WO2017027954A1

WO2017027954A1 - Automated reflex hammer

Info

Publication number: WO2017027954A1
Application number: PCT/CA2015/050782
Authority: WO
Inventors: William Parker; Stéphane BUSSIÈRE; Mathew BUSSIÈRE; Mathew Moore; Deon LOUW
Original assignee: Synew Corporation
Priority date: 2015-08-18
Filing date: 2015-08-18
Publication date: 2017-02-23

Abstract

Reflex testing apparatuses and methods are provided. The apparatuses can be used to elicit deep tendon reflex responses from patients (animals and/or humans). In some embodiments, a mechanism on the hand-held apparatus can allow a user to adjust an impulse in which the apparatus produces and a source of potential energy can be used to produce a desired impulse. The ability to control the impulse produced by the apparatus, or provided by the method, can provide the user with an ability to determine hypo-, normo-, or hyper-reflexic physiologic states of patients with an increased degree of consistency.

Description

TITLE: AUTOMATED REFLEX HAMMER

TECHNICAL FIELD:

[0001 ] The present disclosure relates to apparatuses and methods to elicit deep tendon reflex responses from patients, and more particularly, to automated reflex hammers and methods of using same to elicit deep tendon reflex responses from patients.

BACKGROUND:

[0002] Any discussion of the prior art throughout the specification should in no way be considered as an admission that such prior art is widely known or forms part of common general knowledge in the field.

[0003] The physical exam is an important aspect of the physician-patient encounter. It is the first chance a doctor gets to contact and interact with the human body in order to identify if there is a possible abnormality with the patient. The physical exam has many parts, including a neurological assessment, which aims to identify pathology or injury of the central and peripheral nervous systems. The neurological exam is divided into multiple parts, the majority of which include examination of the corticospinal tracts by means of assessing motor activity of peripheral muscles, the spinothalamic tract by means of assessing sensory stimuli of pain and temperature, and of the dorsal columns and medial lemniscal tracts by means of assessing tactile information, proprioception, two point discrimination and stereognosis. A neurology specialist, a neurologist, uses a reflex hammer to assess an individual's deep tendon reflexes (DTR), which are a component of the corticospinal tracts. A reflex is a muscular contraction that is elicited as a response to a stimulus without conscious control.

[0004] There are many types of reflexes but of particular interest are the deep tendon reflexes, or myotatic reflexes, where the receptor neurons have relatively direct connections to the muscle spindle fibres. Normal DTRs result from the contraction of a muscle whose tendon has been stretched by an impulse elicited upon the tendon, for example, by a reflex hammer. Physicians are currently trained to subjectively grade the reflex responses at the bedside. These response levels are measured from Ό' to '4+', with '2+' being normal, and with Ό' designating no response at all. The presence of DTR responses less than 2+ may denote damage to the peripheral nervous system, more specifically the lower motor neuron. The presence of DTR responses greater than 2+ may suggest damage or pathology to the central nervous system, more specifically the upper motor neuron, or point to underlying anxiety or drug use. Asymmetry of reflexes (unequal reflex responses in the limbs), moreover, frequently implies central or peripheral nervous system perturbation. These findings are paramount in assessing multiple neurologically related medical illnesses and injuries, including hematomas of the brain, diabetic neuropathy, multiple sclerosis, tumours, genetic illnesses, not to mention innumerable and protean pathologic abnormalities. Despite the importance of this clinical window into the health of the nervous system, the current accepted technique of, and technology for, eliciting this physical sign, is over a century old. It relies on the subjective 'feel' and 'experience' of the examiner, which cannot be precisely calibrated on a repeatable basis, and is more 'eminence-based' than evidence-based.

[0005] Recent research has examined the force necessary to elicit a DTR at the knee, for example, as a quadricep reflex (see Marshall, GL, Little, JW. Deep tendon reflexes: a study of quantitative methods. J Spinal Cord Med (2002). 25: 94-99, incorporated by reference herein). Although this research was invaluable in quantifying DTRs, the metric used was not as robust as possible. The paper summarized that there was an unknown relationship between differing reflex hammers and the amount of force required to elicit a DTR.

[0006] There remains a need to provide automated reflex hammers and methods of using same to elicit deep tendon reflex responses from patients that can overcome the limitations of the prior art.

