Deep Tendon Reflexes (DTR)

Question 1

Deep Tendon Reflexes

Answer 1

Reflexes are an automatic response to a stimulus
Not voluntary
Muscles contract when they are stretched
Tapping on a tendon stretched the muscle and it contracts - reflex
DTRs tell us if there is a problem with a reflex arc of the spinal cord

Question 2

Reflex Ratings

Answer 2

0 Absent
1+ decreased
2+ normal
3+ increased and maybe normal
4+ Markedly hyperactive with transient clonus
5+ marked hyperactive with sustained clonus

Question 3

Reflex arc

Answer 3

1. Stretching stimulus SENSORY RECEPTOR
2. SENSORY NEURON excited
3. within INTEGRATING CENTER (spinal cord), sensory neuron activated motor neuron
4. MOTOR NEURON excited
5. EFFECTOR (same muscle) contracts and relieves the stretching

Question 4

Reinforcement

Answer 4

Upper extremities have pt. clench teeth

For the lower extremities, have the pt. interlock hands and pull

Question 5

Biceps Reflex (C5 and C6)

Answer 5

Patients arm should be flexed
Place the thumb over the bicep tendon in the antecubital space
Tap your thumb with the reflex hammer

Question 6

Brachioradialis or Supinator Reflex

Answer 6

Lay lower arm or pt.s own leg, hold arm between supinator or pronation
Tap tendon just above the wrist
Difficult to find the right spot

Question 7

Triceps Reflex

Answer 7

Pt should hold arm abducted, elbow bent and forearm hanging freely
Tap just above the elbow

Question 8

Patellar Reflex

Answer 8

Pt. should be siting with legs dangling off of floor, or upper leg lifted and supported by examiner (thigh should be stable and lower leg should not touch the floor)

Question 9

Achilles Reflex

Answer 9

Have the pt. sitting with leg off of floor
Shoes and socks off
Hold foot in slight dorsiflexion and tap the Achilles

Question 10

Superficial Reflexes

Answer 10

Reflexes have reflex arcs who receptor organs are in the skin rather than in muscle fibers
Adequate stimulus is stroking, scratching or touching
Use a light stroking with moderately sharp instrument

Question 11

Gluteal reflex

Answer 11

touch anal sphincter

Question 12

Cremaster Reflex

Answer 12

L1 and L2, stroke the inner aspect of the thigh from the pubis

Question 13

Babinski (Plantar Reflex)

Answer 13

Stroke the lateral aspect of the foot, heel to the ball of the foot and then across the ball of the foot
Normal - all toes flex, Absent Babinskis
Abnormal - Toes fan out, present Babinskis

Question 14

Ankle Clonus

Answer 14

Sharply dorsiflex foot
Normal - Foot is unchanged
Abnormal - Foot oscillates rapidly

Question 15

Meningeal Irritation

Answer 15

From infection or intracranial hemorrhage
Normal - no pain
Abnormal - feels pain in neck and spine; resists flexion of neck; involuntary flexions of knees/hips to relieve pain

Question 16

Kernigs sign

Answer 16

With the pt. supine passively flex the hip to 90 degrees while the knee is flexed at about 90 degrees, then attempt to straighten leg

Question 17

Nuchal Rigidity

Answer 17

The pt. cannot place the chin upon chest; passive flexion of the neck is limited by involuntary muscle spasm

Question 18

Decerebrate Posturing

Answer 18

From brain stem lesion

Rigid body, arms rigid and extended DTRs exaggerated

Question 19

Decorticate posturing

Answer 19

From deep brain lesions
Flexed arms and fists clenched
Legs less rigidly extended