Practical Physiology

REFLEXES

Prepared and presented By Dr. Mohammed chyad Al-Noaemi

NERVOUS SYSTEM
Reflex, is an involuntary and nearly instantaneous movement in response to a stimulus. Monosynaptic Reflex as stretch reflexes (knee jerk reflex). Multisynaptic Reflex as withdrawal reflex (nociceptive R.) Types of Reflexes: Superficial Reflexes. Deep Reflexes. Eye Reflexes.

1. 2. 3.

Superficial Reflexes

Abdominal reflexes (T6-L1) Plantar reflex or Babinski reflex (L5, S1, S2) Anocutaneous reflex (S2-S4) Cremasteric reflex (L1-L2)

Abdominal Reflex (T6-L1)

Plantar reflex or Babinski reflex (L5, S1, S2) In normal adults the plantar reflex causes a downward response of the hallux (flexion). An upward response (extension) of the hallux is known as, Babinski response or Babinski sign, Its presence can identify disease of the spinal cord and brain in adult and also exists as a primitive reflex in infants

Plantar reflex or Babinski reflex (L5, S1, S2)

The lateral side of the sole of the foot is rubbed with a blunt instrument or device so as not to cause pain, discomfort, or injury to the skin; the instrument is run from the heel along a curve to the toes.

Plantar reflex or Babinski reflex (L5, S1, S2)

Babinski's Sign in a healthy newborn Pathological Babinski's sign in adult

Plantar reflex or Babinski reflex (L5, S1, S2)

Adult
Abnormal

Normal

Infant Normal

Cremasteric Reflex (L1-L2)

The cremasteric reflex is a superficial reflex observed in human males. This reflex is elicited by lightly stroking the superior and medial (inner) part of the thigh. The normal response is a contraction of the cremaster muscle that pulls up the scrotum and testis on the side stroked.

Stretch reflexes (Monosynaptic Reflexs)

The stretch reflexes (often called deep tendon reflexes). Generally, decreased reflexes indicate a peripheral problem (PNS), and lively or exaggerated reflexes a central problem (CNS). Biceps reflex (C5, C6) Brachioradialis reflex (C5, C6, C7) Extensor digitorum reflex (C6, C7) Triceps reflex (C6, C7, C8) Patellar reflex or knee-jerk reflex L2, L3, L4) Ankle jerk reflex (Achilles reflex) (S1, S2)

Stretch reflexes (Monosynaptic Reflexs)

Patellar reflex or knee-jerk reflex (L2, L3, L4)

Patellar reflex or knee-jerk reflex (L2, L3, L4)

Patellar reflex or knee-jerk reflex (L2, L3, L4)

Patellar reflex or knee-jerk reflex (L2, L3, L4)

Patellar reflex or knee-jerk reflex (L2, L3, L4)

Ankle jerk reflex (Achilles reflex) (S1, S2)

Triceps Reflex

Neuro-Brachial-Radialis Reflex

Supination Reflex

The jaw jerk reflex or the masseter reflex

is a reflex used to test the status of a patient's trigeminal nerve (CN V). The mandibleor lower jawis tapped at a downward angle just below the lips at the chin while the mouth is held slightly open. In response, the masseter muscles will jerk the mandible upwards. Normally this reflex is absent or very slight. However in individuals with upper motor neuron lesions the jaw jerk reflex can be quite pronounced

Withdrawal reflex (nociceptive or flexor withdrawal R.)

is a spinal reflex intended to protect the body from damaging stimuli. A classic example is when a person touches something hot and withdraws their hand from the hot object without thinking about it. The heat stimulates temperature and pain receptors in the skin, triggering a sensory impulse that travels to the central nervous system. The sensory neuron then synapses with interneurons that connect to motor neurons.

Vestibuloocular reflex
is a reflex eye movement that stabilizes images on the retina during head movement by producing an eye movement in the direction opposite to head movement, thus preserving the image on the center of the visual field. For example, when the head moves to the right, the eyes move to the left, and vice versa

Vestibuloocular reflex

Withdrawal reflex (cont.)

Some of these send motor impulses to the flexors to allow withdrawal; some motor neurons send inhibitory impulses to the extensors so flexion is not inhibited - this is referred to as reciprocal innervation. While all of this occurs, other interneurons relay the sensory information up to the brain so that the person becomes aware of the pain and what happened

Withdrawal reflex (cont.)

Crossed Extensor reflex

Crossed extensor reflex is a withdrawal reflex. When the reflex occurs the flexors in the withdrawing limb contract and the extensors relax, while in the other limb, the opposite occurs. An example of this is when a person steps on a nail, the leg that is stepping on the nail pulls away, while the other leg takes the weight of the whole body

Crossed extension reflex following withdrawal reflex

Crossed extension reflex following withdrawal reflex

Once a pain receptor has been stimulated, the signal travels via the sensory nerve to the posterior horn of the spinal cord. The nerve synapses with ipsilateral motor neurons that exit the anterior horn of the spinal cord and work to pull the injured body part away from danger. At the same time the sensory neuron synapses with the ipsilateral motor neuron, it also synapses with the motor neuron in the contralateral anterior horn. This motor neuron stabilizes the

Crossed extension reflex following withdrawal reflex

cont.