SUMMARY:

[0007] The following is intended to be a brief summary of the invention and is not intended to limit the scope of the invention.

[0008] Reflex testing apparatuses and methods are provided. The apparatuses can be used to elicit deep tendon reflex responses from patients (animals and/or humans). In some embodiments, a mechanism on the handheld apparatus can allow a user to adjust an impulse in which the apparatus produces and a source of potential energy can be used to produce a desired impulse. The ability to control the impulse produced by the apparatus, or provided by the method, can provide the user with an ability to determine hypo-, normo-, or hyper-reflexic physiologic states of patients with an increased degree of consistency.

[0009] Impulse, or force multiplied by time, can help to quantify this relationship and provide an alternative to the force-based relationship that exists in literature. Another way to visualize impulse, in this specific system, is by the equation mass multiplied by velocity. Thus, the mass of a reflex hammer would make a noticeable difference in the quantified deep tendon reflexes (DTRs).

[0010] The use of a known mass impacting a tendon using some form of potential energy that gives the mass a velocity is provided. The end result, the impulse, can be pre-set and selected by the user, enabling him/her to quantify the DTR portion of the neurological assessment. This present disclosure is designed to enable the medical practitioner to objectively test DTRs by providing a consistent, measurable, and accurate impulse to a tendon.

[001 1 ] Automated reflex hammers are provided. In some embodiments, the apparatus can entail a mechanism, not limited to a mechanism that creates an impulse, to which an impulse is elicited. This impulse can be controlled by an external dial or adjustment mechanism that can provide the user with the ability to control the amount of impulse produced by the device. The impulse can be elicited onto a firm hammer or mallet that with the intent of the hammer or mallet to contact a living human or animal tendon. By contacting the tendon with a known amount of impulse, the user can then observe the reflex response consistently. Depending on the amount of reflex elicited, the user can know if the subject, human or otherwise, has hypo-, normo- or hyper- reflexic DTRs.

[0012] Broadly stated, in some embodiments, an apparatus is provided apparatus for assessing reflexes of a patient's deep tendon, the apparatus comprising: an activatable hammer for contacting the patient's deep tendon when activated; a chamber for containing the activatable hammer; an impulse generator, in communication with the activatable hammer when inactive, for providing an impulse to the activatable hammer to activate the activatable hammer; a tuning mechanism, in communication with the impulse generator, for setting the impulse provided by the impulse generator to a predetermined strength; and an activation mechanism in communication with the impulse generator for releasing the impulse from the impulse generator thereby activating the hammer; wherein the reflexes of a patient's deep tendon are assessed by contacting the hammer to the patient's deep tendon and observing a reaction.

[0013] Broadly stated, in some embodiments, a method of assessing the reflexes of a patient's deep tendon is provided, the method comprising: providing an automated reflex hammer, as described herein, having a hammer mass; activating the release of the hammer mass from the automated reflex hammer proximate the individual's deep tendon; allowing the hammer mass to contact the individual's tendon with a hammering impulse to initiate at least one reflex; observing the individual's deep tendon reflexes; whereby the individual's deep tendon reflexes are assessed. [0014] It is the object of the present invention to overcome or ameliorate at least one of the disadvantages of the prior art, or to provide a useful alternative.

[0015] Unless the context clearly requires otherwise, throughout the description and the claims, the words "comprise", "comprising", and the like are to be construed in an inclusive sense as opposed to an exclusive or exhaustive sense; that is to say, in the sense of "including, but not limited to".

BRIEF DESCRIPTION OF THE DRAWINGS:

[0016] Figure 1 depicts a schematic diagram outlining embodiments of an automated reflex hammer.

[0017] Figure 2 depicts a front perspective view of an embodiment of an automated reflex hammer.

[0018] Figure 3A depicts a front elevation view of the embodiment of an automated reflex hammer from Figure 2.

[0019] Figure 3B depicts a side elevation view of the embodiment of an automated reflex hammer from Figure 2.

[0020] Figure 3C depicts a rear elevation view of the embodiment of an automated reflex hammer from Figure 2.

[0021 ] Figure 3D depicts a bottom planar view of the embodiment of an automated reflex hammer from Figure 2.

[0022] Figure 4A depicts a rear perspective view of the embodiment of an automated reflex hammer from Figure 2 with a portion of the casing removed. [0023] Figure 4B depicts an isolated, close-up perspective view of an embodiment of a collar for use with the automated reflex hammer from Figure 2.

[0024] Figure 5A depicts a close-up rear perspective view of the embodiment of an automated reflex hammer from Figure 2 with a portion of the casing removed.

[0025] Figure 5B depicts a close-up front perspective view of the embodiment of an automated reflex hammer from Figure 2 with a portion of the casing removed.

[0026] Figure 5C depicts a close-up front elevation view of the embodiment of an automated reflex hammer from Figure 2 with a portion of the casing removed.

[0027] Figures 6A to 6E depict different embodiments of impulse generators for embodiments of automated reflex hammers.

[0028] Figure 7 depicts an embodiment of an automated reflex hammer in use to test the reflexes of a patient.

DETAILED DESCRIPTION OF EMBODIMENTS:

[0029] Reflex testing apparatuses and methods are provided. The apparatuses can be used to elicit deep tendon reflex responses from patients (animals and/or humans). In some embodiments, a mechanism on the handheld apparatus can allow a user to adjust an impulse in which the apparatus produces and a source of potential energy can be used to produce a desired impulse. The ability to control the impulse produced by the apparatus, or provided by the method, can provide the user with an ability to determine hypo-, normo-, or hyper-reflexic physiologic states of patients with an increased degree of consistency.

[0030] The reflex testing apparatuses and methods provided can have multiple purposes, for example (1 ) to decrease the inconsistency of the deep tendon reflex exam, (2) to modify the kinematics of impulse delivery so as to reduce the physical space required to deliver the impulse allowing for accurate DTR assessments to be performed in spatially constrained areas, (3) to quantify the impulse of the reflex test, and (4) to provide for a means to best appreciate hypo-, normo-, and hyper- reflexive patients in the clinical setting.

[0031 ] There are many possible mechanisms and construction methods that could be used to build an automated reflex hammer. Some embodiments of possible mechanisms are provided herein.

[0032] Referring now to Figure 1 , in some embodiments, apparatus 10 can comprise various components. Any combination of the various components is contemplated.

[0033] For example, an embodiment of apparatus 10 using a spring 42 based impulse generator 40, can include a fixed or an interchangeable hammer 20, a free-moving chamber 30, a tuning mechanism 50 selected from the group comprising a dial 52, a crank 56, or an electronic 58 mechanism, and an activation mechanism 60 selected from the group comprising a one-step mechanical, two-step mechanical, electronic sensor, electronic button, or electronic proximity sensor. [0034] An embodiment of apparatus 10 using an elastic 44 based impulse generator 40, can include a fixed or an interchangeable hammer 20, a free- moving chamber 30, a tuning mechanism 50 selected from the group comprising a dial 52, a crank 56, or an electronic 58 mechanism, and an activation mechanism 60 selected from the group comprising a one-step mechanical, two-step mechanical, electronic sensor, electronic button, or electronic proximity sensor.

[0035] An embodiment of apparatus 10 using a motor/engine 46 based impulse generator 40, can include a fixed or an interchangeable hammer 20, a free-moving chamber 30, a tuning mechanism 50 selected from the group comprising a dial 52, a crank 56, or an electronic 58 mechanism, and an activation mechanism 60 selected from the group comprising a one-step mechanical, two-step mechanical, electronic sensor, electronic button, or electronic proximity sensor.

[0036] An embodiment of apparatus 10 using a bow 48 based impulse generator 40, can include a fixed or an interchangeable hammer 20, a free- moving chamber 30, a tuning mechanism 50 selected from the group comprising a dial 52, a crank 56, or an electronic 58 mechanism, and an activation mechanism 60 selected from the group comprising a one-step mechanical, two-step mechanical, electronic sensor, electronic button, or electronic proximity sensor.

[0037] An embodiment of apparatus 10 using a hydraulic 49a based impulse generator 40, can include a fixed or an interchangeable hammer 20, a free- moving chamber 30, a tuning mechanism 50 selected from the group comprising a dial 52, a crank 56, or an electronic 58 mechanism, and an activation mechanism 60 selected from the group comprising a one-step mechanical, two-step mechanical, electronic sensor, electronic button, or electronic proximity sensor.

