CoChat
Sign Up
Cited by 4Peripheral Nerve DisordersMotor Control and AdaptationMuscle activation and electromyography studies

Motion Analysis of Normal Patellar Tendon Reflex

Open access
Tham, Lai Kuan, Osman, Noor Azuan Abu, Abas, Wan Abu Bakar Wan, Lim, Kheng Seang·2013·Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques
DOI 10.1017/s0317167100015985
Open this paper in CoChat — free accountOpen PDF

Abstract

Background: Reflex assessment, an essential element in the investigation of the motor system, is currently assessed through qualitative description, which lacks of normal values in the healthy population. This study quantified the amplitude and latency of patellar tendon reflex in normal subjects using motion analysis to determine the factors affecting the reflex amplitude. Methods: 100 healthy volunteers were recruited for patellar tendon reflex assessments which were recorded using a motion analysis system. Different levels of input strength were exerted during the experiments. Results: A linear relationship was found between reflex input and reflex amplitude (r = 0.50, P <0.001). The left knee was found to exhibit 26.3% higher reflex amplitude than the right (P <0.001). The Jendrassik manoeuvre significantly increased reflex amplitude by 34.3% (P = 0.001); the effect was especially prominent in subjects with weak reflex response. Reflex latency normality data were established, which showed a gradual reduction with increasing input strength. Conclusion: The quantitative normality data and findings showed that the present method has great potential to objectively quantify deep tendon reflexes.

Integrity signals

Registry

Crossref · 10.1017/s0317167100015985

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

5 of 24 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Conduction time or velocity along the peripheral nerve, particularly the proximal segment, is evaluated by obtaining measurements of tendon reflex latency.

    “The conduction time or velocity along the peripheral nerve, particularly the proximal segment, is evaluated by obtaining measurements of tendon reflex latency 11,12,19 .”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [11] 11. Frijns CJ, Laman DM, van Duijn MA, van Duijn H. Normal values of patellar and ankle tendon reflex latencies. Clin Neurol Neurosurg. 1997;99(1):31-6. source
    • cites [12] 12. Ogawa Y, Hirata M, Okayama A, Ichikawa YE, Goto S. Latency of the Achilles tendon reflex for detection of reduced functions of the peripheral nervous system in workers exposed to lead. Br J Ind Med. 1993;50:229-33. source

      The Abstract describes tendon-reflex latency as a way to quantify nerve conduction time, and the Results say the method includes proximal as well as distal conduction. But the Results also state that it is not a specific measure of nerve conduction velocity and cannot pinpoint which portion accounts for a change in latency; the claim overstates its ability to evaluate the proximal segment in particular. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [19] 19. Péréon Y, Nguyen The Tich S, Fournier E, Genet R, Guihéneuc P. Electrophysiological recording of deep tendon reflexes: Normative data in children and in adults. Neurophysiol Clin. 2004;34:131-9. source
  • Findingreasoning

    The patellar tendon reflex latencies measured by motion analysis are significantly higher than those reported in studies using electromyography.

    “However, the values of reflex latency found in the study are significantly higher compared to the latencies of other studies using electromyography 11,13,14,19 .”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [11] 11. Frijns CJ, Laman DM, van Duijn MA, van Duijn H. Normal values of patellar and ankle tendon reflex latencies. Clin Neurol Neurosurg. 1997;99(1):31-6. source
    • cites [13] 13. Stam J, van Crevel H. Measurement of tendon reflexes by surface electromyography in normal subjects. J Neurol. 1989;236(4):231-7. source
    • cites [14] 14. Husemann U, Behse F. Reflex time of the knee jerk in controls, spasticity, radiculopathy and neuropathy. EEG-EMG. 1993;24 (4):280-5.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [19] 19. Péréon Y, Nguyen The Tich S, Fournier E, Genet R, Guihéneuc P. Electrophysiological recording of deep tendon reflexes: Normative data in children and in adults. Neurophysiol Clin. 2004;34:131-9. source
  • Findingown data

    There is no statistically significant difference in patellar tendon reflex amplitude between male and female subjects at tapping angles of 30° and 45°.

