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Standardization of Neuromuscular Reflex Analysis -- Role of Fine-Tuned Vision-Language Model Consortium and OpenAI gpt-oss Reasoning LLM Enabled Decision Support System

Accurate assessment of neuromuscular reflexes, such as the H-reflex, plays a critical role in sports science, rehabilitation, and clinical neurology. Traditional analysis of H-reflex EMG waveforms is subject to variability and interpretation bias among clinicians and researchers, limiting reliability and standardization. To address these challenges, we propose a Fine-Tuned Vision-Language Model (VLM) Consortium and a reasoning Large-Language Model (LLM)-enabled Decision Support System for automated H-reflex waveform interpretation and diagnosis. Our approach leverages multiple VLMs, each fine-tuned on curated datasets of H-reflex EMG waveform images annotated with clinical observations, recovery timelines, and athlete metadata. These models are capable of extracting key electrophysiological features and predicting neuromuscular states, including fatigue, injury, and recovery, directly from EMG images and contextual metadata. Diagnostic outputs from the VLM consortium are aggregated using a consensus-based method and refined by a specialized reasoning LLM, which ensures robust, transparent, and explainable decision support for clinicians and sports scientists. The end-to-end platform orchestrates seamless communication between the VLM ensemble and the reasoning LLM, integrating prompt engineering strategies and automated reasoning workflows using LLM Agents. Experimental results demonstrate that this hybrid system delivers highly accurate, consistent, and interpretable H-reflex assessments, significantly advancing the automation and standardization of neuromuscular diagnostics. To our knowledge, this work represents the first integration of a fine-tuned VLM consortium with a reasoning LLM for image-based H-reflex analysis, laying the foundation for next-generation AI-assisted neuromuscular assessment and athlete monitoring platforms.

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