Jansen, D. (Daan) (2013) De tonische respons bij de kniepeesreflex. Een EMG-studie naar de karakteristieken van de tonische respons bij gezonde zuigelingen en zuigelingen met een hoog risico op cerebrale parese. thesis, Medicine.
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Abstract
Introduction: Cerebral palsy (CP) is a heterogeneous group of non-progressive disorders of posture- and motor control caused by pre-and perinatal damage to the central nervous system. Children with CP are the largest group of children with motor impairment in pediatric rehabilitation. It is difficult to predict which children will develop CP. However, identification of children who have a high chance of developing CP could be advantageous, as it offers the possibility of early intervention. In Learn2Move (L2M), a study on the effect of early intervention in children at very high risk for CP, occasionally a tonic response to the patellar tendon reflex (PTR)was identified during the neurological examination. That finding led to the current study in which the EMG characteristics of the tonic response and other characteristics of the PTR such as reciprocal excitation and reflex irradiation were assessed. The study is an exploratory and innovative study of a phenomenon not previously described: the tonic response of the PTR. Methods: A group of 25 typically developing (TD) infants was assessed twice: at the age of 1 month (TD-T0) and 3 months (TD-T1). The PTR was assessed while surface EMG measurements were recorded of 17 arm, neck, trunk and leg muscles. The EMG was analyzed with the software program PedEMG, focusing on the frequency and duration of the tonic response, the frequency of reciprocal excitation and the frequency and extent of reflex irradiation. The results were compared to data available from 14 infants of the L2M study (median corrected age 12 [+3] weeks). For statistical comparison, non-parametric tests were used. Results: In each upper leg muscle and in each study group (TD-T0, TD-T1, L2M), the tonic response was observed. Most frequently the response occurred in the ipsilateral m. quadriceps. In the TD-group the tonic response occurred at T0 in 14% of PTRs. At T1 the median rate was 15%. The tonic response occurred more often in the L2M group than in the TD-group (median: 39%, TD-T0 vs. L2M: P <0.001, TD - T1 vs L2M: P <0.001). The median duration of the tonic response in the ipsilateral m. quadriceps was 1380ms (TD-T0), 968ms (TD-T1) and 621ms (L2M). In the L2M-group the tonic response was not associated with the development of CP (n=7). Reflex irradiation was extensively present. It occurred in all infants in particular in the trunk and leg muscles. Reflex irradiation was significantly more common in various muscles of L2M-infants than in those of TD-infants. Conclusion: The tonic response to the PTR probably is a typical neurophysiological phenomenon. It occurs primarily in the agonist: the ipsilateral m. quadriceps; its median duration varies. The tonic response may be due to an increased excitability of the nervous system during the first months of life. The tonic response occurs more often in infants at high risk for CP, which may be related to an increased excitability of motoneurons induced by the lesion of the brain. Reflex irradiation of the PTR involves many muscles, especially leg and trunk muscles. Reflex irradiation is more common in infants at high risk for CP.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Hadders-Algra, Prof. dr. M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:52 |
| Last Modified: | 25 Jun 2020 10:52 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1289 |
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