    “Female subjects, on the other hand, were showing greater reflex amplitude at tapping angle of 30° and 45°, but the differences were not statistically significant.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In healthy subjects, the left knee exhibits 26.3% higher patellar tendon reflex amplitude than the right knee.

    “The left knee was found to exhibit 26.3% higher reflex amplitude than the right (P <0.001).”
    • Also stated in: § Left-right asymmetry in the patellar tendon reflex · plain
      “Left-right asymmetry was found in the patellar tendon reflex in the study, in which the left knee had 26.3% greater reflex amplitude compared to the right knee (6.29 ± 7.14° versus 4.98 ± 6.33°, P < 0.001, n = 1200).”
    • Also stated in: § Reflex asymmetry · plain
      “In this study, the left-right difference was statistically significant with 26.3% greater reflex amplitude in the left knee, though the actual difference was just 1.31°.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Male subjects have significantly higher patellar tendon reflex amplitude than female subjects at tapping angles of 15° and 90°.

    “The reflex amplitude of male subjects was significantly higher than female subjects at tapping angle of 15° (P = 0.035) and 90° (P = 0.037), as shown in Table 2.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 8
  • The quote only partly states this claim. 1
  • May combine two claims. 7

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Study design and conductcitation

    Sixteen reflective markers were attached according to the Plug-in-Gait Marker Placement.

    “Sixteen reflective markers were attached on the lower limb of the subject according to the Plug-in-Gait Marker Placement 20 .”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [20] 20. Kadaba MP, Ramakrishnan HK, Wootten ME. Measurement of lower extremity kinematics during level walking. J Orthop Res. 1990;8(3):383-92. source

      The MARKER SYSTEM AND EMBEDDED AXES section describes markers placed on the pelvis and lower limb, including thigh- and shank-wand markers. It does not identify the placement as Plug-in-Gait or specify sixteen markers, so those parts of the cited claim are unsupported. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Elderly individuals have reduced reflex responses.

    “In addition, the elderly have been found to have reduced reflex responses 9,10 .”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [9] 9. Carel RS, Korczyn AD, Hochberg Y. Age and sex dependency of the Achilles tendon reflex. The American Journal of the Medical Sciences. 1979;278(1):57-63. source
    • cites [10] 10. Lim KS, Bong YZ, Chaw YL, et al. Wide range of normality in deep tendon reflexes in the normal population. Neurol Asia. 2009;14: 21-5. source

      The ABDOMINAL REFLEXES section says these responses are difficult to elicit in elderly people. The CLINICAL section discusses absent ankle jerks in older adults but notes that only 6% of normal subjects over 65 have them. These passages support an age-related difficulty with particular reflexes, not a general reduction in reflex responses. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Males have higher reflex response compared to females.

    “A previous study on the effect of gender found higher reflex response in males compared to females 10 .”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [10] 10. Lim KS, Bong YZ, Chaw YL, et al. Wide range of normality in deep tendon reflexes in the normal population. Neurol Asia. 2009;14: 21-5. source

      The ABDOMINAL REFLEXES section says abdominal reflexes can be difficult to elicit in multiparous women, but it does not compare male and female reflex responses. The CLINICAL section discusses other sources of reflex variability without reporting a sex difference; searches for gender, males and females found no such comparison in our copy. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The efficacy of the Jendrassik manoeuvre has been statistically proven.

    “Though JM was practised widely in clinical neurology and its efficacy was statistically proven 10,11 , the magnitude of its impact on tendon reflex was not previously measured.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [10] 10. Lim KS, Bong YZ, Chaw YL, et al. Wide range of normality in deep tendon reflexes in the normal population. Neurol Asia. 2009;14: 21-5. source

      The CLINICAL section says the Jendrassik manoeuvre can reinforce difficult-to-elicit reflexes by making motor neurones more excitable. It does not present statistical results or state that its efficacy was statistically proven. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [11] 11. Frijns CJ, Laman DM, van Duijn MA, van Duijn H. Normal values of patellar and ankle tendon reflex latencies. Clin Neurol Neurosurg. 1997;99(1):31-6. source

  • May combine two claims.

    Findingcitation

    The variation in patellar tendon reflex amplitude among healthy subjects is high, consistent with earlier studies.

    “The variation of patellar tendon reflex in healthy subjects remained high as found in earlier studies.”
    • Also stated in: § Relationship between tapping strength and reflex amplitude Normal values of patellar tendon reflex amplitudes in young adults were established in this study.The quantified values still show large variation and these mirror the results of some previous studies 6,13 .In this study, the tapping angle is correlated to the force applied to the tendon based on two physics theory, i.e.; (1) the theory of conservation of mechanical energy, as where v is the tapping velocity, g is the gravitational acceleration, L is the handle length of reflex hammer, and θ is the tapping angle; (2) Newton's second law.The results showed significant effect of tapping force on reflex amplitude.Thus, tapping strength must be taken into consideration in clinical deep tendon reflex interpretation.On the other hand, the mean reflex amplitude of 5.25° produced by the tapping angle of 45°, an angle commonly used in daily clinical practice 21 , might be difficult to observe.Reflex quantification methods will enable clinicians to grade reflexes more accurately.The linear relationship between reflex input (maximum tapping velocity) and output (reflex amplitude) was in agreement with earlier studies 22,23 .Other studies found the relation between stimulus and response to be logarithmic 6,13,24,25 .These differences between other studies are due to variations in the input parameters, e.g.peak tapping force [24][25][26] and deceleration of hammer 6,13 ; and the output parameters, e.g.peak angular speed 24 , peak reflex torque 26 , and electromyography amplitude 6,13 . · plain
      “The quantified values still show large variation and these mirror the results of some previous studies 6,13 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [6] 6. Stam J, Tan KM. Tendon reflex variability and method of stimulation. Electromyogr Clin Neurophysiol. 1987;67(5): 463-7. source
    • cites [13] 13. Stam J, van Crevel H. Measurement of tendon reflexes by surface electromyography in normal subjects. J Neurol. 1989;236(4):231-7. source

  • May combine two claims.

    Findingown data

    The effect of the Jendrassik manoeuvre on patellar tendon reflex amplitude depends on baseline amplitude: it increases amplitude more in subjects with small baseline amplitude, and decreases amplitude in a majority of subjects with large baseline amplitude.

    “A greater increase in reflex amplitude with JM was found in the subgroup with small AMP, as shown in Figure 3.For this subgroup, the increase of reflex amplitude with JM was 79.51%.For subgroup with large AMP, 60.26% exhibited a decrease in reflex amplitude with JM.”
    • Also stated in: § The effect of Jendrassik manoeuvre · plain
      “Nevertheless, what was not previously known is that the effect of JM can be suppressing in those with strong baseline reflex response, in addition to reinforcing in individual who exhibit weaker reflex output.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The response of deep tendon reflexes is affected by factors such as gender, age, subject's position, and mental condition.

    “The response is affected by many factors such as gender, age, subject's position, and mental condition, which plays multiple roles in contributing to the variation of reflex responses [4][5][6] .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4][5][6]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Fixations on subjects might lead to discomfort and affect the natural response of a reflex.

    “Such fixations on subjects might lead to discomfort and affect the natural response of a reflex 17 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] 17. LeMoyne R, Dabiri F, Jafari R. Quantified deep tendon reflex device, second generation. J Mech Med Biol. 2008;8:75-85. source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    The subject's position, mental and muscle condition leading to reflex variability are unavoidable.

    “However, the subject's position, mental and muscle condition leading to reflex variability are unavoidable 7,8 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] 7. Hunt CC. Temporal fluctuation in excitability of spinal motoneurones and its influence on monosynaptic reflex responses. J Gen Physiol. 1955;38(6):801-11. source
    • cites [8] 8. Rudomin P, Dutton H. Effects of conditioning afferent volleys on variability of monosynaptic responses of motorneurones. J Neurophysiol. 1969;32(2):140-57. source

  • May combine two claims.

    Interpretationown data

    The Jendrassik manoeuvre has a modulatory effect on the patellar tendon reflex, enhancing it in subjects with weak baseline response and inhibiting it in those with strong baseline response.