This motor neuron stabilizes the uninjured side of the body (for instance, preparing the opposite leg to support the entire body weight when the other foot has stepped on a tack). At the same time as these two synapses, the sensory neuron also sends signals up the spinal cord to get motor neurons to contract muscles that shift the center of gravity of the body to maintain balance. This contralateral stimulation of motor neurons to stabilize the body is called the crossed extension reflex, and is a result of the withdrawal reflex (usually in the lower extremities

Grading

In medicine, reflexes are often used to assess the health of the central nervous system. Doctors will typically grade the activity of a reflex on a scale from 0 to 4: Grade Description 0 Absent 1+ or + Hypoactive 2+ or ++ "Normal" 3+ or +++ Hyperactive without clonus 4+ or ++++ Hyperactive with clonus

Eye Reflexes

1. Conjunctiva Reflex. 2. Pupillary Light Reflex. 3. Accommodation Reflex (Convergence reflex). 4. Vestibulo-ocular reflex.

Blink Reflex (CR: V&VII)

(Corneal reflex), (conjunctiva reflex). Blinking of both eyes when the cornea of either eye is touched, to protect the eye. it is an involuntary blinking of the eyelids elicited by stimulation (such as touching of a foreign body) of the cornea. Stimulation should elicit both a direct and consensual response (response of the opposite eye). The reflex consumes a rapid rate of 0.1 second. The blink reflex also occurs when sounds greater than 40-60 dB are made

Accommodation Reflex

It is a reflex action of the eye, in response to focusing on a near object, then looking at distant object (and vice versa), comprising coordinated changes in vergence, lens shape and pupil size. It is dependent on cranial nerve II (afferent limb of reflex), superior centres and cranial nerve III.

Accommodation to near vision Convergence of eyes Pupillary constriction Increase lens convexity.

Accommodation Reflex

Light from a single point of a distant object and light from a single point of a near object being brought to a focus.

is a reflex that controls the diameter of the pupil, in response to the intensity (luminance) of light that falls on the retina of the eye, thereby assisting in adaptation to various levels of darkness and light, in addition to retinal sensitivity. Greater intensity light causes the pupil to become smaller (allowing less light in), whereas lower intensity light causes the pupil to become larger (allowing more light in). Thus, the pupillary light reflex regulates the intensity of light entering the eye

The Pupillary Light Reflex (C.R.II&III)

Pupillary Light Reflex

pupillary light reflex. When the light is turned on, the pupil reacts by constricting

Pupillary Light Refelex

Under normal conditions, the pupils of both eyes respond identically to a light stimulus, regardless of which eye is being stimulated. Light entering one eye produces a constriction of the pupil of that eye, the direct response, as well as a constriction of the pupil of the unstimulated eye, the consensual response. Comparing these two responses in both eyes is helpful in locating a lesion

Vestibulo-ocular reflex
Movement of the eyes to the right when the head is rotated to the left, and vice versa

Reflexes involving cranial nerves

Name Pupillary light reflex Accommodation reflex Jaw jerk reflex Corneal reflex, (blink reflex) Vestibulo-ocular reflex Gag reflex

Sensory II II V V VIII IX

Motor III III V VII III, IV, VI X

Reflexes usually only observed in human infants

Newborn babies have a number of other reflexes which are not seen in adults, referred to as primitive reflexes. These include: Tonic neck reflex (TNR) Grasp reflex Hand-to-mouth reflex Moro reflex, also known as the startle reflex Rooting reflex Sucking

Grasp reflex

Tonic neck reflex (TNR)

is a primitive reflex found in newborn humans, but normally vanishes around six months of age. When the face is turned to one side, the arm and leg on the side to which the face is turned extend and the arm and leg on the opposite side bend.

Tonic Neck Reflex

Moro Reflex

It is normally present in all infants/newborns up to 4 or 5 months of age, and its absence indicates a profound disorder of the motor system. An absent or inadequate Moro response on one side is found in infants with hemiplegia, brachial plexus palsy, or a fractured clavicle. Persistence of the Moro response beyond 4 or 5 months of age is noted only in infants with severe neurological defects. It was discovered and first described by Austrian pediatrician Ernst Moro (1874-1951).

Moro reflex

This reflex is a response to unexpected loud noise or when the infant feels like it is falling. It is believed to be the only unlearned fear in human newborns

Moro Reflex

Rooting reflex

The rooting reflex is present at birth; it assists in breastfeeding, disappearing at around four months of age as it gradually comes under voluntary control. A newborn infant will turn his head toward anything that strokes his cheek or mouth, searching for the object by moving his head in steadily decreasing arcs until the object is found. After becoming used to responding in this way (if breastfed, approximately three weeks after birth), the infant will move directly to the object without searching

Rooting reflex

Sucking reflex

The sucking reflex is common to all mammals and is present at birth. It is linked with the rooting reflex and breastfeeding, and causes the child to instinctively suck at anything that touches the roof of their mouth and suddenly starts to suck simulating the way they naturally eat. There are two stages to the action: Expressio: activated when the nipple is placed between a child's lips and touches their palate. They will instinctively press it between their tongue and palate to draw out the milk.

Babkin Reflex
the application of pressure to both palms. Infants may display head flexion, head rotation or opening of the mouth, or a combination of these responses.

Walking/stepping reflex

The walking or stepping reflex is present at birth; though infants this young can not support their own weight, when the soles of their feet touch a flat surface they will attempt to 'walk' by placing one foot in front of the other

http://www.youtube.com/watch?feature=player _detailpage&v=BEQ6BbLLucA