Reflex and Sensation Testing Flashcards
Abdominal reflex:
nerve roots
how
normal response
T8-L1
stroke briskly and lightly with a blunt object from each quadrant of the abdomen in a diagonal manner towards the umbilicus
contraction of abdominals and deviation of the umbilicus in the direction of the stimulus
Corneal “blink” reflex:
nerves
how
normal response
trigeminal and facial nerves
have the pt look up and away and stroke the cornea using cotton
both eyes will blink
Cremasteric reflex:
nerves
how
normal response
L1-L2
scratch the skin of the upper medial thigh
brisk and brief elevation of testicle on ipsilateral side
Gag reflex:
nerves
how
normal response
glossopharyngeal and vagus
stimulates each side of the back of the throat and notes reaction
gag post stimulation; may be absent
Plantar reflex (Babinski):
nerves
how
normal response
L5-S1
stroke lateral aspect of sole of foot from heel to ball and medially to the base of great toe
flexion of toes (Babinski is abnormal
DTR is from a
reflex arc
Reflex arc involves spinal or brainstem segment that innervates …
a specific muscle
Hyerreflexia is indicative of a ____ lesion. Which is a lesion ____the level of the spinal reflex pathways.
suprasegmental lesion
above
Hyporeflexia can be indicative of disease that involves one or multiple components of…
the reflex arc itself
Scale for grading reflexes
0-4
Jendrassik maneuver is…
and used when a reflex cannot be elicited.
locking fingers together and pulling apart
0 on the reflex grading scale
no response
always abnormal
1+ on the reflex grading scale
diminished response
may or may not be normal
2+ on the reflex grading scale
active normal response
3+ on the reflex grading scale
brisk/exaggerated response
may or may not be normal
4+ on the reflex grading scale
very brisk/hyperactive
always abnormal
biceps tendon reflex
C5-C6
sitting or supine
brachioradialis tendon reflex
C5-C6
Absent DTRs will indicate
a lesion in the reflex arc itself
If absent reflex is accompanied by sensory loss then the lesion is found…
within the afferent arc and is either the nerve or the dorsal horn
If absent reflex is accompanied by paralysis, fasciculations or atrophy, the lesion is found…
within the efferent arc and may be the nerve or anterior horn or both
What is the most common etiology surrounding absent reflexes?
peripheral neuropathy
Peripheral neuropathy may affect…
all components of the reflex arc
Hyperactive DTRs are found when there is interruption of the cortical supply to the…
Interruption exists …. the segment of the reflex arc.
LMN
secondary to UMN lesion
above
Deep sensation tests
proprioception
cortical sensation testing is also
combined sensory and deep
superficial sensation testing includes
temp
light touch
pain
deep sensation testing includes
proprioception
kinesthesia
vibration
cortical sensation testing includes
bilateral simultaneous stimulation
stereognosis
two-point discrimination
barognosis
localization of touch
Distribution of C4
bilateral shoulders
distribution of C6-T1
medial and lateral aspects of bilateral forearms
distribution of C6 and C8
thumbs and little fingers
distribution of L2 and L3
bilateral anterior thighs
distribution of L4 and L5
medial and lateral aspects of bilateral lower legs (calves)
distribution of S1
bilateral little toes
distribution of S4
saddle area
Pts with sensory deficits or who are at risk for sensory impairments should be tested using…..
Semmes-Weinstein monofilaments
Barognosis
perceive the weight of different objects in the hand
deep pain
squeeze the forearm or calf muscle
graphesthesia
identify a number or letter drawn on the skin without visual input
kinesthesia
identify direction and extent of movement of a joint or body part
light touch
perceive touch through light pressure or use of cotton ball
localization
ability to identify the exact location of light touch on the body using a verbal response or gesturing
proprioception
identify a static position of an extremity or body part
stereognosis
identify an object without sight
superficial pain
perceive noxious stimulus using a pen cap, paper clip end or pin
temp
perceive warm and cold test tubes
two-point discrimination
using a two-point caliper on the skin, identify one or two points without visual input
vibration
perceive vibration or pain through a tuning fork
Pain testing can be performed through touching the skin while alternating in a random fashion between ___and___ends of the pin.
sharp and dull
Perform pain testing with eyes ..
closed and have them say if they feel a sharp or dull sensation
What tool do you use to do pain testing?
Wartenberg pinwheels
Temperature discrimination testing should use
test tubes one with warm and one with cold water
Vibration testing is done with ___Hz tuning fork.
128
Where do you initially place the tuning fork?
IP joint of the great toe
If there is an impairment in the vibration testing then where do you place the tuning fork next?
bony prominences: wrist, elbow, spinous processes, clavicles, medial malleolus, patella, ASIS etc
When testing pressure sensation, ask the patient to distinguish between ….
light or deep
When treating a pt with peripheral nerve damage… all areas of ….. should be assessed.
face, trunk, and extremities.
Allodynia
sensation of pain in response to a stimulus that would not typically produce pain
Analgesia
absence of pain while remaining conscious
Anesthesia
absence of touch sensation
Causalgia
constant, relentless, burning hyperesthesia and hyperalgesia that develops after a peripheral nerve injury
Dyesthesia
distortion of any of the senses, especially touch
Hyperesthesia
heightened sensation
Hyperpathia
extreme exaggerated response to pain
Hypestheisa
diminished sensation of touch
Neuralgia
severe and multiple shock-like pains that radiate from a specific nerve distribution
Pallanesthesia
loss of vibratin sensation
paresthesia
abnormal sensations such as tingling, pins and needles or burning sensations
