REFLEXES – Symmetrically diminished or absence of

The Reflex Arch reflexes may be found in normal

 Basic unit of integrated reflex activity individuals
• Use of reinforcement may be needed if:
 Consists of:
– Reflexes are diminished (or absent)
• Sense organ
– Isometric contractions of other muscles
• Afferent neuron
may increase reflex activity
• Central integration station
• Efferent neuron
• Example of Reinforcement:
• Effector
– Have patient gently contract muscle being
tested by raising the limb very slightly
Bell Magendie Law
• States that:
Reinforcement
– Dorsal roots are sensory
• Testing Arms:
– Ventral roots are motor
– Clench teeth
– Squeeze one thigh with opposite hand
The Stretch Reflex
• When a skeletal muscle with an intact nerve supply
• Testing Legs:
is stretched, it contracts.
– Lock fingers (pulling one hand against the
• Typified by the knee jerk reflex
other)
The Withdrawal Reflex
The Reflexes (Adult)
• Typical response to a painful stimulation of the skin
Biceps Reflex
or subcutaneous tissues and muscles
• Prepotent (pre-empts other reflex activities taking  C5, C6
place at the moment)  Arm should be partially flexed at the elbow with
- Similar to an override palm down
- Increases chance of survival (or getting away  Strike aimed directly through your digit toward the
from nociceptive stimuli) biceps tendon
• Characterized by:  Observe for flexion at the elbow
– Contraction (flexor muscles)  Watch and feel for the contraction of biceps
– Inhibition (extensor muscles) muscle
– Extension of opposite limb (crossed
extensor response) Triceps Reflex
 C7, C8
Measuring Reflex (Degree of Activity)  Flex arm at the elbow, with palm towards the body
 Pull it slightly across the chest
Grading the Reflex  If with difficulty getting patient relax, try supporting
+5 Sustained contraction (Tetany) the arm
+4 Maximum activity (hyperactive)  Triceps muscle, extension at the elbow
+3 More active than normal Supinator (or Brachioradialis) Reflex
+2 Normal response  C5, C6
+1 Minimal activity (hypoactive)  Hand should rest on the abdomen or the lap
0 No reflex response  With the forearm partly pronated
 Strike radius about 1 to 2 inches above the wrist
• Deep Tendon Reflexes:
 Watch for flexion and supination of the forearm
– +1, +2, +3 (normal unless asymetric or drastic
Abdominal Reflex
difference between arms and legs appears)
– 0, +4, +5 (abnormal)  T8, T9, T10, T11, T12
 Elicit reflex by lightly but briskly stroking each side
of the abdomen above and below the umbilicus
Abnormalities in Reflexes  Use key, wooden end of cotton applicator, tongue
• Hyperactive blade twisted and split longitudinally
– Suggests CNS disease  Above the umbilicus (T8, T9, T10)
– Sustained clonus confirms it  Below the umbilicus (T10, T11, T12)
• Diminished or Absent  Note contraction of the abdominal muscle and
– Relevant spinal segment damage deviation of umbilicus towards the stimulus
– Peripheral nerve damage  Obesity may mask an abdominal reflex
– Muscle disease Knee (or Patellar) Reflex
– Neuromuscular junction problems  L2, L3, L4
 Patient may be either sitting or lying down as long
The Deep Tendon Reflexes as the knee is flexed.
• Principles:  Briskly tap the patellar tendon
– Use just enough force needed to provoke  A hand on the patient’s anterior thigh lets you feel
a definite response this reflex
– Differences between sides are usually  Note contraction of the quadriceps with extension
easier to assess than symmetric changes at the knee
Ankle Reflex Plantar reflex
 Primarily S1  Similar to the palmar grasp reflex, an object placed
 If patient is sitting, dorsiflex the foot at the ankle just beneath the toes causes them to curl around
 If the patient is lying down, flex one leg at both hip it.
and knee and rotate it externally so that the lower  Disappears after 8 mos.
leg rests across the opposite shin. Tonic Neck (or Fencing) reflex
 Strike the Achilles tendon  A postural reflex.
 Watch and feel for plantar flexion at the ankle  When a baby who is lying on its back turns its
 Note speed of relaxation head to the right side, for example, the left side of
 Slowed relaxation phase of reflexes in the body shows a flexing of the left arm and the left
hypothyroidism is often easily seen and felt in the leg.
ankle reflex.  Disappears after 4 mos.
Plantar Response Stepping (or Walking/Dancing) reflex
 L5, S1  Hold the baby upright so that the feet touch a flat
 Elicit reflex by stroking the lateral aspect of the surface.
sole  The legs then move up and down as if the baby
 From heel to the ball of the foot, curving medially were walking.
across the ball  Disappears after 2 mos.
 Use pointed object in stroking Babinski reflex
 Inverted “J” stroke  Sole of the foot is stroked, the big toe rises and the
other toes fan out.
Further Testing  (+) Babinski
• If reflexes are hyperactive, test for ankle clonus  After age 1, the infant exhibits a (-) Babinski,
• Testing for clonus: -toes curl downward.
• Support knee in partially flexed position  (+) Babinski after age 1 indicates brain damage.
• Dorsiflex and plantarflex foot alternately a Blinking reflex
few times (using your other hand)  Occurs in the presence of light or loud noise
• Then sharply dorsiflex foot and maintain it Neck Righting reflex
 Head turned to side where body is rotated
Clonus Landau reflex
• Look and feel for rhythmic oscillations between  Suspend horizontally against trunk and neck
dorsiflexion and plantar flexion. flexed, leg will flex and be drawn up to the trunk.
• In most normal people, ankle does not react to this Parachute reflex
stimulus.  Baby is held prone and lowered quickly towards a
-A few clonic beats may be seen and felt, surface
especially when the patient is tense or  Arms and legs will extend
has exercised.
• Sustained clonus indicate CNS disease.

The Newborn Reflexes

Sucking reflex
 A feeding reflex that occurs when the infant’s lips
are touched.
 Persists throughout infancy.
Rooting reflex
 A feeding reflex elicited by touching the baby’s
cheek causing the baby’s head to turn to the side
that was touched.
 Disappears after 4 months.
Moro (or Startle) reflex
 Often assessed to estimate the maturity of the
CNS.
 A loud noise, a sudden change in position, an
abrupt jarring of the crib elicits this reflex.
 The infant reacts by extending both arms and legs
outward with the fingers spread, then suddenly
retracting the limbs.
 Often the infant cries at the same time.
 Disappears after 4 mos.
Palmar Grasp reflex
 Occurs when a small object is placed against the
palm of the hand, causing the fingers to curl
around it.
 Disappears after 3 mos.