[0038] An embodiment of apparatus 10 using a pneumatic 49b based impulse generator 40, can include a fixed or an interchangeable hammer 20, a free- moving chamber 30, a tuning mechanism 50 selected from the group comprising a dial 52, a crank 56, or an electronic 58 mechanism, and an activation mechanism 60 selected from the group comprising a one-step mechanical, two-step mechanical, electronic sensor, electronic button, or electronic proximity sensor.

[0039] In some embodiments, apparatus 10 can include a hammer component where the hammer 20 of the mechanical reflex hammer apparatus 10 can be similar to current manual reflex hammers used by clinicians.

[0040] The hammer 20 can act as a means to store and release kinetic energy, for example, in a manner similar to a fly wheel. Kinetic energy can be injected into the hammer 20 as it accelerates under some driving force, for example, by an impulse generator 40 through a chamber 30. Once hammer 20 reaches a prescribed velocity (and has a desired amount of momentum), it can decouple, in some embodiments completely decouple, from the driving mechanism to allow hammer 20 to expel the kinetic energy into the target tissue. In cases where hammer 20 is still coupled to the driving mechanism, it is possible that some of the kinetic energy would not be delivered to the tissue. The hammer assembly 20 can include a hammer collar 22 and a hammer mass 24. The hammer collar 22 can be what couples the hammer mass 24 to a lever arm 26 during acceleration. In some embodiments, hammer collar 22 can be connected to lever arm 26 via collar pin 23. In some embodiments, the hammer mass 24 can decouple from driving mechanism and travel freely.

[0041 ] The hammer tip 28, can serve to control the rate of energy delivery and the surface area over which it is delivered to the target tissue. The tissue can be modeled as a spring and damper system with a stiffness that increases as a function of the affected surface area. An alternate way to look at this would be an array of springs (and dampers) configured in parallel. It follows that, the larger the surface area of the impulse, the larger the number of affected springs, and with more springs to resist the impulse, comes higher stiffness of the overall array. Accordingly, changing the shape of hammer tip 28 can not only affect the surface area over which the impulse is delivered, but by changing the local stiffness of the target tissue (increasing or decreasing the amount of tissue that resists the impulse and decelerates the hammer mass 24), the rate of energy transfer and consequently the shape/character of the impulse can be more accurately controlled.

[0042] The hammer 20 of the mechanical reflex apparatus 10 can contact the human body. The hammer 20 can have particular shapes and compositions. The most commonly used reflex hammer shapes are the Taylor™ and the Queen's Square™ although it would be apparent that other shapes could be used to still preform the same function. In some embodiments, the mechanical reflex hammer 10 can utilize a custom hammer shape, which can emulate that of both the Queen's Square™ and Taylor™. Similar to the Queen's Square™ it can have a longer flat shape, and similar to the Taylor™ it can have a pointed, narrow form near the tip. The composition of the hammer material can be important due to the impact it has on the human body. In some embodiments, a stiff composite rubber can be used due to it being stiff enough to elicit a reflex response consistently but not too stiff as to damage tissue on impact. It would be apparent that other compositions could be used to achieve the same function.

[0043] There are multiple possibilities for how the tip 28 can be set on the device 10, for example, tip 28 can be fixed or interchangeable. In fixed embodiments, tip 28 can be solidly attached to the device and is not removable. In these cases, there would be one type of tip per one automated reflex hammer. In interchangeable embodiments, a mechanism can be incorporated into apparatus 10 that can remove the hammer tips 28 providing that any potential tip can be added to the device 10. Some, but not all, potential tips include: Queen's Square™, Taylor™, Babinski™, Tromner™, and pediatric (smaller tip). Any combination or variation of shape between these various types is envisioned.

[0044] In some embodiments, apparatus 10 can include a chamber 30. Chamber 30 can allow the hammer 20 to move freely from the point of maximum kinetic energy, to the point of impact on the tissue. To emulate the free moving nature of the manual reflex hammer 20, chamber 30 can provide an environment of low friction and space to move. Chamber 30 can also allow for the free moving hammer 20 to impact the tissue without being manipulated by lever arm 26 of the force. If the lever arm 26 was attached to the hammer head, then the momentum could prevent the hammer 20 from bouncing off the tissue, and instead would press into the tissue until the impulse was completely released. The ability instead, to bounce off the tissue, is provided. [0045] In some embodiments, apparatus 10 can include an impulse generator 40 which can transmit a tunable force to the hammer assembly 20 as hammer 20 travels through the chamber 30. Different types of impulse generators or driving mechanisms could be used, for example a biasing means, a spring, elastic, motor/engine, bow, hydraulic/pneumatic mechanism, or any functional equivalent.

