PHYSIOLOGY

6.16 Lab Plenary: Reflexes & Motor Systems

Dr. Bartolome | 12 April 2017
LE6
I.
OUTLINE

Testing Reflexes in Man

c. Effector Organ Involved: somatic or visceral #
b. Location of Receptors: superficial or deep tendons

*Please check the APPENDIX section for the results of the

A. Procedures experiment.
B. Results
C. Guide Questions C. Guide Questions
D. Case 1. Draw a typical spinal reflex act. Label the component
II. Motor System Examination parts.
A. Procedures and Results
B. Guide Questions
OBJECTIVES:
Testing Reflexes in Man
1. Trace the component parts of the reflex arc
2. Perform some superficial and deep tendon reflexes
3. Differentiate somatic from visceral reflexes
Motor System Examination
1. To perform some of the clinical examinations to test the
motor system
2. To be able to determine the normal findings in these tests
for the motor system
3. To describe some of the abnormal findings in these tests for Afferents go to the dorsal horn, while efferents come from
the motor system ventral horn.
Legend:
Remember Previous 2. What is the expected response if a component part or
Lecturer Book Trans Com parts of the reflex arc is/are damaged?
(Exams) Trans
• If any one of the components are damaged, a reflex
     will not be elicited.
I. TESTING REFLEXES IN MAN • Spinal nerve: It contains both afferent and efferent
A. Procedure nerves= loss of response
1. Corneal Reflex: Touch the cornea gently from the side • Center: It is where the integration center is located,
with a thread or wisp or cotton. Maks sure that you DO hence if destroyed there will be no connection
NOT touch the eyelashes of the subject. between afferent and efferent nerves.
2. Pupillary Light Reflex: Let the subject look into the
distance. Measure the pupillary size. Shine a flashlight 3. How do you elicit these reflexes? Give the specific
obliquely into the right eye and note the change in the components of the reflex arc.
size of the pupil. Observe both eyes at the same time. a. Cremasteric: Stroke inner thigh (medial)
Repeat with the left eye. Mechanoreceptor  Femoral branch of the
3. Gag or Vomiting Reflex: Touch the uvula or the genitofemoral nerve  spinal cord segment L1-L2 
posterior pharyngeal wall with an applicator. genital branch of the genitofemoral nerve 
4. Jaw Jerk: With the patient’s jaw sagging loosely open, cremasteric ms.  ipsilateral movement of the
the examiner’s finger rests across the chin. Strike the scrotum (upward)
finger with a crisp blow with a neurological hammer. b. Anal: Stroke skin around anal opening 
5. Biceps Jerk: With the subject’s arm relaxed and slightly Nociceptors  pudendal nerve  spinal cord
flexed, strike the bicep tendon at the antecubital fossa. segment S2-S4  pudendal nerve  external anal
6. Triceps Jerk: Strike the triceps tendon a few inches sphincter contraction (anal wink)
above the olecranon process.
7. Abdominal Reflex: Stroke the external abdominal wall 4. When do you elicit the following reflexes? Are they
medial ward (towards the umbilicus) with a blunt probe on normal?
all 4 quadrants of the abdomen. Note the direction of the a. Babinski: It causes the big toe to dorsiflex and
response. fanning out of the other toes by eliciting pressure on
8. Knee Jerk: Let the subject sit down on a table and cross the lateral border of the sole of the foot from the back
his/her legs. Tap the patellar tendon just below the knee of the heel to the base of the toes. Babinski sign is
cap with a reflex hammer. normal in infants (9 months – 1 y/o) because the
9. Ankle Jerk: Let the subject stand with one knee resting corticospinal tract fibers are not yet myelinated.
on a chair. Tap the tendon of Achilles However, it is pathologic in adults and indicative of an
10. Plantar Reflex: With a blunt probe, stroke the lateral side upper motor neuron lesion.
of the sole of the foot starting from the heel going towards b. Clasp knife: Initial resistance is present upon flexion/
the toes. extension of the muscle followed by a sudden
collapse. This reflex is indicative of an upper motor
B. Results neuron lesion.
Classify the reflexes according to the following:
a. Number of Synaptic Connections: monosynaptic or
polysynaptic
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c. Withdrawal: When pain is elicited, flexors of the 3. Classify the stimulus.

