NEUROLOGIC

EXAM
INFANT/ CHILD REFLEX AND ADULT REFLEX
Infant and Adult
Reflexes
A reflex is a muscle reaction that happens automatically in
response to stimulation. Certain sensations or movements
produce specific muscle responses.
Infant Reflexes
Blink Reflex
The purpose of blink reflex in newborn is to protect the eye from any
object coming near it by rapid eyelid closure.
Shining a strong light such as a flashlight or penlight into an eye
This reflex lasts into adulthood and should not be inhibited
Rooting Reflex
Appears at birth and disappears at about 4th month of life
Stimulated by brushing the cheek or stroking near the mouth of the
newborn which will cause the head of the newborn to turn to that
direction.
Sucking Reflex
Sucking is another survival reflex present even before birth.
It disappears by 4 months of age
Touching the newborn’s lips the areas around the mouth causes the
baby to make sucking motions. Like rooting reflex, sucking reflex helps
the baby find food.
Swallowing Reflex
food that reaches the posterior portion of the tongue is automatically
swallowed .
Gag, cough, and sneeze reflexes also present to maintain a clear
airway in the event that normal swallowing does not keep the pharynx
free of obstructing muscles.
It is integrated by 12-18 months.
Swallowing Reflex: The swallow is initiated when food, liquid, or saliva
reaches your baby's throat.
Your baby comes under control of this reflex by 18 months and it
continues as an important reflex throughout our lives.
 Extrusion Reflex
any substance placed on the anterior portion of the tongue of babies
will be expelled by them.
Serves a protective reflex prevents the swallowing of inedible
substances.
Until 4 months of age
Spitting out or refusing solid food place in the mouth.
Complementary feeding or introduction of solid food is done at about
6 months
Normal Response- the newborn pushes the tongue outward.
Abnormal Response- continues extrusion
of tongue or repetitive tongue thrusting
occurs with CND anomalies and seizures.
Palmar Grasp Reflex
Grasp an object placed in the palm by closing their fingers on it.
Mature newborn grasp are so strong that they can be momentarily
raised from supine position through this reflex
Palmar grasp reflexes disappears between 3 months to 6 months.
The Step (Walk)-in-
Place Reflex
This reflex is also called the walking or dance reflex because a baby
appears to take steps or dance when held upright with his or her feet
touching a solid surface.
This can last until three months of age
Tonic Neck Reflex
The tonic neck reflex is also called boxer of fencing reflex because of
the position of the newborn.
If you turn a newborn’s head to the opposite side, he or she may
change the extension and contraction of legs and arms accordingly.
The reflex typically disappears between the second and third months
of life
 Moro Reflex
Often called a startle reflex
The most accurate method of eliciting the reflex is to hold a newborn
in a supine position and then allow the head to drop backward about 1
in.
In response to this sudden backward head movement, the newborn
first extends arms and legs, then swings the
arms into an embrace position and pulls up
the legs against the abdomen.
It is strong for the first 8 weeks of life and then
fades by the end of the fourth or fifth month.
 Startle Reflex
Startle reflex is different from Moro reflex in the sense that it lacks full
extension and hand opening and can be elicited spontaneously by
sudden noise or movement.
Newborn suddenly arch his back, fling his arms
up and out, and open his hands.
The Moro reflex is present at birth. In the
first 12 weeks after birth, babies may exhibit
a full Moro reflex, which involves the arms, legs,
and head. The Moro reflex disappears
completely when the baby is 6 months old.
 Babinski Reflex
The Babinski reflex, or plantar reflex, happens
naturally in babies and young children until they’re
about 6 months to 2 years old.
When the nurse strokes the sole of the foot in an
inverted “J” curve. When the big toe bends up and
back toward the top of the foot while the other four
toes spread out from one another, it’s called the
Babinski sign.
It is use it to make sure that child brain activity,
neurological responses, and nerve activity are normal
and don’t indicate any underlying abnormalities in the
brain or the nervous system.
Magnet Reflex
Reflexes of spinal cord integrity- reflexes to test spinal cord integrity
of newborns.
Present at birth.
Technique: With infant supine, flex the leg and apply pressure to soles
of feet. The newborn extends legs against pressure.
Crossed Extension Reflex
Reflexes of spinal cord integrity- This is a Age of Appearance: Birth
second reflexes to test spinal cord integrity Age of Disappearance: 4-6 mo
of newborns. Origin in CNS: Spinal cord
The examiner holds one of the baby's legs
extended and applies firm pressure to the
sole or knee of the same leg. The baby's free
leg flexes, adducts, and then extends.
Response: Flexion, adduction, and then the
extension of the opposite leg.
If one leg of a newborn lying supine is
extended and the sole of that foot is
irritated by being rubbed with a sharp
object, such as a thumbnail, the infant
raises the other leg and extends it, as if
trying to push away the hand irritating
the first leg
Trunk Incurvation /Galant Reflex
When a newborn lies in a prone position and is touched along the
paravertebral area on the back by a probing finger, the newborn
flexes the trunk and swings the pelvis toward the touch
The Galant reflex, which is also
known as truncal incurvation reflex,
is one of them, and usually
disappears when the baby is around
one year old
Age of Appearance: Birth
Origin in CNS: Spinal cord
The trunk incurvation reflex. When the paravertebral
area is stroked, the newborn flexes his or her trunk
toward the direction of the stimulation.
Landau Reflex
A newborn who is held in a prone position with a hand underneath,