[0046] A spring 42 can be used to transmit a prescribed force to the hammer 20 as it travels through the chamber 30. A mechanism can be used to deform the spring 42 in order to create potential energy, hold spring 42 in its deformed state, and then release it with a trigger mechanism 60, for example, as described herein. After the trigger 60 is released, the spring 42 can exert a force onto the lever arm 26 of the apparatus 10 and through to the hammer 20. The hammer assembly 20, under the force of the spring 42, can slide through the chamber 30 until it comes into contact with an internal stopper 32 which can decouple the hammer mass 24 from the hammer assembly 20 allowing it to travel freely and without any other forces acting on it (except small friction forces) until impact with the tissue.

[0047] In some embodiments, an elastic 44 can be used in place of spring 42 described above, for generating the force. The elastic 44 can be stretched in order to create potential energy, which is then released by the trigger mechanism 60, and acts on the lever arm 26. The lever arm 26 can then slide on an internal track 34, until it comes into contact with an internal stopper 32 that releases the hammer 20 from being in contact with the lever arm 26, and sends the hammer 20 down the chamber 30, free-moving until impact with the tissue. [0048] In some embodiments, force can be generated by using a motor or an engine 46, to act on the lever arm 26 of the reflex hammer 20. The energy source can be from electricity or another fuel source. Depending on the setting placed onto the motor 46 by the setting or tuning mechanism 50, for example a dial 52, the motor 46 can have a differing impulse generation onto the lever arm 26. The lever arm 26 can then slide on an internal track 34, until it comes into contact with an internal stopper 32 that releases the hammer 20 from being in contact with the lever arm 26, and sends the hammer 20 down the chamber 30, free-moving until impact with the tissue.

[0049] In some embodiments, like a bow and arrow, a bow 48 can be used to initiate an force potential onto the hammer 20 head, by a lever arm 28. The bow 48 can be a material that is flexed out of its natural position in order to create an impulse potential. When released by the trigger mechanism 60, the bow 48 can be released from the potential position, and moves the lever arm 28 down an internal track 34, until it comes into contact with an internal stopper 32 that releases the hammer from being in contact with the lever arm 28, and sends the hammer 20 down the chamber 30, free-moving until impact with the tissue.

[0050] In some embodiments, by incorporating a mechanism in which a pressure differential is created using either a liquid or gaseous substance, the release of the mechanism 40 can cause the hammer 20 to go forth and strike the tissue. In some embodiments, the pressure differential can be created through manual pressure differential creation, including but not limited to a hand-pump or screw mechanism, or combination of the two. [0051 ] In some embodiments, apparatus 10 can include a setting or tuning mechanism 50. In some embodiments, setting or tuning mechanism 50 can comprise a dial 52. Dial 52 can be used by a user to tune the impulse output of the impulse generator 40. Setting or tuning mechanism 50 can allow the user to measure/record the amount of momentum that the hammer mass 24 will have prior to impact with the tissue and, in some embodiments, ultimately to quantify the impulse generated by the device 10. The setting or tuning mechanism 50 can be made of many types of materials and forms.

[0052] In some embodiments, dial 52 can be a rotary dial and can be used to manipulate the impulse output by the impulse generator 40. The dial 52 can be rotated by the user in relation to the main body 12 of the device 10. In some embodiments, rotating the dial 52 in one direction (e.g. clockwise) can increase the impulse generated, and rotating the dial 52 in the opposite direction (e.g. counter-clockwise) can decrease the impulse generated. It would be understood that setting or tuning mechanism 50 could be configured to rotate in the opposite directions to increase or decrease the impulse. Markings along dial 52 in relation to the main body 12 of the device 10 can indicate the impulse output setting by the impulse generator 40.