ipsilateral side contracts/retracts. It is done to assess The soft and smelly object can be classified as a noxious or
the integrity of the lateral spinothalamic tract, thus this harmful stimulus (nociceptor).
reflex is protective and normal.
d. Crossed extensor: This reflex same goes with 4. Give the extent of the response.
withdrawal reflex, wherein the flexors of a stimulated The response elicited is a local or segmental type according to
muscle contract and the extensors relax. The opposite extent. The center of the response is from the spinal cord
reaction is occurring at the other limb, that is, flexors segments and exemplified by deep tendon reflexes.
relax and extensors are stimulated to maintain
balance. It is done to check pain sensitivity reaction II. MOTOR SYSTEM EXAMINATION
on opposite side of the body. This reflex is protective A. Procedures and Results
and normal STRENGTH
e. Extensor thrust: This involves the extension of the 1. Definition: Power of a muscle group in performing a
lower limb when a tactile stimulus is elicited to the specific action according to age, occupation, physical
plantar surface of the foot. This is normal in infants activity and muscular development
until 6 months but persistence is indicative of anorexic
brain damage. 2. Grading of strength
0/5 No muscle movement
5. Enumerate some visceral reflexes 1/5 Visible muscle movement but no movement at the
a. Respiratory
joint
• Upper respiratory tract: Coughing, Sneezing 2/5 Movement at the joint but not against gravity
• Lower respiratory tract: Hering-Breuer reflex→ 3/5 Movement against gravity but no resistance
prevents over-inflation of the lung. Pulmonary
4/5 Movement against added resistance but less than
stretch receptors present in the smooth muscle of
normal
the airways respond to excessive stretching of
5/5 Normal muscle strength
the lung during large inspirations.
b. Cardiovascular
3. Procedure/Muscle Group tested
• Oculo-cardiac reflex
a. Facial Muscles - subject wrinkles forehead,
• Baroreceptor reflex
squeezes the eyes shut and shows the teeth
• Bainbridge b. Neck Muscles - subject resists attempts
c. Gastrointestinal by the examiner to flex and extend the
• Defecation reflex neck by exerting pressure on the occiput
• Deglutition reflex/swallowing reflex and forehead, respectively
• Gastrocolic, Ileolial reflexes c. Arm Abductors - subject holds his arm
d. Genitourinary laterally at right angles to the body while
• Micturition reflex the examiner pushes down on the elbow
d. Hip Flexors - in a sitting position, the
D. Case subject holds the knee up off the chair
A 24-year-old clinical clerk was walking along Aurora Blvd against resistance
when he stepped on a soft and smelly object. His immediate e. Ankle Extensors - the subject resists
involuntary reaction was to flex the thigh of the same lower attempts to bend from 90 degrees angle
limb to elevate his foot from the offensive object. At the same position
time, he also cursed. He then stomped his foot to remove the
sticky object from his new white shoes and wiped the shoe on 4. Results
the sand and gravel around the area. Muscle Level of Strength
Facial Muscles 5
1. What reflex was elicited in response to the stimulus? Neck Muscles 5
The reflex elicited in response to the stimulus is flexion or Arm Abductors 5
withdrawal reflex. In response to the stimulus, it causes Hip Flexors 5
excitatory interneurons to activate a-motor neurons that supply Ankle Extensors 5
the flexor muscles in the ipsilateral limb that caused it to flex.
On the other hand, it causes inhibitory interneurons to inhibit a- Terms to Remember:
motor neurons that supply the antagonistic extensor muscles. Paresis: Impaired strength or weakness
Hemiparesis: Weakness of one half of the body
2. Give the specific component parts of the reflex arc Plegia: Absence of strength or paralysis
demonstrated in the above scenario. Hemiplegia: Paralysis of one of half of the body
Stimulus Pain (noxious) Paraplegia: Paralysis of the legs
Receptor Cutaneous Quadriplegia: Paralysis of all 4 limbs
Afferent neuron A-delta or C or IV
Center Spinal cord COORDINATION
Efferent neuron A-alpha motor neuron 1. Procedures:
Effector Flexor muscle Finger to nose test - the subject is asked to
Response Activation of flexor muscles touch alternately his or her nose and then the

