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Amplitude and velocity dependence of patellar pendulum triggered by T reflex in Parkinson’s rigidity

Neurological Sciences volume 42, pages 3257–3266 (2021)Cite this article

Abstract

Objectives

The relation between increase of tonus and joint movement velocity is controversial in Parkinson’s rigidity. It is accepted that the increase of tonus in rigidity is constant during joint movement, and does not change within all limits of movement. However, there is thoughtful evidence that the change in tonus in rigidity has a correlation with joint movement velocity and amplitude of movement. The pendulum movement that is formed by triggering of the patellar T reflex allows the examination of phasic stretching reflexes and physiological changes of passive stretching. Therefore, the velocity and amplitude properties of tonus in Parkinson’s rigidity can be scanned together.

Materials and methods

Patellar T reflex-triggered patellar pendulum was recorded in 40 Parkinson’s patients. The velocity and amplitude changes in the pendulum were observed according to the rigidity scale. Muscle action potentials were recorded from the rectus femoris muscle and biceps femoris muscles simultaneously via superficial recording electrodes. Knee joint angle changes were recorded with a goniometer. The kinesiological and electromyographic features were compared with those of the control subjects.

Results

The number of pendulums decreased significantly, the angle of joint movement decreased, the peak time decreased and the angular velocity slowed down significantly in the Parkinson’s group. While the latency of the patellar T reflex did not change significantly, its amplitude decreased, and the onset time of joint movement measured by accelerometer was prolonged.

Conclusions

Parkinson’s rigidity has a velocity-dependent component, and this correlates negatively with the rigidity scale.

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References

  1. Jankovic J (2008) Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry 79(4):368–376. https://doi.org/10.1136/jnnp.2007.131045

    CAS  Article  Google Scholar 

  2. Samii A, Nutt JG, Ransom BR (2004) Parkinson’s disease. Lancet 363(9423):1783–1793. https://doi.org/10.1016/S0140-6736(04)16305-8

    CAS  Article  PubMed  Google Scholar 

  3. Schrag A (2007) Epidemiology of movement disorders. In: Tolosa EaJ JJ (ed) Parkinson's disease and movement disorders. Lippincott Williams & Wilkins, Hagerstown, pp 50–66

    Google Scholar 

  4. Fung VT, PD. (2002) Rigidity and spasticity. In: Jankovic ET JJ (ed) Parkinson’s disease and movement disorders, 4th edn. Lippincott Williams& Wilkins, Philadelphia, pp 473–482

    Google Scholar 

  5. Powell D, Threlkeld AJ, Fang X, Muthumani A, Xia R (2012) Amplitude- and velocity-dependency of rigidity measured at the wrist in Parkinson’s disease. Clin Neurophysiol 123(4):764–773. https://doi.org/10.1016/j.clinph.2011.08.004

    Article  PubMed  Google Scholar 

  6. Rothwell JC, Obeso JA, Traub MM, Marsden CD (1983) The behaviour of the long-latency stretch reflex in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 46(1):35–44. https://doi.org/10.1136/jnnp.46.1.35

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. Delwaide PJ, Sabbatino M, Delwaide C (1986) Some pathophysiological aspects of the parkinsonian rigidity. J Neural Transm Suppl 22:129–139

    CAS  PubMed  Google Scholar 

  8. Bergui M, Dimanico U, Paglia G, Quattrocolo G, Troni W, Bergamini L (1992) Stretch reflex of quadriceps femoris in normal man: methodological considerations and normative data. Electromyogr Clin Neurophysiol 32(12):597–601

    CAS  PubMed  Google Scholar 

  9. Meara RJ, Cody FW (1993) Stretch reflexes of individual parkinsonian patients studied during changes in clinical rigidity following medication. Electroencephalogr Clin Neurophysiol 89(4):261–268. https://doi.org/10.1016/0168-5597(93)90105-x

    CAS  Article  PubMed  Google Scholar 

  10. Tatton WG, Bedingham W, Verrier MC, Blair RD (1984) Characteristic alterations in responses to imposed wrist displacements in parkinsonian rigidity and dystonia musculorum deformans. Can J Neurol Sci 11(2):281–287. https://doi.org/10.1017/s0317167100045546

    CAS  Article  PubMed  Google Scholar 

  11. Tatton WG, Eastman MJ, Bedingham W, Verrier MC, Bruce IC (1984) Defective utilization of sensory input as the basis for bradykinesia, rigidity and decreased movement repertoire in Parkinson’s disease: a hypothesis. Can J Neurol Sci 11(1 Suppl):136–143. https://doi.org/10.1017/s0317167100046291

