OF THE KNEE-JERK , 1931 .

[3]  J. A. Bastron.  Clinical examinations in neurology , 1963 .

[4]  A. Clarke.  Relationship Between the Electromyogram and the Force of the Isometric Reflex Response of Normal Human Subjects , 1965, Nature.

[5]  H. Weiner,et al.  Some Factors Affecting the Reliability of Surface Electromyography , 1966, Psychosomatic medicine.

[6]  J. Bartko.  The Intraclass Correlation Coefficient as a Measure of Reliability , 1966, Psychological reports.

[7]  C. M. Davis,et al.  Facilitation and adaptation of the human quadriceps stretch reflex produced by auditory stimulation. , 1968, Journal of comparative and physiological psychology.

[8]  L. Pellegrino.  Amygdaloid lesions and behavioral inhibition in the rat. , 1968, Journal of comparative and physiological psychology.

[9]  Reflex Action: A Study in the History of Physiological Psychology. , 1970 .

[10]  P. Dietrichson,et al.  CLINICAL METHOD FOR ELECTRICAL AND MECHANICAL RECORDING OF THE MECHANICALLY AND ELECTRICALLY ELICITED ANKLE REFLEX , 1971, Acta neurologica Scandinavica.

[11]  N. Bathien.  Reflexes spinaux chez l'homme et niveaux d'attention , 1971 .

[12]  Quantitative variations in the force of quadriceps responses to serial patellar tendon taps in normal man. , 1972 .

[13]  M. Hugon.  Methodology of the Hoffmann Reflex in Man , 1973 .

[14]  B. Everitt,et al.  Statistical methods for rates and proportions , 1973 .

[15]  L. Koran,et al.  The reliability of clinical methods, data and judgments (second of two parts). , 1975, The New England journal of medicine.

[16]  L. Koran,et al.  The reliability of clinical methods, data and judgments (first of two parts). , 1975, The New England journal of medicine.

[17]  B. Bonke,et al.  Interpretation of plantar reflexes: biasing effect of other signs and symptoms. , 1977, Journal of neurology, neurosurgery, and psychiatry.

[18]  P. Delwaide,et al.  Facilitation of monosynaptic reflexes by voluntary contraction of muscle in remote parts of the body. Mechanisms involved in the Jendrassik Manoeuvre. , 1981, Brain : a journal of neurology.

[19]  A. Feinstein,et al.  Clinical biostatistics: LIV. The biostatistics of concordance , 1981 .

[20]  Paul Delwaide,et al.  FACILITATION OF MONOSYNAPTIC REFLEXES BY VOLUNTARY CONTRACTIONOF MUSCLES IN REMOTE PARTS OF THE BODY , 1981 .

[21]  A simple measurement hammer for quantitative reflex studies. , 1984, Electroencephalography and clinical neurophysiology.

[22]  J. Stam,et al.  Tendon reflex variability and method of stimulation. , 1987, Electroencephalography and clinical neurophysiology.

[23]  J. Stam,et al.  Tendon reflex asymmetry by voluntary mental effort in healthy subjects. , 1989, Archives of neurology.

[24]  J. Stam,et al.  Measurement of tendon reflexes by surface electromyography in normal subjects , 1989, Journal of Neurology.