Reflexes Flashcards
What are the 5 types of reflexes?
1) deep tendon reflexes (DTR)
2) pathological
3) primitive
4) superficial
5) visceral
What is a deep tendon reflex?
-apply a stretch reflex stimulus directly to a tendon
-the reflex is caused by a sudden muscle stretch
The biceps reflex is testing which nerve root?
C5
The brachioradialis reflex is testing which nerve root?
C6
The triceps reflex is testing which nerve root?
C7
The patellar reflex is testing which nerve root?
L4
The achilles reflex is testing which nerve root?
S1
Which reflex is this?
-pt is supine
-muscles can be tapped indirectly through the examiners fingers or directly
-all 4 quadrants of abdomen should be tested
-top upper quadrants near costal margins (insertion)
-tap 2 inches lateral to the umbillicus for the midline
-tap about 2 inches lower than the midline for the lower quadrants or just above the pubic area
-response: contraction of muscles in quadrant being tested
-upper quadrants are at T8/T9
-midline is at T9/T10
-lower quadrants are at T11/T12
abdominal reflex
At what level is the umbilicus?
T10
Which reflex is this?
-patient’s mouth is slightly open
-tap the middle of the chin
-response: sudden closing of the mouth
-cord level: mid pons reflex centers
-CN V is being tested
jaw jerk reflex
Which nerve is being tested with the jaw jerk reflex?
CN V
Which reflex is this?
-patient is supine or prone with the knee flexed to 90 degrees
-examiner curls fingers over medial hamstring tendon and compresses tendon towards the inner area of the popliteal fossa
-tap on the overlying finger
-response: knee flexion
medial hamstring reflex
What cord level is being tested with the medial hamstring reflex?
L5
What nerve innervates the medial hamstring?
sciatic n.
What muscles are involved in the medial hamstring reflex?
medial hamstring/ semimembranosus
What is the reflex grading scale called?
Wexler reflex scale
What does a 0+ on the Wexler reflex scale mean?
no response, abnormal finding, may have LMNL
What does a 1+ on the Wexler reflex scale mean?
trace or decreased response
What does a 2+ on the Wexler reflex scale mean?
normal response
What does a 3+ on the Wexler reflex scale mean?
exaggerated response
What does a 4+ on the Wexler reflex scale mean?
transient clonus (clonus that bounces, then relaxes), may have UMNL
What does a 5+ on the Wexler reflex scale mean?
sustained clonus (clonus that remains, it can be stopped by pressing on the GTO of respective muscle) , may have UMNL
Which reflex grades are always abnormal?
0, 4, and 5+
What is the muscle strength grade scale called?
Van Allyn’s motor scale
What does a 5 mean on the Van Allyn’s motor scale?
normal, full ROM with full resistance
What does a 4 mean on the Van Allyn’s motor scale?
full ROM with some resistance
What does a 3 mean on the Van Allyn’s motor scale?
full ROM against gravity only
What does a 2 mean on the Van Allyn’s motor scale?
full ROM but not against gravity
What does a 1 mean on the Van Allyn’s motor scale?
some evidence of muscle contraction
What does a 0 mean on the Van Allyn’s motor scale?
no muscle contraction
Pathological reflexes occur only in the presence of an….
test q
UMNL
Which pathological reflex is this?
-dorsiflexion of the great toe and abduction of the remaining toes on the same foot
babinski response/reflex
What are the 7 pathological reflexes that have a babinski response?
1) Babinski
2) Chaddock
3) Gordon
4) Schaefer
5) Oppenheim
6) Gonda
7) Throckmorton
Which reflex is this?
-firmly grasp the ankle and stroke the lateral plantar surface and ball of the foot
Babinski reflex
Which reflex is this?
-stroke around the lateral malleolus (draw a big C) and around the lateral edge of the foot
Chaddock’s reflex
Which reflex is this?
-squeeze the calf firmly
Gordon reflex
Which reflex is this?
-squeeze/pinch the Achilles tendon
Schaefer’s reflex
Which reflex is this?
-draw 2 knuckles down either side of the shin
Oppenheim’s reflex
Which reflex is this?