    CAS  Article  PubMed  Google Scholar 

  12. Cody FW, MacDermott N, Matthews PB, Richardson HC (1986) Observations on the genesis of the stretch reflex in Parkinson’s disease. Brain 109(Pt 2):229–249. https://doi.org/10.1093/brain/109.2.229

    Article  PubMed  Google Scholar 

  13. Burke D, Gillies JD, Lance JW (1970) The quadriceps stretch reflex in human spasticity. J Neurol Neurosurg Psychiatry 33(2):216–223. https://doi.org/10.1136/jnnp.33.2.216

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. Voerman GE, Gregoric M, Hermens HJ (2005) Neurophysiological methods for the assessment of spasticity: the Hoffmann reflex, the tendon reflex, and the stretch reflex. Disabil Rehabil 27(1–2):33–68

    CAS  Article  Google Scholar 

  15. Uysal H, Mogyoros I, Burke D (1999) Reproducibility of tendon jerk reflexes during a voluntary contraction. Clin Neurophysiol 110(8):1481–1487

    CAS  Article  Google Scholar 

  16. Burke D, Knowles L, Andrews C, Ashby P (1972) Spasticity, decerebrate rigidity and the clasp-knife phenomenon: an experimental study in the cat. Brain 95(1):31–48. https://doi.org/10.1093/brain/95.1.31

    CAS  Article  PubMed  Google Scholar 

  17. Burke D, Andrews CJ, Lance JW (1972) Tonic vibration reflex in spasticity, Parkinson’s disease, and normal subjects. J Neurol Neurosurg Psychiatry 35(4):477–486. https://doi.org/10.1136/jnnp.35.4.477

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. Dietrichson P (1971) Tonic ankle reflex in parkinsonian rigidity and in spasticity. The role of the fusimotor system. Acta Neurol Scand 47(2):163–182. https://doi.org/10.1111/j.1600-0404.1971.tb07474.x

    CAS  Article  PubMed  Google Scholar 

  19. Lance JB, D.; Andrews, CJ. (1973) The reflex effects of muscle vibration. In: JED (ed) new developments in electromyography and clinical neurophysiology, vol 3. Basel, Karger, pp 44–462

    Google Scholar 

  20. Gurbuz M, Bilgin S, Albayrak Y, Kizilay F, Uysal H (2015) Biceps femoris late latency responses and the “notching sign” in spasticity. J Neuroeng Rehabil 12:93. https://doi.org/10.1186/s12984-015-0084-7

    Article  PubMed  PubMed Central  Google Scholar 

  21. Goetz CG, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stebbins GT, Stern MB, Tilley BC, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, Van Hilten JJ, LaPelle N (2007) Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): process, format, and clinimetric testing plan. Mov Disord 22(1):41–47. https://doi.org/10.1002/mds.21198

    Article  PubMed  Google Scholar 

  22. Goetz CG, Poewe W, Rascol O, Sampaio C, Stebbins GT, Counsell C, Giladi N, Holloway RG, Moore CG, Wenning GK, Yahr MD, Seidl L, Movement Disorder Society Task Force on Rating Scales for Parkinson's D (2004) Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: status and recommendations. Mov Disord 19(9):1020–1028. https://doi.org/10.1002/mds.20213

    Article  PubMed  Google Scholar 

  23. Uslu S, Nuzket T, Albayrak Y, Uysal H (2016) Evaluation of the patellar tendon reflex with reflex hammer that can measure impact force, muscle vibration and CMAP. J Neurol Sci-Turk 33(2):214–226

    Google Scholar 

  24. Uslu SNT, Uysal H (2018) Modified motor unit number index (MUNIX) algorithm for assessing excitability of alpha motor neuron in spasticity. Clin Neurophysiol Pract 3:127–133

    Article  Google Scholar 

  25. Brown RA, Lawson DA, Leslie GC, Part NJ (1988) Observations on the applicability of the Wartenberg pendulum test to healthy, elderly subjects. J Neurol Neurosurg Psychiatry 51(9):1171–1177. https://doi.org/10.1136/jnnp.51.9.1171

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  26. Brown RA, Lawson DA, Leslie GC, MacArthur A, MacLennan WJ, McMurdo ME, Mutch WJ, Part NJ (1988) Does the Wartenberg pendulum test differentiate quantitatively between spasticity and rigidity? A study in elderly stroke and Parkinsonian patients. J Neurol Neurosurg Psychiatry 51(9):1178–1186. https://doi.org/10.1136/jnnp.51.9.1178

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  27. Andrews CJ, Burke D, Lance JW (1972) The response to muscle stretch and shortening in Parkinsonian rigidity. Brain 95(4):795–812. https://doi.org/10.1093/brain/95.4.795

