Reflexes

What are reflexes?

Involuntary motor responses to potentially harmful stimuli

How do we test reflexes?

All tests are done bilaterally with the normal side tested first

What is Westphal’s sign?

Absence of any DTR, especially patellar (LMNL)

Why use Jendrassik’s maneuver aka reinforcement test?

Brings out reflexes by cortical distraction

What is a 0+ on the Wexler scale (DTR)?

Absent with reinforcement

What is a 1+ on the Wexler scale (DTR)?

Hypoactive with no reinforcement or normal with reinforcement

What is a 2+ on the Wexler scale (DTR)?

Normal

What is a 3+ on the Wexler scale (DTR)?

Hyperactive

What is a 4+ on the Wexler scale (DTR)?

Hyperactive with transient clonus

What is a 5+ on the Wexler scale (DTR)?

Hyperactive with sustained clonus

What nerve and nerve root does jaw jerk reflex test?

Trigeminal; CN 5

What nerve and nerve root does biceps reflex test?

Musculocutaneous; C5

What nerve and nerve root does brachioradialis reflex test?

Radial; C6

What nerve and nerve root does triceps reflex test?

Radial; C7

What nerve and nerve root does patellar aka knee jerk reflex test?

Femoral; L4

What nerve and nerve root does medial hamstring reflex test?

Sciatic; L5

What nerve and nerve root does achilles aka ankle jerk reflex test?

Tibial; S1

What are superficial reflexes?

Withdrawal reflex to noxious stimuli

How do you perform corneal reflex?

Touch with cotton wisp produces blinking or tearing

What is the afferent innervation for corneal reflex?

CN 5

What is the efferent innervation for corneal reflex?

CN 7

How do you test pharyngeal reflex?

Touch back of tongue with tongue blade produces gagging

What is the afferent innervation for pharyngeal reflex?

CN 12

What is the efferent innervation for pharyngeal reflex?

CN 10

What is the cremasteric (L1) reflex?

Stroke inner thigh of male; ipsilateral rise in testes

What is the afferent innervation for cremasteric (L1) reflex?

Femoral nerve

What is the efferent innervation for cremasteric (L1) reflex?

Genitofemoral nerve

What is the geigel’s reflex?

Stroke up the inner female thigh; poupart’s ligament contracts

What is the afferent innervation for geigel’s reflex?

Femoral nerve

What is the efferent innervation for geigel’s reflex?

Genitofemoral nerve

What is the plantar reflex (L4-S2)?

Stroke up sole of foot see curling of toes and pulling away of foot

What is both the afferent and efferent innervation for plantar reflex (L4-S2)?

Tibial nerve

What is the abdominal reflex?

Stroke in all 4 abdominal quadrants away from the umbilicus; normal is that umbilicus moves towards stroked side

What is both the afferent and efferent innervation for abdominal reflex?

Upper (T7 to T9); lower (T10 to T12)

What is beevor’s reflex?

While observing the umbilicus, the patient does a partial sit up; normal is that the umbilicus stays midline

What is both the afferent and efferent innervation for beevor’s reflex?

Upper (T7 to T9); lower (T10 to T12)

What is an upper motor neuron lesion (UMNL)?

Lesion of the brain and spinal cord not including the anterior horn cells

What is a lower motor neuron lesion (LMNL)?

Lesion of the anterior horn cells out to the myoneural junction

What is the characteristic of paralysis in an UMNL?

Spastic

What is the characteristic of paralysis in an LMNL?

Flaccid

What is the characteristic of a DTR in an UMNL?

Hyperactive

What is the characteristic of a DTR in an LMNL?

Hypoactive/absent

What is the characteristic of a pathological reflex in an UMNL?

Present

What is the characteristic of a pathological reflex in an LMNL?

Absent

What is the characteristic of clonus in an UMNL?

Present

What is the characteristic of clonus in an LMNL?

Absent

What is the characteristic of tone in an UMNL?

Hypertonic

What is the characteristic of tone in an LMNL?

Hypotonic

What is the characteristic of reaction of degeneration in an UMNL?

Absent

What is the characteristic of reaction of degeneration in an LMNL?

Present

What is the characteristic of atrophy in an UMNL?

Absent

What is the characteristic of atrophy in an LMNL?

Present

What is the characteristic of fasciculation in an UMNL?

Absent

What is the characteristic of fasciculation in an LMNL?

Present

What is the characteristic of superficial reflexes in an UMNL?

Absent

What is the characteristic of superficial reflexes in an LMNL?

Absent

What are visceral organic reflexes?

The brainstem integrates these reflexes; absent in UMNL and LMNL

How do you perform the ciliospinal reflex?

Pinch neck while noting dilation of the eyes

What provides sensory innervation for the ciliospinal reflex?

From neck

What provides motor innervation for the ciliospinal reflex?

Cervical sympathetics

How do you perform the oculocardiac reflex?

Press on eye note slowing of the heart by 10 BPM

What provides sensory innervation for the oculocardiac reflex?

CN 5

What provides motor innervation for the oculocardiac reflex?

CN 10

How do you perform the carotid sinus reflex?

Press on carotid sinus note slowing of heart and decreased pressure

What provides sensory innervation for the carotid sinus reflex?

CN 11

What provides motor innervation for the carotid sinus reflex?

CN 10

What are pathological reflexes?

Presence indicates an UMNL

How do you perform babinski reflex?

Stroke up lateral aspect of foot to great toe

What is the response to babinski reflex?

Dorsiflexion of great toe with splaying of other toes

How do you perform chaddock reflex?

Stroke lateral malleolus to fifth toe

What is the response to chaddock reflex?

Babinski-like response

How do you perform opprenheim reflex?

Stroke down tibial crest to the ankle

What is the response to oppreheim reflex?

Babinski-like response

How do you perform gordon’s calf reflex?

Squeeze the calf below the knee

What is the response to gordon’s calf reflex?

Babinski-like response

How do you perform schaefer reflex?

Squeeze achilles tendon

What is the response to schaefer reflex?

Babinski-like response

How do you perform rossolimo reflex?

Tap the ball of the foot

What is the response to rossolimo reflex?

Plantar flexion of great toe with curling of the other toes

How do you perform hoffman reflex?

Examiner extends middle phalanx and flicks distal phalanx inferior

What is the response to hoffman reflex?

Flexion and adduction of the thumb and flexion of the fingers

How do you perform tromner reflex?

Examiner sharply taps the tips of the middle 3 fingers

What is the response to tromner reflex?

Flexion and adduction of the thumb and flexion of the fingers

How do you perform gordon’s finger reflex?

Examiner strokes the pisiform of the patient

What is the response to gordon’s finger?

Flexion of wrist and fingers or thumb and index finger

How do you perform chaddock’s wrist reflex?

Examiner strokes the distal ulnar side of the forearm near the wrist

What is the response to chaddock’s wrist reflex?

Flexion of wrist with extension and fanning of the fingers