supporting the trunk, should demonstrate some muscle tone. Babies
may not be able to lift their head or arch their back in this position (as
they will at 3 months of age), but neither should they sag into an
inverted “U” position. The latter response indicates extremely poor
muscle tone, the cause of which should be investigated.
If we place the baby face
down in the ventral
position, his upper body
will straighten, his head will
rise and his feet and arms
will stretch instinctively.
It’s normal for this reflex to
appear around the fourth
month and disappear
towards the tenth month
of the baby’s life.
Adult Reflexes
 Bicep Reflex
Biceps reflex is a reflex test that examines the function of the
C5 reflex arc and the C6 reflex arc.
The test is performed by using a tendon hammer to quickly
depress the biceps brachii tendon as it passes through the
cubital fossa.
Tricep
It is measured by striking the triceps tendon directly with the hammer
while holding the patient's arm with the other hand.
Repeat and compare to the other arm.
This is tested as part of neurological examination to asses the sensory
and motor pathways within the C7 and C8 spinal nerves.
Brachioradialis
The examiner prompts the brachioradialis reflex by tapping the
brachioradialis muscle tendon at its point of insertion onto the styloid
process of the radius.
A normal reflex would produce flexion and supination of the forearm.
 Patellar
Exaggeration or absence of
Patellar reflex, also called Knee-jerk the reaction suggests that
reflex, sudden kicking movement of the there may be damage to the
lower leg in response to a sharp tap on central nervous system.
the patellar tendon, which lies just below It can also be helpful in
the kneecap. recognizing thyroid disease.
Positions that may take for the test is to
sit with knees bent and foot hangs clear
of the floor.
In reaction, these muscles contract, and
the contraction tends to straighten the
leg in a kicking motion.
 Ankle Jerk Reflex
The ankle jerk reflex, also known as the Achilles reflex, occurs
when the Achilles tendon is tapped while the foot is
dorsiflexed.
It is a type of stretch reflex that tests the function of the
gastrocnemius muscle and the nerve that supplies it.
It is elicited by holding the relaxed foot with one hand and
striking the Achilles tendon with the hammer and noting
plantar flexion.
 Jaw Jerk Reflex
The jaw jerk reflex or the masseter reflex is a stretch reflex
used to test the status of a patient's trigeminal nerve.
It is to help distinguish an upper cervical cord compression
from lesions that are above the foramen magnum.
The test is done by tapping at a downward angle the lower jaw
through the chin just below the lips.
Hoffman
It is a test that doctors use to examine the reflexes of the upper
extremities.
This test is a quick, equipment-free way to test for the possible
existence of spinal cord compression from a lesion on the spinal cord
or another underlying nerve condition.
Palmomental
Is an involuntary contraction of the mentalis muscle caused by
stimulation of thenar eminence.
Presence may indicate cerebral pathology
Rooting
The rooting reflex is present if stroking the lateral upper lip causes
movement of the mouth toward the stimulus.
It can be observed in adult patients with frontal lobe pathology.
Glabellar
The forehead is tapped to induce blinking; normally, each of the first 5
taps induces a single blink, then the reflex fatigues.
Blinking persists in patients with diffuse cerebral dysfunction.
 Plantar
It is a nociceptive segmental spinal reflex that serves the purpose of
protecting the sole of the foot.
The clinical significance lies in the fact that the abnormal response
reliably indicates metabolic or structural abnormality in the
corticospinal system upstream from the segmental reflex.
Clonus
Testing for clonus is done by rapid dorsiflexion of the foot at the
ankle.
Clonus is a rhythmic oscillating stretch reflex that is related to upper
motor neuron lesions.
Clonus is generally accompanied by hyperreflexia.
Sustained clonus indicates an upper motor neuron disorder.
Superficial Abdominal Reflex
Is the contraction of the abdominal muscles in response to the area
being stroked
Is done by stroking areas around the umbilicus using a wooden tool
applicator or end of patella hammer
Absence may indicate spinal cord injury
Bulbospongiosus Reflex
Is the contraction of the bulbocavernosus muscles and/or external
anal sphincter in response to squeezing of the penis or clitoris
Presence may indicate intactness of the sacral spinal reflex arcs
Absence may indicate spinal shock
 Cremasteric Reflex
A reflex found in human males that is elicited when the inner part of the
thigh is stroked and by lightly stroking the superior and medial part of
the thigh in a downward direction.
It is dependent upon the nerve roots L1 and L2 and the normal response
is a contraction of the cremaster muscle that pulls up the scrotum and
testis on the side stroked.
The upper and lower motor neuron disorders can cause an absece of
cremasteric reflex.
 PATIENT
EDUCATION
STANDARD AND ISOLATION PRECAUTIONS
INTRODUCTION
What is Isolation Precaution?
Isolation precautions create barriers between microbes
and patients, staff, and equipment to prevent the spread
of infection in the health care setting.
Standard Precaution
Standard precautions are based on the principle that all blood,
body fluids, secretions, excretions except sweat, non-intact
skin, and mucous membranes may contain transmissible
infectious agents.
EXAMPLE of STANDARD
PRECAUTIONS ARE:
HAND HYGIENE
PERSONAL PROTECTIVE EQUIPMENT
SAFE HANDLING
SAFE INJECTION
RESPIRATORY HYGIENE
 TRANSMISSION-BASED
PRECAUTION
Transmission based precautions provide
additional infection control measures based on
disease specific recommendations and should
always be used in addition to standard
precautions.
 There are 3 categories of
Transmission-Based Precautions:

