Three-dimensional vector graphing of the H reflex

Comparison of latencies of the H reflex from side-to-side is considered a valid indicator of pathology, but amplitudes are too variable to allow similar comparison. Three pairs of electrodes were placed circumferentially and longitudinally along the calf to record the H reflex in three axes simultaneously. An H reflex with the greatest amplitude was produced by incrementally increasing submaximal stimulation to the tibial nerve. Three-dimensional vector graphs were constructed at three levels in each calf in ten normal individuals. Best fit curve Procrustes statistical analysis showed an average of 82.2 to 90.6% agreement of 3-D shape left-to-right with greater agreement at distal levels. Standard deviation ranged from 11.3% proximally to 8.2% distally. This represents much closer agreement than established norms for amplitude, which can vary from two to four times side-to-side. Three-dimensional vector analysis holds promise to further understanding of peripheral and central electrophysiologic phenomena.