1.

Unlike extremity reflexes which use muscle spindles to trigger the response,
most superficial reflexes are ____extraoceptive____ reflexes, provoked by
____pain, temperature, light touch_____
stimuli to a localized area of ___skin, mucous membrane__________.

2. Are superficial reflexes graded? What term is used to describe the

superficial reflexes?
Present or Absent

3. What type of problem is it when the superficial reflexes are absent

bilaterally?
UMNL

4. What type of problem is in when the superficial reflexes are absent

unilaterally?
LMNL

Case study 1

Jack is a 40-year-old labourer who has decided to change his career. He has
decided to enroll into University and has been undertaking his studies now for
around two years. Jack now presents to you with headaches which seem to be
worse with studying. Upon taking the case history, he mentions his mother suffers
the same problem

ASSUME ALL OTHER EXAMINATION AND CASE HISTORY FINDINGS ARE

UNREMARKABLE.

Jack has been diagnosed with tension headaches.

1. List the statements (clues) in the case history that aligns with the
diagnosis of tension headaches. Use the script concordance. (Found in
Moodle)
a. 40 year old male (degeneration of IVD or IVF) -1
b. Mum has same problem 0
c. University study 2 years (forward head position = reading, computer
work) +1
d. H/A worse with studying (concentration clench of jaw) +2
2. The above case history is incomplete. What further questions or what
information would you need to acquire?
a. Can you describe the location of H/A pain?
b. When did the H/A start?
 c. How long do the H/A last for?
d. It has gotten worse, when did it start to get worse?
e. Can you describe the quality of pain?
f. Does the H/A pain refer anywhere?
g. Is studying the only thing which aggravates the H/A pain?
h. Does anything relieve the pain?
i. Has this happened to you before on gone away?
j. Have you had any treatment for this condition before?
k. Are there any other issues which you are experiencing right now?
l. On average how long were the study sessions?
m. Is your laptop/computer screen in your eyeline or do you have to look
down to use it?
n. Do you still do any laboring work? Or full-time student?
3. List the muscles (trigger points that are likely to refer pain to the head
leading to tension headaches?
a. Masseter
b. Pterygoid (Lateral and Medial)
c. Temporalis
d. Splenius Capitus/Cervicus
e. Upper Trapezius
f. Levator Scapulae
g. Paraspinals (Cx)

For case study 1 indicate the likely

outcome for the following tests. Is it
likely to be positive or negative?
Discuss false positives and
negatives.

Pelvic Rock Test -ve no sij involvement

Hoovers Test -ve no malingering

Stoop Test -ve no thoracic or lumbar disc issue

Brachial Plexus Nerve Tension Test FP for local pain in upper trapezius, no
radiculopathy expected

Upper Limb Nerve Tension Test 1 Possible +ve C5-C7 Nerve Roots
(ULNNT)

Gluteal Reflexes -ve

Superficial Visceral Abdominal -ve no thoracic involvement

Reflexes

Djerine’s Triad (Cough,Valsalva and -ve

Sneeze)

Lhermittes Sign -ve no MS