-forcefully flex the 3rd and 4th toe and release suddenly
Gonda’s reflex
Which reflex is this?
-scratch inner side of great toe
Throckmorton’s reflex
What are the 5 pathological reflexes that DO NOT show Babinski response?
1) ankle clonus
2) patellar clonus
3) rossolimo’s/ toe flexion reflex
4) Hoffman’s/ finger flexion/digital reflex
5) Trommer’s/finger flexion
Which reflex is this?
-forced dorsiflexion causes rapid flexion/extension of the foot (clonus)
ankle clonus
Which reflex is this?
-superior to inferior depression of the patella with leg extended and relaxed causes the patella to move up and down
patellar clonus
Which reflex is this?
-tapping the ball of the foot with a reflex hammer in 2 or 3 places causing plantar flexion
Rossolimo’s/ toe flexion reflex
Which reflex is this?
-tap the nail of the middle finger into flexion will cause flexion of the distal phalanx of the thumb
Hoffman’s reflex/ finger flexion/ digital reflex
Which reflex is this?
-similar to Hoffman’s reflex
-middle finger is flicked into extension causing the opposition of pinkie and thumb
Tromner’s/ finger flexion reflex
What type of paralysis is present with an UMNL?
spastic
What type of paralysis is present with a LMNL?
flaccid
What is the reflex response for a patient with an UMNL?
hyperactive
What is the reflex response for a patient with a LMNL?
hypoactive or absent
T/F: superficial reflexes are absent in both UMNL and LMNL patients
true
Is muscle tone increased or decreased with an UMNL?
increased
Is muscle tone increased or decreased with a LMNL?
decreased
Are pathological reflexes present in UMNL or LMNL patients?
UMNL
Is clonus present in UMNL or LMNL patients?
UMNL
Is atrophy present in UMNL or LMNL patients?
LMNL
Are fasciculations/fibrillations present in UMNL or LMNL patients?
LMNL
What would cause UMNL?
-stroke
-TBI
-spinal cord injury
-MS
-encephalitis
-cerebral palsy
Upper motor neurons originate where?
cerebral cortex, Brodman’s area 4, motor cortex
Where do upper motor neurons terminate?
brainstem (midbrain, pons, medulla) or spine
UMNs in the _________________ tract directly synapses with LMNs
corticospinal
UMNs in which tracts synapse with neurons in the red nucleus or the reticular formation?
-rubrospinal
-vestibulospinal
-reticulospinal
-tectospinal
Lower motor neurons that originate in the ______________ (cranial nerves) or spinal cord (spinal nerves), terminate at the _______ of muscles
brainstem, NMJ
T/F: all LMNs innervate ipsilateral muscles (the muscle and the LMN that innervates it are always on the same side)
true
What are the 8 primitive reflexes?
1) rooting
2) sucking
3) asymmetrical tonic neck reflex (ATNR)
4) symmetrical tonic neck reflex (STNR)
5) tonic labyrinthine reflex (TLR)
6) moro
7) palmar
8) spinal galant
Which primitive reflex is this?
-begins when the corner of the baby’s mouth is stroked or touched
-the baby will turn his or her head and open their mouth to follow and root the direction of the stroking
-this helps the baby find the breast or bottle to begin feeding
rooting reflex
Which primitive reflex is this?
-rooting helps the baby become ready to suck
-when the roof of the baby’s mouth is touched, the baby will begin to suck
-premature babies may have a weak or immature sucking ability
-babies also have a hand to mouth reflex that goes with rooting and sucking and may suck on fingers or hands
sucking reflex
Which primitive reflex is this?
-activated by turning the head to the left or right side
-as the head turned, the arm and leg on the same side will extend while the opposite limbs bend
asymmetrical tonic neck reflex (ATNR)
If the asymmetrical tonic neck reflex (ATNR) is not fully integrated, then it can cause what difficulties?
-hand eye coordination
-written expression
-crossing midline
-visual tracking
-bilateral integration (use of both sides of the body simultaneously)
-hand dominance
Which primitive reflex is this?