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 6.16 Lab Plenary: Reflexes & Motor Systems PHYSIOLOGY 2020C

examiner’s finger with the tip of his or her index finger.
The examiner’s finger must be far away so that the
subject must fully extend the arm with the eyes open
and then with the eyes closed.
Heel to shin test - the subject places the heel
carefully on the opposite knee and slides it slowly
along the edge of the tibia to the ankle and back up
the knee again
Rapid alternating test - alternately patting the front
and back of the hand on the knee as rapidly
and regularly as possible.
• Inability to hop on each leg = there may be a
cerebellar lesion or lesion on corticospinal tract (distal
muscles are affected)
• When a normal muscle with an intact nerve supply
is relaxed voluntarily, it maintains a slight residual
tension known as muscle tone
MUSCLE TONE
1. Procedure:
• Alternately flex and extend elbow and wrist
• Alternately flex and extend the knee joint

2. Results 2. Grading:
Test Observation + Hypotonia
Finger to nose Able to perform ++ Normal
Heel to shin Able to perform +++ Hypertonia
Rapid alternating Able to perform ++++ Hypertonia with clonus
STATION AND GAIT 3. Results:
1. Procedures: Area Tested Muscle Tone
• Station Elbow ++
o Romberg’s Test: The subject stands Wrists ++
straight with the heels together first with the
Knees ++
eyes open then with eyes closed
• Gait: Observe certain aspects of the gait of the patient
REFLEXES
wile doing the following:
o Walks normally back and forth at moderate 1. Procedure:
rate
Perform the following tests and record your results in the table:
o Walks on heels
A. Triceps jerk – Strike the patient’s elbow a few inches
o Walks on toes
above the olecranon process. Look for elbow
o Tandem walk along a straight line (touching
extension and triceps contraction
heel to toe) B. Biceps jerk – Ensure patient’s arm is relaxed and
o Hops on each leg
slightly flexed. Palpate the biceps tendon with the
*Note the following during each of the different steps
thumb and strike with tendon hammer. Look for elbow
• Length of step (vertical distance between flexion and biceps contraction
heel of one foot and the toe of the other foot) C. Knee jerk – Ensure that the patient’s leg is relaxed by
• Width of the base (horizontal distance hanging it over the edge of the bed. Tap the patellar
between both heels) tendon with the hammer and observe quadriceps
• Abnormal leg movement (example: contraction
excessively high step) D. Ankle jerk – Tap the achilles tendon and watch for
• Instability (gait ataxia) calf muscle contraction and plantar flexion of the foot
• Associated Postural Movement (example:
pelvic swaying) 2. Grading reflex:
2. Results 0 No response
+ Diminished; Low normal
STATION:
++ Normal
Eyes Open: - Romberg Sign
Eyes Closed: - Romberg Sign +++ Brisker than average; not necessarily abnormal
+ Romberg Sign with eyes open = cerebral ataxia ++++ Hyperactive
+ Romberg Sign with eyes closed = sensory ataxia
3. Results:
Gait Result Reflex Results Cranial
Normal walk at moderate rate Able to perform test Nerve/Spinal root
Walk on heels Able to perform test Triceps jerk ++ Radial N. C6-C7
Walk on toes Able to perform test Biceps jerk ++ Musculocutaneous
Tandem Walk Able to perform test C5-C6
Hop (right and left foot) Able to perform test Knee jerk ++ Femoral N. L2-L4
Ankle jerk ++ Tibial N. S1-S2
• If patient can’t walk on heels and toes, there may be a
weakness of distal muscles or corticospinal Terms to Remember:
weakness. Dysdiadochokinesia
• Incoordination may be seen during tandem walk that • Inability to perform rapid alternating movements such
couldn’t be seen during a normal walk as repeated pronation and supination of hands.

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 6.16 Lab Plenary: Reflexes & Motor Systems PHYSIOLOGY 2020C

