H-reflex amplitude asymmetry is an earlier sign of nerve root involvement than latency in patients with S1 radiculopathy

Abstract Background Based on our clinical experience, the H-reflex amplitude asymmetry might be an earlier sign of nerve root involvement than latency in patients with S1 radiculopathy. However, no data to support this assumption are available. The purpose of this study was to review and report the electrophysiological changes in H-reflex amplitude and latency in patients with radiculopathy in order to determine if there is any evidence to support the assumption that H-reflex amplitude is an earlier sign of nerve root involvement than latency. Results Patients with radiculopathy showed significant amplitude asymmetry when compared with healthy controls. However, latency was not always significantly different between patients and healthy controls. These findings suggest nerve root axonal compromise that reduced reflex amplitude earlier than the latency parameter (demyelination) during the pathologic processes. Conclusion Contrary to current clinical thought, H-reflex amplitude asymmetry is an earlier sign/parameter of nerve root involvement in patients with radiculopathy compared with latency.</p

Similarities and Differences of the Soleus and Gastrocnemius H-reflexes during Varied Body Postures, Foot Positions, and Muscle Function: Multifactor Designs for Repeated Measures

<p>Abstract</p> <p>Background</p> <p>Although the soleus (Sol), medial gastrocnemius (MG), and lateral gastrocnemius (LG) muscles differ in function, composition, and innervations, it is a common practice is to investigate them as single H-reflex recording. The purpose of this study was to compare H-reflex recordings between these three sections of the triceps surae muscle group of healthy participants while lying and standing during three different ankle positions.</p> <p>Methods</p> <p>The Sol, MG and LG muscles' H-reflexes were recorded from ten participants during prone lying and standing with the ankle in neutral, maximum dorsiflexion, and maximum plantarflexion positions. Four traces were averaged for each combination of conditions. Three-way ANOVAs (posture X ankle position X muscle) with planned comparisons were used for statistical comparisons.</p> <p>Results</p> <p>Although the H-reflex in the three muscle sections differed in latency and amplitude, its dependency on posture and ankle position was similar. The H-reflex amplitudes and maximum H-reflex to M-response (H/M) ratios were significantly 1) lower during standing compared to lying with the ankle in neutral, 2) greater during standing with the ankle in plantarflexion compared to neutral, and 3) less with the ankle in dorsiflexion compared to neutral during lying and standing for all muscles (<it>p </it>≤ .05).</p> <p>Conclusion</p> <p>Varying demands are required for muscles activated during distinctly different postures and ankle movement tasks.</p

Electrodiagnosis-based management of patients with radiculopathy: The concept and application involving a patient with a large lumbosacral disc herniation

Objectives: The evaluation of patients with lower back pain (LBP) is based mainly on clinical examinations and imaging procedures that are subjective or anatomic in nature. The treatments, either physical therapy or osteopathy, lack evidence-based protocol and may be disruptive to the spine. Therefore, a neurophysiologic-based approach to managing such patients is necessary. Methods: A 40-year-old female complained of LBP and radiculopathy for more than 12 years, a condition that was accompanied by numbness, tingling and weakness in the left leg. This study examined the effectiveness of using an innovative concept and method on a patient with a 19-mm disc herniation. An electro diagnosis-based evaluation and treatment approach testing tool, Soleus H-reflexes, was applied during unloading (with the patient lying down), loading (with the patient standing or sitting), and various trunk position protocols. A structured treatment was based on the results of H-reflex, including direction-sensitive exercises and manipulation, progressing from unloading to full loading. A custom-based home program was developed for sleeping and sitting positions, with all being directed at non-invasively decompressing the compromised nerve root. Data was analyzed using descriptive statistics. Intervention and results: Stepwise application of the developed procedures resulted in complete resolution of the radicular and spinal symptoms, with a reduction in the size of the herniated disc from 19 mm to 4 mm and recovery of the H-amplitude by the end of the treatment. Functional recovery was also complete by the end of the program. A follow-up after 12 months showed maintained results. Conclusions: The discussed concept and method exhibited their effectiveness in this case study, and the results obtained are due to the consistency and maintenance of the neural decompression using a direction sensitive therapy protocol. Significance: Direction sensitive exercise therapy based on H-reflex testing is effective in treating large herniated lumbar discs. Keywords: Herniated lumbar disc, Lower back pain, H-reflex, Non-surgical therapy, Direction sensitive exercise, Spinal rehabilitatio

Similarities and differences in cervical and thoracolumbar multisegmental motor responses and the combined use for testing spinal circuitries

Study design: Experimental study

Reliability of the Soleus H-Reflex in Different Sitting Postures

The Soleus (SOL) Hoffmann reflex (H-reflex) is commonly recorded in sitting position. However, the reliability of recording is unknown. We assessed the reliability of SOL H-reflex amplitude measurements across multiple traces and sessions during erect, slumped, and slouched sitting postures using the generalizability theory. Five traces of the SOL H-reflex maximum amplitude (Hmax) were recorded from 10 healthy participants during erect, slumped, and slouched sitting postures in two sessions. A decision study analysis was then conducted to calculate the reliability coefficients of the Hmax for five traces and two sessions and to mathematically calculate the coefficients for seven and ten traces, and one and three sessions in the three sitting postures. For five traces and two sessions, the results showed reliability coefficients between 0.970 and 0.971, 0.980 and 0.979, and equal to 0.943 for erect, slumped, and slouched sitting, respectively. Averaging five traces of the Hmax in a single recording session was sufficient to obtain acceptable reliability in the three sitting postures (reliability range, 0.892&ndash;0.988). It was concluded that the SOL Hmax can be recorded during erect, slumped, and slouched sitting postures with adequate reliability