    “This study, however, suggests that JM has a modulation effect on tendon reflex, both enhancing and inhibiting depending on the baseline reflex response.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study was approved by a board in the Department of Biomedical Engineering of the University of Malaya and written consent was obtained from participants.

    “This study has been approved by a board in the Department of Biomedical Engineering of the University of Malaya.Written consent was obtained from the participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Jendrassik manoeuvre is a well-known technique of reinforcement applied during unresponsive tendon reflexes.

    “The Jendrassik manoeuvre (JM) is a well-known technique of reinforcement applied during the encounter of unresponsive tendon reflexes 5 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] 5. Dick JPR. The deep tendon and the abdominal reflexes. J Neurol Neurosurg Psychiatry. 2003;74(2):150-3.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Height influences reflex, with a linear relationship between height and reflex response.

    “Height, which indicates the length of nerve conduction pathway, is also found to influence reflex, and a linear relationship between height and reflex response has been reported [11][12][13] .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11][12][13]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

13 of 13

  • The paper relies on this without support.

    Reflex assessment currently lacks normal values in the healthy population.

    “Reflex assessment, an essential element in the investigation of the motor system, is currently assessed through qualitative description, which lacks of normal values in the healthy population.”

  • The paper relies on this without support.

    The magnitude of the impact of the Jendrassik manoeuvre on tendon reflex had not been previously measured.

    “Though JM was practised widely in clinical neurology and its efficacy was statistically proven 10,11 , the magnitude of its impact on tendon reflex was not previously measured.”

  • The paper relies on this without support.

    The motion analysis method allows subjects to remain comfortable and relaxed, minimizing anxiety during the experiment.

    “Motion analysis that avoids major fixations on the subject was proposed for this study.The method, which required only the attachment of reflective markers, allowed subjects to sit with their desired position.Thus, the possibility to develop anxiousness during the experiments could be minimized.”

  • The paper relies on this without support.

    The 100 healthy volunteers are representative of the healthy population for patellar tendon reflex normality.

    “One hundred volunteers, 50 males and 50 females, aged 21 to 32 years were recruited in this study.All volunteers were healthy with no past and present history of neurological disorder or diabetes mellitus.”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Sex difference at the lowest tapping angle conflicts with the discussion

    Minor

    The discussion describes females as having greater responses at smaller tapping angles, but the results report a significantly greater response in males at 15°, the smallest angle tested.

1 of 1

Cites

Flagged first, then by citations

2 of the 33 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Jendrassik, 1883, Beiträge zur Lehre von der Sehnen-Reflexen Dtsch Arch Klin Med, 33, 177
  2. Wadman, 1980, Responses of the arm movement control system to force impulses, J Hum Mov Stud, 6, 280
  3. Husemann, 1993, Reflex time of the knee jerk in controls, spasticity, radiculopathy and neuropathy, EEG-EMG, 24, 280

Cited by

Sorted by citations

Related

Authors
Tham, L. K., Osman, N. A. A., Abas, W. A. B. W., & Lim, K. S.
Affiliations
University of Malaya (MY)
Corresponding author
Tham, Lai Kuan
ORCID
Venue
Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques
Publisher
Cambridge University Press (CUP)
Published
2013-11
Volume
40
Issue
6
Pages
836-841
ISSN
  • 0317-1671 (ISSN-L)
  • 2057-0155
DOI
10.1017/s0317167100015985
OpenAlex
W2325080806
Cited by
4
References
33
Citations by year
2025: 1 · 2022: 1 · 2018: 1 · 2016: 1
FWCI
0.26
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified, 326 d)
Locations
  • Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Peripheral Nerve Disorders
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Motor Control and Adaptation
  • Physical Sciences › Engineering › Biomedical Engineering › Muscle activation and electromyography studies
Keywords
patellar reflex, deep tendon reflexes, reflex amplitude, reflex latency, reference values, motion analysis
MeSH terms
Electromyography, Humans, Reference Values, Reflex, Reflex, Stretch, Patellar Ligament

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-30.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-30.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review