-causes the arms to bend and the legs to extend when the head is bent down and causes the opposite- legs bent, arms straight when the head is bent backwards
symmetrical tonic neck reflex (STNR)
If the symmetrical tonic neck reflex (STNR) remains present in older children, it can cause what difficulties?
-integration of upper and lower portions of the body
-sitting posture
-typical muscle tone development
-poor hand eye coordination
Which primitive reflex is this?
-associated with balance and coordination of the extremities
-it is activated by bending the head forward or backwards (head forward- the body and limbs curl inwards, head backwards- the body and torso straighten and extend)
tonic labyrinthine reflex (TLR)
If the tonic labyrinthine reflex (TLR) is not fully integrated then what happens?
-the alignment of the head with the rest of the body will be uncoordinated
-proper head and neck alignment is necessary for balance, visual tracking, auditory processing, and organized muscle tone which is all vital to the ability to focus and pay attention
Which primitive reflex is this?
-serves as the baby’s fight or flight response
-around 4 months will be replaced by an adult startle reflex
moro reflex
When the moro reflex is retained in older children, what happens?
-it becomes an automatic uncontrollable overreaction to any type of stimulus which overrides the higher decision making center of the brain
-hyperactivity
-extreme sensitivity to sudden movement, noise, or light
-sleeping problems
-impulsive behaviors
-inappropriate behavioral responses
-food sensitivities
-emotional and social immaturity
-poor adaptation skills
Which primitive reflex is this?
-the automatic flexion of the fingers over the thumb whenever the palm is stimulated
-this is why when you put your finger in a baby’s hand, they immediately grab onto it
palmar reflex
Retention of the palmar reflex can cause….
-poor hand manipulation skills
-poor finger dexterity
-poor pencil grip
-difficulty with writing tasks
Which primitive reflex is this?
-exists to help babies move their hips as they move through the birth canal and is elicited when the side of the lower spine is stroked gently
spinal galant reflex
If the spinal galant reflex is not fully integrated, it can result in what difficulties?
-potty training
-concentration
-posture
-digestion
-excessive fidgeting and hip movements when seated in a chair
What are the 9 superficial reflexes?
1) corneal blink reflex
2) nasal reflex/ sneeze reflex
3) uvular reflex/ palatine reflex
4) gag reflex/ pharyngeal reflex
5) superficial abdominal reflex
6) cremastric reflex (males only)
7) geigle reflex (females only)
8) plantar reflex
9) anal reflex/ anal wink/ perianal reflex
What are superficial reflexes?
reflexes that are elicited in response to the application of a stimulus to the skin or mucous membranes
Which superficial reflex is this?
-sensory: touch eye= CN V
-motor: close eyelids= CN VII
-take a wisp of cotton and pull it to a point
-have a patient look to the left and doctor will touch the cornea of the right eye, cornea gets irritated so the patient will blink and tear up
-normal reaction: both eyes close (consensual) and at the same time
corneal blink reflex
What cranial nerves are being tested in the corneal blink reflex?
CN V (sensory) and VII (motor)
What is another name for the nasal reflex?
sneeze reflex
Which superficial reflex is this?
-sensory: CN V
-motor: CN V, VII, IX, X, and cervical spinal nerves if shoulders move
-1st make patient blow nose
-have patient sniff irritating substance like pepper
nasal reflex/ sneeze reflex
Which cranial nerves are being tested in the nasal reflex/ sneeze reflex?
CN V (sensory and motor), VII (motor), IX (motor), and X (motor)
What is the other name for uvular reflex?
palatine reflex
Which reflex is this?
-sensory: CN IX
-motor: CN X
-stroke the uvula with a tongue depressor or Q tip
-normal reaction: soft palate rises (uvula rises)
uvular reflex/ palatine reflex
What cranial nerves are being tested in uvular/palatine reflex?
CN IX (sensory) and CN X (motor)
What is the other name for gag reflex?
pharyngeal reflex
Which superficial reflex is this?
-sensory: CN IX
-motor: CN X
-stroke the pillars of the throat with a tongue depressor or q tip
-normal reaction: gagging
gag reflex/ pharyngeal reflex
What cranial nerves are being tested with the gag/pharyngeal reflex?
CN IX (sensory) and X (motor)
Which superficial reflex is this?
