Electrophysiologic and kinesiologic features of patellar t reflex and pendulum in normal subjects and patients with spasticity and rigidity

Parkinson's disease is a movement disorder characterised by an increase in muscle tone. Spasticity is a movement disorder developed after upper motor neuron lesion. Spasticity is increase of muscle tone and depending on the speed limb muscles movement. Therefore it affects the functions of daily living. In this study, our purpose is analyzing electrophysiologically and kinesiologically the normal subjects and situation in the disease of patellar T reflex (a phasic stretching in normal subjects, Parkinson's disease and spasticity, and it can be affected by alteration of tone significantly) and pendulum. Firstly, we stimulated patellar T reflex by an electronic triggered reflex hammer and recorded with surface electrodes into the quadriceps femoris and biceps femoris muscles. Than we analyzed electrophysiological features of patellar T reflex, with is a monosynaptic reflex. We also analyzed motion characteristics of the knee joint during the reflex motion in patients with spasticity and rigidity and normal subjects. Initial time of patellar reflex response, joint angle changes and instantaneous angular velocity during reflex was measured with a goniometric approach. 25 normal subjects included study as a control group and mean age of this grup was 32±10.1 (19 male, 6 female). Patellar T reflex had 17.9±1.9 milliseconds latency and 6404.1±2860.0 microvolts amplitude. Bf-SLR response had 19.5±2.8 milliseconds latency and 1065.2±740.8 microvolts amplitude. Bf-MLR response was seen in one case and had 32.4 milliseconds latency and 1013.0 microvolts amplitude. Bf-LLR response was seen in 7 patients (28%). Bf-LLR response had 82.4±10.7 milliseconds latency and 596.0±247.5 microvolts amplitude. Initial time of joint motion was 51.5±9.9 milliseconds and it was measured with an accelerometer. The pendulum count was 4.8±1.5. Angle of joint motion was 18.3±5.6°; extension time was 317.4±23.4 milliseconds; instantaneous angular velocity was 58.0±16.6 degrees/second; frequency was 1.0±0.1. First damping ratio (x1/x2) was calculated as 2.2±1.2, and second damping ratio (x2/x1) was calculated as 0.6±0.2. Y parameter value was calculated as 60.3±16.1. There were 65 patients with mean age 47.6±14.0 years (38 male, 27 female) in the spasticity group. Patellar T reflex had 17.7±2.3 milliseconds latency and 6938.1±4228.9 microvolts amplitude. Bf-SLR response had 17.6±2.4 milliseconds latency and 1195.4±1039.5 microvolts amplitude. Bf-MLR response had 51.2±9.7 milliseconds latency, 398.5±325.9 microvolts amplitude and it was seen in 58 cases (89.2%). Bf-LLR response was seen in 49 cases (75,4 %). Bf-LLR response had 100.3±16.4 milliseconds latency and 335.6±209.5 microvolts amplitude. Initial time of joint motion was 51.9±9.4 milliseconds and it was measured with an accelerometer. The pendulum count was 4.7±2.2. Angle of joint motion was 14.8±6.8°; extension time was 255.5±80.0 milliseconds; instantaneous angular velocity was 60.5±28.0 degrees/second; frequency was 1.3±0.5. First damping ratio (x1/x2) was calculated as 1.8±1.2. Second damping ratio (x2/x1) was calculated as 0.5±0.3. Y parameter value was calculated as 49.3±23.8. There were 45 Parkinson's disease patients (23 male, 22 female) with mean age 66±10 in the rigidity group. Patellar T reflex had 17.9±2.4 milliseconds latency and 4467.7±2528.4 microvolts amplitude. Bf-SLR response had 18.1±2.7 milliseconds latency and 912.9±443.9 microvolts amplitude. Bf-MLR response had 61.0 milliseconds latency, 750.0 microvolts amplitude and it was seen in one cases (2.2%). Bf-LLR response had 94.2±17.0 milliseconds latency, 770.8±488.0 microvolts amplitude and it was seen in 28 cases (62.2%). Initial time of joint motion was 61.7±5.7 milliseconds and it was measured with an accelerometer. The pendulum count was 1.8±0.7 in the rigidity group. Angle of joint motion was 9.2±4.2°; extension time was 274.5±39.3 milliseconds; instantaneous angular velocity was 33.7±15.5 degrees/second; frequency was 1.3±0.2. First damping ratio (x1/x2) was calculated as 2.8±2.8. Second damping ratio (x2/x1) was calculated as 0.2±0.2. Y parameter value was calculated as 27.5±13.9. We compared rigidity group with normal group and the results were as follows for rigidity group; the pendulum count was less, angle of joint motion was smaller, extension time was shorter and instantaneous angular velocity was less significantly. There were not significant changing on latency of patellar T reflex. On the other hand amplitude of patellar T reflex was smaller, and initial time of joint motion measured with an accelerometer was longer. Than, we compared spasticity group with normal group and the results were as follows for spasticity group; the pendulum count was similar, angle of joint motion was smaller, extension time was shorter and instantaneous angular velocity was higher. Latency of patellar T reflex was similar, amplitude was higher, and initial time of joint motion measured with an accelerometer was similar. DTR (deep tendon reflexes) and the damping ratio has increased significantly in the spasticity group. Kinesiologic features of patellar T reflex change significantly in Parkinson's disease. The most striking changes occur on the pendulum count and angle of the first movement. The "Yaltkaya" parameter that generated by using kinesiologic scales can distinguish between Parkinson's disease and normal subjects. Kinesiologic features of patellar T reflex change significantly in spasticity. The most striking changes occur on number of DTR, amplitude of reflex and extension time. The value that generated by multiplying the 2. damping ratio and Y parameter can use for assessment the level of spasticity in spastic patients