CONTACT PRECAUTIONS
DROPLET PRECAUTIONS
AIRBONE PRECAUTIONS
 STANDARD
PRECAUTION
(PATIENT EDUCATION)
 1.Hand Hygiene
Soap and water
Alcohol-based hand disinfection (AHD)
Perform after touching discharges and
possible contaminated items
Perform before and after removing gloves
Perform before and after patient contact.
Proper Hand Washing
 2. Personal Protective
Equipment (PPE)
Gloves: use to protect our hands from any discharges,
non-intact skin and contaminated items.
Gown: use during procedures anticipated exposure of
skin/ clothes to body fluids, secretions and excretions.
Mask/Eye Protection: use during procedures or
activities with anticipated splashes or sprays of blood,
body fluids, or secretions and when handling
chemicals.
3. Cleaning, Disinfecting and
Safe Handling
Safely handle potentially contaminated
equipment or surfaces in the patient
environment.
Ensure environmental cleaning and
disinfection, per facility policy
Always clean frequently touched materials
 4. Safe Injection
Needles and syringes are single-use
devices.
Limit use of multi-dose vials, and dedicate
to a single patient, when possible.
Dispose of needles and sharp instruments
in impervious or sharp containers.
 5. Respiratory Hygiene
Dispose of tissues in no-touch
receptacles.
Perform hand hygiene after soiling hands
with respiratory secretions.
Use mask or maintain social distancing
(greater than 6 feet) if possible.
5. Respiratory Hygiene
Isolation Precaution
TRANSMISSION-BASED
PRECAUTION

