REFLEXES - Hold handle of the reflex hammer between

- Are involuntary, almost instantaneous index and thumb

movements in response to a specific - Palpate the tendon that you will need to
stimulus strike
- Tap the tendon, not the muscle or bone
• Monosynaptic – one motor, one
sensory DEEP TENDON REFLEXES
• Polysynaptic 1+ to 3+ are still considered normal)
- Clinical classification - 0 = NR
• SUPERFICIAL REFLEXES - 1+ = diminished
- 2+ = normal
o Initiated by stimulating skin
- 3+ = brisk, above normal
or mucous membranes
- 4+ = hyperactive
involving moving away from
the receptor BICEPS REFLEX
o E.g., nociceptor - Evaluates function of spinal levels C5 and C6
• DEEP REFLEXES - Biceps tendon
- Normal: Flexion and contraction of biceps
o Stimulating receptor deep in
muscle
muscles (Stretch reflexes,
tendon reflexes) TRICEPS REFLEX
o E.g., knee jerk, ankle jerk - Evaluates function of spinal levels (C6 & C7)
• VISCERAL REFLEXES - Tap the tendon above the olecranon process
- Normal: Elbow extends
o At least one part of the reflex
arc is autonomic nerve, BRACHIORADIALIS
stimulates receptors in - C5 & C6
viscera - Forearm flexes and supinates
o E.g., pupillary reflex, carotid PATELLAR/KNEE JERK
sinus reflex - L2, L3, L4
• PATHOLOGICAL REFLEXES - Patellar tendon
o Are not usually present - Normal: Knee extends, quadriceps muscle
o Presence indicates contracts
pathological condition ACHILLES REFLEX
o E.g., Babinski’s Sign - S1, S2
• May indicate - Achilles tendon
upper/lower motor - Normal: Plantar flexion of the foot
lesion
ANKLE CLANUS TESTING
- Reflect integrity of the reflex at specific
spinal levels and cerebral cortex function (HYPERREFLEXIA)
- Approach - Dorsiflex foot toward the client’s head
• Done last - Normal: No rapid contraction or oscillation
• Patient in sitting position (clonus) of the ankle
• Limbs to be tested should be relaxed, - Abnormal: Repeated rapid contractions or
partially stretched oscillations of ankle and calf muscle (lesions
o Clenching teeth, humming, of upper motor neurons)
counting ceiling blocks, PLANTAR/BABINSKI REFLEX
interlocking of hands - L5, S1
REFLEX HAMMER - Lateral aspect of the sole from heel to the
ball of the foot
 -Normal: Flexion of the toes • Pain and increased resistance to
-Abnormal: Extension (dorsiflexion) of the big extending the knee
toe and fanning of all toes • Bilateral = meningeal irritation
• Normal in children 2 >
• Lesions of UMN, drug and alcohol
intoxication, brain injury, subsequent
epileptic seizure
- Indicates meningeal irritation
ABDOMINAL REFLEXES
- Upper: T8, T9, T10
- Lower: T10, T11, T12
- Normal: Abdominal muscles contract,
umbilicus deviates toward the side being
stimulated
- Abnormal: Absent
EVALUATION
- Hyperreflexia = UMN lesion
- Hyporeflexia = LMN lesion
- Clonus = severe hyperreflexia
• Repeated rhythmic contraction
elicited by striking a tendon or
dorsiflexing the ankle

TEST FOR MENINGEAL IRRITATION OR

INFLAMMATION
- Normal: Supple neck, easily bend head and
neck forward
- Abnormal: Nuchal rigidity
• Pain in the neck
• Resistance to flexion
• Meningeal irritation, arthritis or neck
injury
BRUDZINSKI SIGN
- Flex the neck while watching the hips and
knees
- Normal: Remain relax and motionless
- Abnormal: Pain and flexion of hips and knees
KERNIG’S SIGN
- Flex patient’s leg at both the hip and knee,
then straighten the knee
- Normal:
• Discomfort behind the knee during
full extension
• No pain is felt
- Abnormal: