Reflexes

Question 1

Why do we test reflexes?

Answer 1

To assess the health and function of the nervous system, specifically the peripheral and central nervous systems, and to help pinpoint the location of potential neurological lesions or damage

Question 2

How do we grade reflexes?

Answer 2

Reflex grading scale 0-4+

0 = absent
1+ = hypoactive
2+ = normal
3+ = hyperactive without clonus
4+ = hyperactive with clonus

Question 3

What could a hypoactive or absent reflex indicate?

Answer 3

An injury or disease involving an LMN (nerve roots or peripheral nerves)

Question 4

What could a hyperactive reflex indicate?

Answer 4

A lesion or injury involving an UMN (brain, brainstem or spinal cord)

Question 5

What are the basic upper limb reflexes?

Answer 5

Biceps (C5)
Brachioradialis (C6)
Triceps (C7)

• Palpate tendon & use a reflex hammer

Question 6

What are the basic lower limb reflexes?

Answer 6

Patellar tendon (L3/L4)
Achilles (S1)

• Palpate tendon & use a reflex hammer

Question 7

What are the pathological upper limb reflexes?

Answer 7

Pronator drift
- test for a UMNL
- Arms at 90* in front
- Palms supinated
- Hold position for 30s with eyes closed
- +ve test = pronation

Hoffman’s reflex
- Test for a UMNL
- Flick the finger nail of middle finger downward
- +ve test = involuntary flexion & adduction of thumb/index finger

Clonus
- Test for a UMNL (hyperactive)
- Extend wrist 5x to relax
- Briskly extend wrist & hold in that position
- +ve test = spasticity

Question 8

What are the pathological lower limb reflexes?

Answer 8

Ankle clonus
- Test for UMNL (hyperactive response)
- Dorsiflex foot 5x to relax
- Briskly dorsiflex foot & hold in that position
- +ve test = spasticity

Babinski’s plantar response
- Test for UMNL
- Stroke the lateral outer sole of foot with a blunt object
- +ve test = big toe extends upwards & other toes flare out
- Consider that Babinski’s reflex is a normal finding in infants as their NS is still developing