[0053] Depending on the type of impulse generator 40 employed, the dial 52 can be coupled via gears and/or other mechanical linkages 54 to a rotary crank 56. The crank 56 can serve to tune the output of the impulse generator 40 and the dial 52 would simply display the desired and/or resulting impulse value. This can be useful if a mechanical advantage is required to manage potentially impractical amounts of manual torque that may be required to tune/set the impulse generator 40. In this arrangement multiple rotations of the crank 56 can correspond to relatively small and precise movements of the dial 52.

[0054] In some embodiments, a display device, such as a screen or monitor 58, on the side of the apparatus 10 can display the impulse output setting to be created by the impulse generator 40. This screen 58 can be digital that displays numbers and words that communicate the settings. In some embodiments screen 58 can also provide displays of settings in forms other than digital screens, such as needle displays, bar graph displays, etc.

[0055] In some embodiments, apparatus 10 can include an activation mechanism 60, such as a trigger mechanism . The activation mechanism 60 can provide the means for a user to release the impulse generated by the impulse generator 40 at an appropriate time. Depending on the type of impulse generator 40 used, the activation mechanism 60 can also be used to store the required potential energy by applying manual force to deform a spring 42 and/or elastic 44 (this includes mechanical springs, pneumatic springs, magnetic springs, or any method by which a manual force is used to store potential energy in a physical system). In this way, the activation mechanism 60 can be a single motion trigger that re-loads in the same motion as the release of the trigger 62. When the trigger 62 is depressed, a trigger stopper can move out of the way of the lever arm 26, so that it can begin to travel down the internal track 34. In the same motion, a diverter, can redirect the trigger 62 to displace the lever arm 26 after impact with the internal stopper 32, which can subsequently reset the trigger 62 back into the loaded position. [0056] In some embodiments, a two-step trigger mechanism 60 can be used, which would require the user to depress the trigger 62 to release the impulse, and then manually reset the trigger 62 as well before using the device 10 again.

[0057] Referring now to Figure 2, a front perspective view of an embodiment of an automated reflex hammer 10 is depicted. Hammer mass 24 is shown above trigger 62 and between casing parts A and B 12a, 12b which can form main body 12. Figure 3A to 3D depicts the embodiment of an automated reflex hammer 10 from Figure 2 in different views.

[0058] Referring now to Figures 4a, 4b and Figures 5a, 5b, and 5c, the internal components of an embodiment of an automated reflex hammer 10 are shown. An embodiment of mechanical linkage 54 functionally connecting dial 52 and crank 56 is shown. Mechanical linkage 54 can comprise a dial spur gear 68, a worm 70 and corresponding worm gear 72 as well as a dial bevel gear 74 and worm bevel gear 76 in interacting arrangement. In some embodiments, mechanical linkage 54 can also comprise radial bearings 78.

[0059] Rotation of dial 52 at the bottom of apparatus 10 can provide for a tunable momentum. Rotation of dial 52 can activate gear assembly 54 attached to lever 26. The gear assembly 52 can include a worm gear 72 to ensure position changes are applied to the lever 26 and not back to the dial 52. The lever 26 can be activated through the compression of activation mechanism 60 that can bend the lever 26 only to the supplied calibrated momentum. At the top of apparatus 10, the hammer mechanism 20 can be attached to the lever 26 and can enable a free application of a momentum to a given tendon.

[0060] Referring now to Figures 6A to 6E, different embodiments of impulse generators are depicted for use in embodiments of automated reflex hammer 10.

[0061 ] Referring now to Figure 7, an embodiment of an automated reflex hammer 10 is depicted in use to test the reflexes of a patient. Certain embodiments of automated reflex hammer 10 can be useful where space is limited and the proximity is not conducive for a user to use a backswing and/or forward-swing of a traditional hammer in order to contact the patient's tissue. In some embodiments, automated reflex hammer 10 can be placed proximate patient's tissue and activated to produce an impulse and contact the patient's tissue with the hammer mass in order to test the patient's reflexes, without the need for a backswing and/or forward-swing.

[0062] Put another way, in operation, apparatus 10 can modify the kinematics of impulse delivery so as to reduce the physical space required to deliver the impulse allowing for accurate DTR assessments to be performed in spatially constrained areas. Apparatus 10 does not require the swinging motion of a traditional hammer, thus allowing the clinician to apply the impulse to a tendon that is difficult to otherwise access when needing to swing a hammer. Swinging a traditional hammer can take up a lot of space, whereas apparatus 10 does not require that swinging space.

[0063] A force, F, can be applied to a target tissue over some time, At. The integral of F with respect to time can be defined as the impulse and the resulting reflex response can be a function of impulse magnitude. Generally speaking, an impulse delivered to a mass can be equal to the change in its momentum. In the case of the hammer striking the target tissue, the momentum in the hammer mass after it strikes the tissue and is brought to rest is zero; therefore, the total momentum in the hammer mass can be equal to the impulse delivered to the tissue. For simplicity momentum can be herein synonymous with impulse. By adding a known quantity of momentum to a hammer of mass m, then allowing it to collide with a target tissue, it is possible to predict the impulse that is to be delivered to the target tissue in a quantifiable and highly repeatable manner. This method can be preferred over others which attempt to deliver a known force to the target tissue. It can be difficult to predict exactly how the tissue will dynamically absorb the energy that is delivered to it and therefore prohibitively challenging to devise a system that will deliver a prescribed force consistently without the use of dynamic feedback control. The current device and method can eliminate or ameliorate these complications while closely resembling an authentic, freely swinging, hammer hit as performed by a trained clinician.

[0064] In some embodiments, automated reflex hammer 10, can use/produce approximate impulse ranges of between, or around, 90-620 g*m/s. In some embodiments, automated reflex hammer 10, can have a hammer mass 24 of approximately 120g with a chamber 30 length of approximately, a lever arm 26 length of approximately 100mm, and a spring 42 stiffness of approximately twenty N*mm/deg. [0065] In some embodiments, a method of assessing the reflexes of a patient's deep tendon is provided. The method can include providing an automated reflex hammer having a hammer mass, setting the automated reflex hammer to a hammering impulse of a predetermined level, activating the release of the hammer mass from the automated reflex hammer proximate the individual's deep tendon, allowing the hammer mass to contact the individual's tendon with the hammering impulse to initiate at least one reflex, observing the individual's deep tendon reflexes, whereby the individual's deep tendon reflexes are assessed. In some embodiments, activating the release of the hammer mass can include triggering the release of the hammer mass.

[0066] The scope of the claims should not be limited by the embodiments as set forth in the examples herein, but should be given the broadest interpretation consistent with the description as a whole.

[0067] Although a few embodiments have been shown and described, it will be appreciated by those skilled in the art that various changes and modifications can be made to the embodiments described herein. The terms and expressions used in the above description have been used herein as terms of description and not of limitation, and there is no intention in the use of such terms and expressions of excluding equivalents of the features shown and described or portions thereof, it being recognized that the invention is defined and limited only by the claims that follow.

[0068] The teachings provided herein can be applied to other apparatuses and methods, not necessarily the apparatuses and methods described herein. The elements and acts of the various embodiments described above can be combined to provide further embodiments.

[0069] These and other changes can be made to the invention in light of the above description. While the above description details certain embodiments of the invention and describes certain embodiments, no matter how detailed the above appears in text, the invention can be practiced in many ways. Details of the method may vary considerably in their implementation details, while still being encompassed by the invention disclosed herein.

[0070] Particular terminology used when describing certain features or aspects of the invention should not be taken to imply that the terminology is being redefined herein to be restricted to any specific characteristics, features, or aspects of the invention with which that terminology is associated. In general, the terms used in the following claims should not be construed to limit the invention to the specific embodiments disclosed in the specification. Accordingly, the actual scope of the invention encompasses not only the disclosed embodiments, but also all equivalent ways of practicing or implementing the invention.

[0071 ] The above description of the embodiments of the invention is not intended to be exhaustive or to limit the invention to the precise form disclosed above or to the particular field of usage mentioned in this disclosure. While specific embodiments of, and examples for, the invention are described above for illustrative purposes, various equivalent modifications are possible within the scope of the invention, as those skilled in the relevant art will recognize. The elements and acts of the various embodiments described above can be combined to provide further embodiments.

[0072] While certain aspects of the invention are presented below in certain claim forms, the inventor contemplates the various aspects of the invention in any number of claim forms. Accordingly, the inventor reserves the right to add additional claims after filing the application to pursue such additional claim forms for other aspects of the invention.

REFERENCES:

[0073] The following references are hereby incorporated into this application by reference in their entirety.

