Hoffmann reflex (H-reflex)
Keywords:
H-reflexAbstract
The H-reflex is a monosynaptic spinal reflex, with a sensory afferent part, a synapse, and a motor efferent part of the reflex arc, the electrophysiological equivalent of tendon reflexes. It is caused by activation of IA proprioceptive sensory nerve fibers by electrical stimulation. In elderly people, it is most easily obtained from the muscles of the lower leg (m. soleus) with submaximal electrical stimulation of n. tibialis in the popliteal fossa. The H-reflex is widely used, both in clinical practice and for scientific research, because of its ease of elicitation from certain muscles.
Reflex latency is used to assess the condition of the anterior and posterior spinal roots (predominantly S1) and the conduction along the afferent sensory (IA) fibers of the peripheral nerve in case the motor fibers of the nerve are not affected. However, amplitude asymmetry is an earlier symptom than prolonged latency in S1 radiculopathy.
Through the H-reflex, the conduction velocity along the IA afferent fibers of the nerve in the proximal segments can also be calculated, while routine research methods establish the conduction in the distal parts of the nerves. The H-reflex except from m. soleus is often examined by m. vastus medialis, m. flexor carpi radialis and m. brachioradialis, for the diagnosis of radiculopathy affecting the corresponding nerve roots. The amplitude of the reflex depends on the excitability of the motoneurons involved in its generation and can be used to assess motoneuron excitability. As an indicator of the motoneuron activity, its relationship to the maximum amplitude of the direct muscle response can be used – H/M amplitude ratio. The increase in the amplitude of the H-reflexes and the H/M amplitude ratio, as well as their appearance in muscles from which they are not normally found, has the same meaning as the increase in the tendon reflexes – increased motoneuronal excitability due to damage to the central motor neuron. The amplitude of the H-reflex can also be used to study presynaptic inhibition, which is greatly reduced to absent in patients with spasticity. The ratio of the amplitudes of the H-reflex (Hvibr./Hmax.) before and after applying vibrations to the Achilles tendon is used.
In conclusion, the H-reflex is a simple method that finds application in clinical practice primarily for establishing S1 radiculopathy and determining conduction in the proximal segments of nerves. It is also used to detect subclinical damage to the central nervous system, in patients suspected of having amyotrophic lateral sclerosis or for another reason.
References
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