Reflexes - superficial, deep 1/11 Flashcards
What type of reflex?
- Must have intact sensory and motor spinal cord tracts
- Polysynaptic reflux
superficial reflex
How to grade superficial reflex?
Present or absent
Indicate abnormal response such as large difference between right and left side
What superficial reflex test spinal level T8 to L1? what is normal response?
abdominal reflex
Contraction of abdominal and deviation of umbilicus and direction of stimulus
What superficial reflex test CN5 and 7? what is normal response?
corneal blink reflex
Both eyes will blink with contact to eye
what directions do you give patient for corneal reflex?
look up and away from me
then stroke eye with cotton
What superficial reflex test spinal level L1-2? what is normal response?
cremasteric reflex
Brisk and brief elevation of ipsilateral testicle
What superficial reflex test CN9 and 10? what is normal response?
gag reflex
normal gag, may be absent in some pop
What superficial reflex test spinal level L5-S1? what is normal response?
plantar reflex
flexion of toes
abnormal babinski - toes splay
what cranial nerves does gag reflex test?
CN 9 and 10
what cranial nerves does corneal reflex test?
CN 5 and 7
what spinal levels does abdominal reflex test?
T8-L1
what spinal levels does cremasteric reflex test?
L1-2
what spinal levels does plantar reflex test?
L5-S1
purpose of Jendrassik maneuver?
Distract the patient, Decreased gaurding, and increase reflex activity
eg. interlock fingers and pull apart
what causes DTR?
Muscle contraction when muscle tendon is stimulated due to reflex arc involving spinal or brain stem segment in a rating specific muscles
how is DTR graded?
0-4 grade grade 0 = no response 1+ = diminished/depressed response 2+ normal 3+ brisk/exaggerated 4+ very brisk, hyperactive
what DTR grades are always abnormal?
0 and 4+
what is normal DTR grade?
2+
what spinal levels tested with biceps tendon? what do you hit with reflex hammer?
C5-6
thumb over biceps tendon at elbow
what spinal levels tested with brachioradialis tendon? what do you hit with reflex hammer?
C5-6
radius 1-2 inches superior to wrist
what spinal levels tested with triceps tendon? what do you hit with reflex hammer?
C6-7
directly above elbow
what spinal levels tested with patellar tendon? what do you hit with reflex hammer?
L3-4
inferior to patella
what spinal levels tested with achilles tendon? what do you hit with reflex hammer?
S1-2
flex foot to stretch achilles
strike achilles tendon above foot
where is the lesion?
absent DTR
sensory loss on nerve distribution
afferent arc of reflex - nerve or dorsal horn
where is the lesion?
absent DTR
paralysis, fasciculations, or atrophy in nerve distribution
efferent art of reflex - efferent nerve and/or anterior horn
Common etiologies of peripheral neuropathy?
Diabetes
Alcoholism
Vitamin deficiencies, eg. pernicious anemia vitamin B12
Certain cancers
Certain toxins-lead, arsenic, vincristine