-upper quadrant sensory and motor: T7-9
-lower quadrant sensory and motor: T10-12
-ask patient to move shirt up to expose abdomen
-with the pointed end of the reflex hammer, draw a fast and quick stroke in each of the 4 quadrants moving toward the umbilicus at a 45 degree angle
-normal reaction: muscles near the umbilicus jump toward the quadrant that was stimulated
superficial abdominal reflex
Which reflex is for males only?
cremastric reflex
Which superficial reflex is this?
-sensory: L1/L2 of femoral n.
-motor: L1/L2 of genitofemoral n.
-stroke the inner upper 1/3 of the inner thigh up towards testes
-normal reaction: testes rise
cremastric reflex
Which reflex is for women only?
geigle reflex
Which superficial reflex is this?
-sensory: L1/L2 of femoral n.
-motor: L1/L2 of genitofemoral n.
-stroke the inner upper 1/3 of the inner thigh up
-normal reaction: slight contraction of the inguinal ligament
geigle reflex
Is the plantar reflex normal or abnormal?
normal
Which superficial reflex is this?
-sensory and motor: tibial n.
-using the metal end of the reflex hammer, firmly stroke the lateral side of the foot (barefoot) from the heel to ball then across the ball of the foot, lateral to medial
-normal response: toes curl down (plantar flexion of toes) and foot everts (healthy adults)
-indifferent response: no response
-abnormal response: big toe dorsiflexes, other toes fan out (babinski reflex indicates UMNL)
plantar reflex
What is another name for anal reflex?
anal wink or perianal reflex
Which superficial reflex is this?
-sensory: pudendal n.
-motor: S2-S4
-stimulating or irritating the skin next to the anus (perianal region) will cause the anus to contract
anal reflex/ anal wink/ perianal reflex
What are the 7 visceral reflexes?
1) pupillary reflex (direct/indirect, consensual)
2) accommodation reflex (near/far)
3) ciliospinal reflex
4) occulocardiac reflex
5) carotid sinus reflex
6) bulbocavernous reflex
7) bladder and rectal reflex
T/F: visceral reflexes are normal, involuntary, good reflexes
true
Which visceral reflex is this?
-sensory: CN II
-motor: CN III
-shine light into eye and pupil constricts
-shine light into eye and contralateral pupil constricts
pupillary reflex
Pupillary reflex is testing which cranial nerves?
CN II (sensory) and CN III (motor)
Which visceral reflex is this?
-sensory: CN II
-motor: CN III
-look in the distance and pupils dilate
-look close up and pupils constrict
accommodation reflex
Accommodation reflex is testing which cranial nerves?
CN II (sensory) and CN III (motor)
Which visceral reflex is this?
-sensory: cervical sympathetic chain
-motor: CN III
-pinch skin on neck, pupil on ipsilateral side should dilate
ciliospinal reflex
Which cranial nerve is being tested in ciliospinal reflex?
CN III (motor)
What are the 3 characteristics of horner’s syndrome?
1) unilateral Ptosis (drooping eye lid)
2) Anhydrosis (lack of sweating)
3) Miosis (constricted pupil)
“horny PAM”
Which visceral reflex is this?
-sensory: CN V
-motor: CN X
-pressure on cornea decreases heart rate
occulocardiac reflex
Which cranial nerves are being tested with the occulocardiac reflex?
CN V (sensory) and CN X (motor)
Which visceral reflex is this?
-sensory: CN IX
-motor: CN X
-pressure on carotid decreases heart rate
carotid sinus reflex
Which cranial nerves are being tested in the carotid sinus reflex?
CN IX (sensory) and CN X (motor)
Which visceral reflex is this?
-sensory and motor: S2-S4
-squeeze the head of the penis and anus tightens up “perianal wink”
bulbocavernous reflex
Which visceral reflex is this?
-sensory: pudendal n.
-motor: S2-S4
-sphincter relaxes for urination and evacuation
-sensory- urge to urinate
-motor- closing sphincters
-damage to the sacral plexus could result in the inability to hold urine
bladder and rectal reflex
What are the segments of the sympathetic NS?
T1-L2
