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The H-Reflex


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Stephanie McDonough's Presentation on a surgical modality used during her clinical rotation in the ENDT program.

Published in: Health & Medicine
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The H-Reflex

  1. 1. The H-Reflex and Its Clinical Utility in the Operating Room in Conjunction with Normal Somatosensory Evoked Potentials By Stephanie McDonough
  2. 2. Introduction: Statement of Purpose This paper was written for the Neurophysiological technicians of Neuro IOM Services to state the feasibility of the H-Reflex in the operating room, and tell why it is of consequential qualitative and quantitative diagnostic value.
  3. 3. Statement of Importance <ul><li>The importance of this research is creating a clear and understandable support to using the H-Reflex routinely by Neurophysiological Technologists and give the monitorists a strong understanding as to the reasoning of what they are doing. </li></ul>
  4. 4. Statement of Research Question <ul><li>This paper set out to answer the question of whether or not the H-Reflex was of diagnostic value to Intraoperative Neuro Monitoring during lumbar procedures. </li></ul>
  5. 5. What is the H-Reflex? <ul><li>The H-Reflex or Hoffman Reflex is a neurophysiological reflex all humans have at birth. All joints when stimulated have this “jerk” and it sends out a particular waveform when hooked up to Neuromonitoring equipment. </li></ul>
  6. 6. The H-Reflex Continued <ul><li>This reflex is a motor function and takes about 40-60% of your spinal cords motor section to perform it. </li></ul><ul><li>It is present in adulthood in the major limbs of the body. </li></ul>
  7. 7. A little more… <ul><li>In traditional monitoring we do what is called an MEP or Motor Evoked Potential. This is highly uncomfortably to not only the patient (has jerked patient so hard can break teeth) but also to the surgeon since he must leave his sterile field when it is performed. </li></ul>
  8. 8. MEP’s Continued <ul><li>These also only use 5-7% of your motor spinal cord function and therefore are less complete of a picture of what is going on inside you. </li></ul><ul><li>The more we monitor the more we see! </li></ul>
  9. 9. Research Methods <ul><li>This was researched through a series of interviews with Technologists familiar with the H-Reflex, survey of all technologists and their personal feelings on its clinical usefulness, interview with a Neurosurgeon and Nurse Anesthetist and through field research. </li></ul>
  10. 10. Field Research <ul><li>The field research included tests run by the author and those working with the author during operations. Scans of consideration were taken to further show the effectiveness of showing motor responses of the spinal cord during surgery. </li></ul>
  11. 11. Field Research Continued <ul><li>Normally, the motor function of your spinal cord is not routinely monitored due to the severity of the procedure to perform it. Usually only the sensory function is monitored for ease of use. </li></ul>
  12. 12. Data <ul><li>The data showed that when there was a drop in the patient’s sensory pathways that there were correlational drops in the motor pathways as shown by the H-Reflex. </li></ul>
  13. 13. More Data <ul><li>Survey and interview showed that not only did surgeon’s want the H-Reflex performed, but almost demanded that extra information be given to them to assist them in their patient care. </li></ul>
  14. 14. And More Data <ul><li>Also it was shown that the majority of technologists felt that when they used the H-Reflex, it correlated to their other data being gathered. </li></ul>
  15. 15. Conclusions <ul><li>Since the H-Reflex could continuously be monitored due to its non invasive nature, the surgeon is provided with a more complete picture of how the spinal cord is holding up during surgery. </li></ul><ul><li>This helps patient outcome and helps the monitorist warn the surgeon of any negative changes. </li></ul>
  16. 16. What I Learned <ul><li>Through this research I learned the value of drawing upon others knowledge and also the value of seeing the raw data yourself and being able to draw conclusions on your own experience. </li></ul><ul><li>Overall I found this to be extremely useful to me as a future monitorist in the field. </li></ul>