Taylor Hammer-Lanska Edition
Dr. Douglas Lanska, Tomah VA Medical Center
Because of his expertise on the history of neurologic technologies, and on reflex hammers in particular, Dr. Douglas Lanska of the Tomah VA Medical Center in Wisconsin was consulted by the American Academy of Neurology (AAN) to redesign the Taylor reflex hammer.
The Taylor reflex hammer was originally designed by American neurologist J. Madison Taylor in 1888 and was the first tool specifically developed to elicit reflexes. It had a distinctly American design compared to earlier European chest percussion hammers. The Taylor hammer was subsequently praised and popularized by many of the founding fathers of American neurology, including S. Weir Mitchell, who used it in his neurological assessments of Civil War veterans, and Charles Mills, who considered it “the best hammer for tapping the much-abused patellar ligament.” It was later incorporated into the original logo of the American Academy of Neurology more than a half century ago.
According to Lanska, most reflex hammers currently available are underweighted and too short to be effective at eliciting the full range of reflex responses, particularly for eliciting depressed reflexes. “Most hammers are cheaply made models often distributed by pharmaceutical companies as promotional items. These appeal to medical students because of their low cost and the ease with which they can be carried in a pocket. Experienced neurologists, however, tend to favor heavier and better-made models of German or British hammers designed nearly a century ago.”
Dr. Lanska was determined to create a new, high-quality version of Taylor hammer that would be useful to modern neurologically oriented clinicians. The general shapes of the head and the handle have been preserved. The hammer has been reweighted with a much heavier head, and has been provided with soft rubber striking surfaces and a longer, high-quality-metal shaft. The new hammer weighs approximately 180 grams, comparable to that of a high-quality modern Trömner hammer, rather than the 55-60 gram weight of typical commercial models.
“We went through at least half-dozen iterations between the engineers, the machinists, and myself with about a dozen prototypes,” said Dr. Lanska. All of the prototypes were tested at the bedside and compared for overall feel and appearance, convenience, ease of use, and effectiveness in eliciting reflexes. Interestingly, this was a process very much like that which Taylor had utilized in the 1880s when he worked with a medical instrument manufacturer in Philadelphia.
Dr. Lanska noted that the Taylor hammer is held and swung differently from other reflex hammers. In use, the Taylor hammer should be held between the thumb and index finger at an enlarged and scalloped portion of the shaft opposite the head, so that the hammer swings or pivots at this point prior to (and after) striking a tendon. This whip-like technique effectively increases the force on the tendon, and decreases the time of contact, so that when properly used the hammer functions like a hammer with an even longer shaft or heavier head. This is the only reflex hammer available with this design, the rest being held in a fisted hand like a conventional hammer. Still the Taylor hammer has only a moderate weight, and easily fits in pocket of a lab coat unlike the unwieldy Queen Square hammer.
Dr. Lanska's new reflex hammer has been named the "Taylor hammer – Lanska edition" by the American Academy of Neurology in his honor, and was highlighted in the American Academy of Neurology in their 2010 and 2011 catalogues, in the "AAN News" in December 2009, and at their annual meeting in Toronto in April 2010.
“I hope neurologists and other neurologically oriented clinicians will find this new model of the Taylor hammer to be both convenient and useful in performing the neurologic examination,” said Dr. Lanska. “It carries special significance as an updated version of the original reflex hammer and the iconic hammer of the American Academy of Neurology.”
Dr. Lanska also helped design a new and improved Queen Square hammer for AAN which debuted at the 2011 Annual meeting in Honolulu, Hawaii. Both are signature products for the academy. Further information on the history of reflex hammers, and the Taylor hammer in particular, can be found in some of Dr. Lanska's publications.
Lanska DJ. The history of reflex hammers. Neurology 1989;39:1542-1549.
Lanska DJ, Lanska MJ. John Madison Taylor (1855-1931) and the first reflex hammer. J Child Neurol 1990; 5:38-39.
This story first appeared in the July/August 2010 edition of the Vanguard magazine.