(PATIENT EDUCATION)

CONTACT PRECAUTIONS
What is Contact Precautions?
It prevents transmission of infectious organisms
spread by direct or indirect contact with the
patient or patient's environment. These are
recommended when the presence of excessive
wound drainage, fecal incontinence or other
discharges from the body suggest an increased
risk for environmental contamination and
transmission of infection


When these safeguards are in place, hospital

personnel will:

Clean hands frequently

Put a sign on your door to let staff know what to do
Clean, nonsterile gown when entering the room;
remove before existing
 For Patients:
Clean your hands frequently
Be sure visitors read the sign on your door
Limit visitors to a few family members and
friends
 For Visitors:
Clean hands upon entering the room
Avoid contact with dressings, tubes, bed sheets
and other items the patient may touch
Do not go into the rooms of other patients
 DROPLETS PRECAUTIONS
guidelines used for the care of a patient with
diseases that are spread in tiny droplets
caused by coughing and sneezing (examples:
influenza, pertussis, diphtheria, invasive
Neisseria meningitis, some types of
pneumonia, and some types of severe acute
respiratory syndrome (SARS).
 For the patients:
Wear a mask if you go to another area of the
hospital or clinic. Make sure the mask fits
tightly.
Cover your mouth with a tissue when you
cough.
Cover your mouth and nose with a tissue when
you sneeze.
Discard the tissue used in the appropriate waste
receptacle immediately.
Try to stay at least 3 ft (1 m) away from another
person while talking.
Wash your hands often with soap and water for at
least 20 seconds or use alcohol-based hand
sanitizer. This is an important way to prevent
spread of the dise ase.
D D
R R
O O
P P
L L
E E
T T

P Stay 1 meter away P

R Wash hands Wear a mask from people R
E E
C C
A A
U U
T T
I I
O O
N Cover mouth with tissue
when coughing or sneezing
Throw used tissues in
appropriate waste bin
N
S S
 For the visitors:
Check with a nurse before you enter a room that has a
sign that says "Droplet Precautions."
If you are allowed to enter the room, you will be asked
to wash your hands and wear a mask over your nose
and mouth. Make sure that the mask fits tightly. You
may also be told to wear eye protection.
Do not take off your mask in the room. If you were told
to wear eye protection, do not take it off in the room.
Do not eat or drink in the room unless you ask a
nurse first.
Do not use or touch any items in the room
unless you ask a nurse first.
Take off your mask and eye protection and
throw them in the trash, and wash hands with
soap and water or use alcohol-based hand
sanitizer after leaving the ro om
D D
R R
O O
P P
L L
E E
T T

Wash hands before Wear mask and

P and after entering the room face/eye mask P

R R
E E
C C
A A
U U
T T
I I
O O
N Ask a nurse before Throw away mask N
S entering the room after leaving the room S
Airborne precaution
Use Airborne Precautions for patients
known or suspected to be infected
with pathogens transmitted by the
airborne route (e.g., tuberculosis,
measles, chickenpox, disseminated
herpes zoster).
How airborne transmission
occurs:
Airborne diseases are bacteria or viruses that are most
commonly transmitted through small respiratory droplets.
These infectious vehicles can travel along air currents, linger
in the air, or cling to surfaces, where they are eventually
inhaled by someone else.
These droplets are expelled when someone with the airborne
disease sneezes, coughs, laughs, or otherwise exhales in some
way.
 What Airborne
Precautions Means:

Either a purple or gold

sign will be posted at the
entrance to the room
when these precautions
are needed so that
everyone entering knows
what to wear.
Airborne Precautions
Source control: put a
mask on the patient.
Use personal protective
equipment (PPE)
appropriately
Limit transport and
movement of patients
Everyone (parents, family,
guests, and healthcare
workers) must wash their
hands with soap and water
or use a waterless alcohol-
based hand rub when
entering and leaving the
room.