•May indicate damage to the posterior lobe of the 6. Differentiate between upper and lower motor neuron
cerebellum or neocerebellum lesions by filling out this table.
Dysmetria
• Characterized by overshooting or undershooting of Upper motor Lower
range of motion needed to place the limbs correctly neuron lesion motor
during active voluntary movements neuron
• Indicated damage to the posterior lobe of the lesion
cerebellum Loss of power Pyramidal Distal,
Ataxia distribution proximal, or
• Inability to coordinate movement weakness/ general
• Indicates damage to the posterior lobe of the paralysis weakness/
cerebellum, flocculonodular lobe, or anterior lobe paralysis
o Cerebellar ataxia – swaying when eyes are Extent of paralysis Paresis Complete
open (weakness) paralysis
o Sensory ataxia – swaying when eyes are Atrophy and wasting None initially, but With muscle
closed atrophies due to atrophy
disuse
B. Guide Questions Muscle tone Spasticity Flaccidity
1. What is muscle tone? What causes muscle tone? (increased (decreased
• Muscle tone is the passive contraction of muscles muscle tone) muscle
caused by reflex arcs from muscle spindles tone)
Reflexes
2. What is coordination? a. Deep Hyperreflexia Areflexia
• Coordination is the organization of the different b. Superficial, Loss of reflex Presence of
elements of a complex body movement as to abdominal reflex
enable them to work efficiently. Muscle fasciculation With clonus No clonus
and fibrillation
3. Explain why deep reflexes can be diminished or
absent. Give some clinical conditions that result in 7. Define stance and gait.
diminished or absent DTRs. • Stance is the ability to maintain an erect posture.
• Deep reflexes can be diminished or absent due to Gait is the pattern of movement of the limbs.
lesions along the reflex arc. It is also possible that
stimulation of the afferent nerve is insufficient due 8. Describe the following forms of abnormal gait and
to human error. be able to demonstrate each example. Give some
clinical conditions that result in the following gait
4. Explain why deep reflexes can be exaggerated. Give abnormalities.
some clinical conditions that result in diminished or a. Hemiplegic gait
absent DTRs. • involves flexion of the hip due to foot drop
• Deep reflexes can be exaggerated due to upper and circumduction of the leg
motor neuron lesions. These lesions can cause • most commonly seen in stroke
loss of inhibition allowing uninhibited firing of the b. Festinating gait
reflex arc. • short steps on tiptoe with the trunk flexed
forward and legs flexed stiffly.
5. What is clonus? In which clinical condition can this • seen in Parkinson’s disease
be seen? c. Drunken gait
• Clonus is an involuntary, rhythmic muscle • ataxic gait; inability to walk heel to toe;
contraction due to lack of inhibition of the upper walking with a wide base
motor neuron lesions. Conditions such as • indicative of a cerebellar lesion
cerebral palsy, Huntington disease, multiple d. Stamping gait
sclerosis may result in clonus. • high stepping gait due to loss of sensation
• If unilateral, causes include peroneal nerve
palsy and L5 radiculopathy. If bilateral,
causes include amyotrophic lateral
sclerosis, Charcot-Marie-Tooth disease and
other peripheral neuropathies including
those associated with uncontrolled diabetes.

REFERENCES:
1. Lecture Notes of Dr. Bartolome

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APPENDIX

Table 1: Results of Experiment XVII – Testing Reflexes in Man

Reflex Classification Afferent Nerve Center Efferent Nerve Response
Corneal Polysynaptic Opthalmic branch Pons Facial Nerve Contraction of the
Right Superficial of the Trigemminal (CN VII) orbicularis oris muscle on
Left Visceral Nerve (CN V1) both eyes
Pupillary Polysynaptic Optic Nerve (CN II) Edinger Oculomotor Direct: constriction of
Right eye Superficial Westphal Nerve (CN III) stimulated eye
Left eye Visceral Nucleus in the Consensual: constriction
midbrain of non-stimulated eye
Gag or Vomiting Polysynaptic Glossopharyngeal Medulla or Vagus Nerve Gagging, vomiting, soft
Superficial Nerve (CN X) Spinal Cord (CN X) palate elevation
Visceral
Jaw Jerk Monosynaptic Mandibular branch Pons Trigeminal Nerve Contraction of temporal
Deep Tendon Reflex of the Trigemminal (CN V) muscles
Somatic Nerve (CN V3)
Biceps Jerk Monosynaptic C5-C6 Spinal Cord C5-C6 Flexion of the elbow
Deep Tendon Reflex
Somatic
Triceps Jerk Monosynaptic C7-C8 Spinal Cord C7-C8 Extension of the elbow
Deep Tendon Reflex
Somatic
Abdominal Polysynaptic T8-T12 Spinal Cord T8-T12 Contraction of ipsilateral
Superficial abdominal muscle
Visceral
Knee Jerk Monosynaptic L2-L4 Spinal Cord L2-L4 Extension of leg due to
Deep Tendon Reflex quadriceps muscle
Somatic
Ankle Jerk Monosynaptic S1-S2 Spinal Cord S1-S2 Plantar flexion
Deep Tendon Reflex
Somatic
Plantar Polysynaptic S1-S2 Spinal Cord S1-S2 Normal: Curling or flexion
Superficial of toes or no reaction
Visceral Abnormal: Extension of big
toe or fanning of other toes

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