[0074] 1 . Marshall, GL, Little, JW. Deep tendon reflexes: a study of quantitative methods. J Spinal Cord Med (2002). 25: 94-99.

[0075] 2. Electric reflex hammer. US 5657763 A, Application number US 08/436,834, Publication date 19 Aug 1997, Filing date 8 May 1995, Original Assignee, Nicolet Biomedical, Inc.

Claims

WE CLAIM:

1 . An apparatus for assessing reflexes of a patient's deep tendon, the apparatus comprising:

an activatable hammer for contacting the patient's deep tendon when activated;

an impulse generator, in communication with the activatable hammer when inactive, for providing an impulse to the activatable hammer to activate the activatable hammer; a tuning mechanism, in communication with the impulse generator, for setting the impulse provided by the impulse generator to a predetermined strength; and

an activation mechanism in communication with the impulse generator for releasing the impulse from the impulse generator thereby activating the hammer; wherein the reflexes of a patient's deep tendon are assessed by contacting the hammer to the patient's deep tendon and observing a reaction.

2. The apparatus of claim 1 wherein the activatable hammer is within a chamber.

3. The apparatus of either one of claim 1 or claim 2 wherein the activatable hammer comprises a hammer collar around a hammer mass having a hammer tip.

4. The apparatus of claim 3 wherein the hammer tip is selected from the group of hammer tips consisting of Queen's Square™, Taylor™, Babinski™, Tromner™, and pediatric.

5. The apparatus of either one of claim 3 or claim 4 wherein the hammer tip is fixed to the activatable hammer.

6. The apparatus of either one of claim 3 or claim 4 wherein the hammer tip is interchangeable and removable from the activatable hammer.

7. The apparatus of any one of claims 1 to 6 wherein the impulse generator is selected from the group consisting of a means for biasing, a spring, an elastic, a motor, an engine, a bow, a hydraulic mechanism, and a pneumatic mechanism.

8. The apparatus of any one of claims 1 to 7 wherein the setting mechanism comprises a dial for setting the strength of the impulse provided by the impulse generator by rotation.

9. The apparatus of any one of claims 1 to 8 wherein the activation mechanism comprises a trigger mechanism for releasing the impulse from the impulse generator to the activatable hammer.

10. The apparatus of claim 9 wherein the trigger mechanism comprises a one-step trigger mechanism comprising a trigger reload mechanism for reloading the trigger.

1 1 . The apparatus of claim 9 wherein the trigger mechanism comprises a two-step trigger mechanism.

12. The apparatus of any one of claims 1 to 8 wherein the activation mechanism comprises a sensor mechanism for releasing the impulse from the impulse generator to the activatable hammer.

13. The apparatus of any one of claims 1 to 12 further comprising a display device on the apparatus for displaying an impulse output setting to be created by the impulse generator.

14. A method of assessing the reflexes of a patient's deep tendon, the method comprising:

• providing an automated reflex hammer having a hammer mass;

• activating the release of the hammer mass from the automated reflex hammer proximate the individual's deep tendon;

• allowing the hammer mass to contact the individual's tendon with a hammering impulse to initiate at least one reflex;

• observing the individual's deep tendon reflexes;

whereby the individual's deep tendon reflexes are assessed.

15. The method of claim 14 further comprising previously setting the automated reflex hammer to a hammering impulse of a predetermined level.

16. The method of either one of claim 14 or 15 wherein activating the release of the hammer mass comprises triggering the release of the hammer mass.

17. A kit for eliciting deep tendon reflex responses from patients, the kit comprising the automated reflex hammer of any one of claims 1 to 13 and instructions for using the automated reflex hammer.

18. The kit of claim 17 further comprising interchangeable hammer tips.

19. The kit of either claim 17 or 18 further comprising replaceable hammer tips.

20. An automated reflex hammer substantially as herein described with reference to any one of the embodiments of the invention illustrated in the accompanying drawings and/or examples.

21 . A method of eliciting deep tendon reflex responses from patients with an automated reflex hammer substantially as herein described with reference to any one of the embodiments of the invention illustrated in the accompanying drawings and/or examples.

22. A kit for eliciting deep tendon reflex responses from patients with an automated reflex hammer substantially as herein described with reference to any one of the embodiments of the invention illustrated in the accompanying drawings and/or examples.