Reflex Testing/Grading

Question 1

What is a reflex?

Answer 1

A motor response to a sensory stimulation that is used to examine the integrity of the nervous system

Question 2

What is the difference between superficial and deep tendon reflexes?

Answer 2

Superficial = response to stimulation of receptors within the skin

Deep tendon = elicit muscle contraction when the muscle’s tendon is stimulated

Question 3

Describe the spinal levels, procedure and normal response expected for the abdominal reflex.

Answer 3

Spinal levels: T8-L1

Procedure: Stroke briskly and lightly with a blunt object (tongue depressor) from each quadrant of the abdomen in a diagonal manner towards the umbilicus

Normal response: contraction of the abdominals and deviation of the umbilicus towards the direction of the stimulus

Question 4

Describe the spinal levels, procedure and normal response expected for the corneal ‘blink’ reflex.

Answer 4

Spinal levels: Trigeminal and facial nerves

Procedure: Ask the patient to look up and away from you; stroke the cornea using a piece of cotton

Normal response: Both eyes will blink with contact to one eye

Question 5

Describe the spinal levels, procedure and normal response expected for the cremasteric reflex.

Answer 5

Spinal levels: L1-L2

Procedure: Scratch the skin of the upper medial thigh

Normal response: a brisk and brief elevation of the testicle on the ipsilateral side

Question 6

Describe the spinal levels, procedure and normal response expected for the gag reflex.

Answer 6

Spinal levels: Vagus and glossopharyngeal nerves

Procedure: Lightly stimulate each side of the back of the throat

Normal response: A gag will occur post stimulation; may be absent in some % of the normal population

Question 7

Describe the spinal levels, procedure and normal response expected for the plantar reflex.

Answer 7

Spinal levels: L5-S1

Procedure: Stroke the lateral aspect of the sole of the foot with the blunt end of the reflex hammer from the heel to the ball of the foot and medially to the base of the great toe.

Normal response: Flexion of the toes

Babinski response = extension of toes which indicates CNS lesion

Question 8

What may hyperreflexia indicate?

Answer 8

Can be indicative of a suprasegmental lesion (lesion above the level of the spinal reflex pathway

Question 9

What may hyporeflexia indicate?

Answer 9

May be indicative of a disease that involves one or multiple components of the reflex arc itself.

Question 10

What is the Jendarassik maneuver? When is it used?

Answer 10

Used when the therapist has difficulty eliciting a reflex

Locking the fingers together and directly pulling against each other immediately prior to the reflex stimulus

Question 11

Describe all the grades on the reflex grading scale.

Answer 11

0= no response (always abnormal)
1+ = diminished or depressed response (may or may not be normal)
2+ = active normal response (normal)
3+ = brisk/exaggerated response (may or may not be normal
4+ = very brisk/hyperactive (always abnormal)

Question 12

What is the most common etiology surrounding absent reflexes?

Answer 12

Peripheral neuropathy

Question 13

What is the function of the flexor withdrawal reflex? What stimulus elicits this reflex?

Answer 13

Stimulus: cutaneous sensory stimuli

Functions as a protective withdrawal mechanism to remove body part from harmful stimuli

Question 14

What is the function of the inverse stretch (myostatic) reflex? What stimulus elicits this reflex?

Answer 14

Stimulus: muscle contraction

Functions to provide agonist inhibition, diminution of force of agonist contraction, stretch protection reflex

Question 15

What is the function of the crossed extension reflex? What stimulus elicits this reflex?

Answer 15

Stimulus: noxious stimuli and reciprocal action of antagonists; flexors of one side are excited, causing extensors on same side to be inhibited; opposite responses occur in opposite limb

Function: coordinates reciprocal limb activities such as gait