Abstract
The deep tendon reflex exam is an important part of neurological assessment of patients consisting of two components, reflex elicitation and reflex grading. While this exam has traditionally been performed in person, with trained clinicians both eliciting and grading the reflex, this work seeks to enable the exam by novices. The COVID-19 pandemic has motivated greater utilization of telemedicine and other remote healthcare delivery tools. A smart tendon hammer capable of streaming acceleration measurements wirelessly allows differentiation of correct and incorrect tapping locations with 91.5% accuracy to provide feedback to users about the appropriateness of stimulation, enabling reflex elicitation by laypeople, while survey results demonstrate that novices are reasonably able to grade reflex responses. Novice reflex grading demonstrates adequate performance with a mean error of 0.2 points on a five point scale. This work shows that by assisting in the reflex elicitation component of the reflex exam via a smart hammer and feedback application, novices should be able to complete the reflex exam remotely, filling a critical gap in neurological care during the COVID-19 pandemic.
Highlights
The deep tendon reflex (DTR) is a critically important diagnostic tool for multiple upper and lower neuron neurological illnesses Chardon et al (2014); Walker et al (1990)
The results shown demonstrate the potential viability of the remote deep tendon reflex exam
Tapping data on human subjects shows that 68% of the power difference between tapping locations is contained in acceleration signals below 100 Hz, and that the signals below 50 Hz are significantly different, allowing the combined use of readily available wireless Inertial Measurement Unit (IMU) and support vector machine classifiers to provide DTR elicitation feedback
Summary
The deep tendon reflex (DTR) is a critically important diagnostic tool for multiple upper and lower neuron neurological illnesses Chardon et al (2014); Walker et al (1990). Assessment of the DTR is often the first step toward localization of a neurological lesion. The DTR exam requires physical interaction with a patient, and is limited when in-person healthcare delivery is reduced. The COVID-19 pandemic has strained existing healthcare resources while simultaneously providing significant impetus for the development and implementation of remote diagnostic and therapeutic systems for healthcare delivery Chauhan et al (2020). The development of a system for smart delivery of tendon tapping stimulation will aid in the remote assessment of deep tendon reflexes (DTRs) with future potential for therapeutic applications as well. There have been reported neurological symptoms of COVID-19 Ottaviani et al (2020); Pezzini and Padovani (2020), the primary effect to neurological diagnosis and treatment is likely the backlog of urgent, nonCOVID-19 related healthcare needs
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