    CAS  Article  PubMed  Google Scholar 

  28. Berardelli A, Sabra AF, Hallett M (1983) Physiological mechanisms of rigidity in Parkinson’s disease. J Neurol Neurosurg Psychiatry 46(1):45–53. https://doi.org/10.1136/jnnp.46.1.45

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  29. Xia R, Rymer WZ (2004) The role of shortening reaction in mediating rigidity in Parkinson’s disease. Exp Brain Res 156(4):524–528. https://doi.org/10.1007/s00221-004-1919-9

    Article  PubMed  Google Scholar 

  30. Pierrot-Deseilligny E, Burke D (2005) The circuitry of the human spinal cord. Its role in motor control and movement disorders. Cambridge University Press

  31. Fahn SE, Elton RL (1987) Unified Parkinson’s disease rating scale. Recent Developments in Parkinson’s Disease. Macmillan Health Care Information, Florham Park

  32. Simonetta Moreau M, Meunier S, Vidailhet M, Pol S, Galitzky M, Rascol O (2002) Transmission of group II heteronymous pathways is enhanced in rigid lower limb of de novo patients with Parkinson’s disease. Brain 125(Pt 9):2125–2133. https://doi.org/10.1093/brain/awf201

    CAS  Article  PubMed  Google Scholar 

  33. Lee RG (1989) Pathophysiology of rigidity and akinesia in Parkinson’s disease. Eur Neurol 29(Suppl 1):13–18. https://doi.org/10.1159/000116448

    CAS  Article  PubMed  Google Scholar 

  34. Lee RGT, W.G. (1978) Long loop reflexes in man: clinical applications. In: Cerebral Motor Control in Man: Long Loop Mechanisms, Progress in Clinical Neurophysiology, vol 4. Karger, Basel

    Google Scholar 

  35. Kushnir M, Klein C, Rabey JM (2001) H reflex behavior in Parkinson’s disease patients and patients with extrapyramidal and pyramidal signs combined. J Neurol Sci 186(1–2):101–105. https://doi.org/10.1016/s0022-510x(01)00511-1

    CAS  Article  PubMed  Google Scholar 

  36. Sabbahi M, Etnyre B, Al-Jawayed I, Jankovic J (2002) H-reflex recovery curves differentiate essential tremor, Parkinson’s disease, and the combination of essential tremor and Parkinson’s disease. J Clin Neurophysiol 19(3):245–251

    Article  Google Scholar 

  37. Sabbahi M, Etnyre B, Al-Jawayed IA, Hasson S, Jankovic J (2002) Methods of H-reflex evaluation in the early stages of Parkinson’s disease. J Clin Neurophysiol 19(1):67–72

    CAS  Article  Google Scholar 

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Acknowledgments

We would like to thank Ms. Barbara for making the English revisions of the article in her native language. We thank the patients for their cooperation.

Funding

The study was supported by the Scientific and Technological Research Council of Turkey Grant (grant number: 214 S 175).

Author information

Affiliations

  1. Department of Biophysics, Akdeniz University Faculty of Medicine, Antalya, Turkey

    Serkan Uslu & Tunca Nüzket

  2. Department of Neurology, Akdeniz University Faculty of Medicine, Dumlupınar Blv. Campus, 07070, Antalya, Turkey

    Mehmet Gürbüz, Ferah Kızılay, Sibel Özkaynak & Hilmi Uysal

Authors
  1. Serkan Uslu
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  2. Mehmet Gürbüz
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  3. Ferah Kızılay
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  4. Sibel Özkaynak
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  5. Tunca Nüzket
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  6. Hilmi Uysal
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Contributions

(1) Research project: A. conception, B. organization and C. execution

(2) Statistical analysis: A. design, B. execution and C. review and critique

(3) Manuscript: A. writing of the first draft, B. review and critique and C. writing major reviews

S.U: 1C, 2A, 2B, 3A, 3B

MG: 1B, 1C, 3C

F.K: 1B, 3B

S.Ö: 1B, 2C, 3B

T.N.:1B, 1C, 2B, 3B

H.U: 1A, 1B, 1C, 2A, 2C, 3A, 3C

Corresponding author

Correspondence to Hilmi Uysal.

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Cite this article

Uslu, S., Gürbüz, M., Kızılay, F. et al. Amplitude and velocity dependence of patellar pendulum triggered by T reflex in Parkinson’s rigidity. Neurol Sci 42, 3257–3266 (2021). https://doi.org/10.1007/s10072-020-04936-y

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  • DOI: https://doi.org/10.1007/s10072-020-04936-y

Keywords

  • Parkinson’s disease
  • Rigidity
  • Patellar
  • Reflex
  • Kinesiology
  • Velocity dependence
  • Amplitude dependence