Practice evoking the flexor carpi radialis h-reflex: a guideline for proficiency

The purpose of this research was to identify the number of sessions required for a new investigator to become proficient at evoking an H-reflex in the flexor carpi radialis (FCR), in comparison to an experienced investigator. 31 students from Brock University in the greater Niagara region (16 women M age = 32.2, SD = 8.9 yr.; 15 men M age = 27.8, SD = 7.8 yr.) with no known neurological disorders volunteered and completed two test sessions performed by either an experienced or a novice investigator. In randomized order, both investigators stimulated each subject's median nerve 10 times, once every 15 sec. Each session included the measurement of the subject's flexor carpi radialis maximal M-wave amplitude and H-reflex amplitude and latency with surface electromyographic electrodes. The intraclass correlation coefficients (ICC) indicated an adequate correlation between investigators for both M-wave maximal amplitude and H-reflex at 5% of the M-wave maximal amplitude (.84 and .70, respectively). However, there was a low correlation (.38) between the latency values obtained by the two investigators. The peak-to-peak amplitudes of the H-reflex and M-wave do not appear to be influenced by experience of the tester. The latency of the response, however, appears to have an associated learning curve, improving in consistency with increasing practice of tester.