Reflex Examination, Introduction and Procedure

A reflex is an involuntary and nearly instantaneous movement in response to a stimulus. The reflex is an automatic response to a stimulus that does not receive or need conscious thought as it occurs through a reflex arc. Reflex arcs act on an impulse before that impulse reaches the brain

1. Reflexes Dr . Simran Mishra ( BPTh , MPT – Neurophysiotherapy ) Assistant professor, SEF’s SIHS, COP Pune

2. Learning Objectives At the end of the lecture first year students should be able to Define Reflexes and Types Classify Reflexes Explain Testing Procedure Demonstrate Reflex testing

3. Definition A reflex is an involuntary, predictable, and specific response to a stimulus dependent on an intact reflex arc

4. Classification Superficial Reflex Deep Tendon Reflex

5. Superficial Cutaneous Reflexes Superficial cutaneous reflexes are elicited with a light stroke applied to the skin. The expected response is brief contraction of muscles innervated by the same spinal segments receiving the afferent inputs from the cutaneous receptors . Abdominal Plantar

6. Deep Tendon Reflexes The deep tendon reflex (DTR) results from stimulation of the stretch-sensitive afferents of the neuromuscular spindle producing muscle contraction via a monosynaptic pathway. DTRs are tested by tapping sharply over the muscle tendon with a standard reflex hammer or with the tips of the therapist’s fingers. Biceps Triceps

7. Testing Relaxed and Comfortable Positioning Reinforcement maneuvers -for Upper Extremity - for Lower Extremity Documentation

8. Superficial Reflexes Polysynaptic Skin Mucosal Membrane Cranial Spinal

9. Abdominal Reflex Patient Position Supine Lying Stimulus Brisk , light strokes skin of abdominal Muscle Response A localized contraction under the stimulus is produced, with a resultant deviation of the umbilicus toward the area stimulated . Spinal Segments T8-T12

10. Plantar Reflex Patient Position Supine Lying Stimulus Stroke on the sole of the foot along the lateral border and up across the ball of the foot. Response Flexion of the big toe Spinal Segment S1-S2

11. Pupillary Reflex Patient Position Sitting with gaze fixed. Bridge the nose Stimulus Shine bright light in eye with a torch Response Observe immediate constriction of pupil Supplied By CN II & III Direct & Indirect

12. Patient Position Sitting with gaze fixed. Stimulus Bring Index finger near nose in between both eyes ask to look at the tip. Response Observe immediate constriction of pupil and convergence. Supplied By CN II & III Accomodation

13. Corneal Reflex Patient Position Sitting with gaze fixed. Stimulus Bring wisp of cotton from side at stimulate lateral edge of cornea Response Observe the blinking response Supplied By CN V & VII

14. Conjunctival Reflex Patient Position Sitting with gaze fixed. Stimulus Bring wisp of cotton from side and stimulate bulbous Conjuctiva Response Observe the blinking response Supplied By CN V & VII

15. Biceps Patient Position Patient is sitting with arm flexed and supported. Stimulus Place thumb over the biceps tendon in the cubital fossa , stretching it slightly. Tap thumb or directly on tendon. Response Slight contraction of elbow flexors Root Value C5-C6

16. Triceps Patient Position Patient is sitting with arm supported in abduction, elbow flexed. Stimulus Palpate triceps tendon just above olecranon . Tap directly on tendon. Response Slight contraction of elbow extensors Root Value C6-C7

17. Brachioradialis Patient Position Patient is sitting with arm flexed onto the abdomen. Stimulus Place finger on the radial tuberosity and tap finger with hammer. Response Slight contraction of elbow flexors, slight wrist extension or radial deviation Root Value CN V & VII

18. Quadriceps Patient Position Patient is sitting with knee flexed, foot unsupported. Stimulus Tap tendon of quadriceps muscle between the patella and tibial tuberosity . Response Slight contraction of knee extensors or knee extension Root Value ( L2, L3, L4)

19. Achilles Patient Position Patient is prone with foot over the end of the plinth. Stimulus Tap tendon just above its insertion on the calcaneus . Response Slight contraction of plantarflexors Root Value (S1-S2)

20. Masseter Patient Position Patient is in sitting, mouth partially open. Stimulus Finger firmly on chin, strike with help of hammer . Response Slight contraction of elevators and closure of mouth Root Value CN V & VII

21. Grading

22. Abnormalities Exaggeration Very brisk, clonus UMN, Pyramidal Diseases Dimished or Absent Defective technique, breach in reflex arc, Spinal and cerebral shock

23. Thank You