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    Reflexes

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    WanAlimin
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    Reflexes

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    WanAlimin
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    reflexes

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    reflexes

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    115 views7 pages

    Reflexes

    Uploaded by

    WanAlimin
    reflexes

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    REFLEXES

    Subconscious stimulus-response mechanisms. Act as defense mechanism.


    Ex. Corneal (blink), Nasal (sneeze).

    Activity 3 THE REFLEXES

    Important in the diagnosis and localization of neurologic lesion.

    5 Components of reflex arc


    Receptor Dendritic endings of a sensory neuron located within the skin, a tendon, joint, or other peripheral organ that responds to specific stimuli. Sensory neuron (afferent) extending from the receptor through the posterior root, the sensory neuron conveys the stimuli to the posterior horn of the spinal cord. Center The axon of a sensory neuron synapses with an association neuron within the H-shaped gray matter of the spinal cord.

    Motor neuron (efferent) beginning at the synapse with the association neuron, the motor neuron conveys impulses from the anterior horn of the spinal cord, through the anterior root, to the effector organ. Effector The muscle or gland that responds to the motor impulse by contracting or secreting, respectively.

    Assessment Techniques
    Reflexes are graded on a scale of 0 to 4. A stick figure typically appears in the chart to designate the elicited reflexes. 0 ............Not present 1+ ..........Present but diminished 2+.......... Normal 3+ ..........Hyperactive, may have clonus but not sustained 4+...........Hyperactive with sustained clonus

    Pontine level (brain) Jaw jerk


    Rest your thumb on the subjects middle chin with mouth slightly open in relaxed state. Tap your thumb using the reflex hammer. Grade the subjects reflex response.

    Jaw jerk reflex


    Trigeminal - CN 5 downward stroke on jaw

    Normal Response: Mouth closes as the masseter contracts and pulls the jaw upwards. the jaw should not deviate to either side. the jaw-jerk is usually weakly present. Abnormal Response:

    Masseter / Temporal M.

    Pons

    the masseter muscles will jerk the mandible upwards

    Masseter / Temporal M.

    the masseter muscles will jerk the mandible upwards If the jaw-jerk is exaggerated and brisk, it Indicates damage which occured to higher centers (upper motor neurons), the reflex arc is uninhibited and reflex is hyperactive. lesions affecting the pyramidal pathways above the 5th nerve motor nucleus, especially if the lesions are bilateral. Absence of reflex may be due to pathology along the course of CN 5.

    C2-C3 Neck muscles


    Ask the subject to extend his neck backward and bow his neck forward. Note for jerky movements of the head.

    Neck muscles reflex


    Cervical C2 C3 N Head drop forward

    Sternocleidomastoid (SCM) muscle spindle

    C2 C3 level

    Head jerks upward (SCM and trapezius flex)

    SCM and Trapezius

    C4 Diaphragm percussion
    Ask a male subject to lie flat on his back on table or floor. Gently expose and locate his diaphragm. Put your left forefinger and middle finger together on the diaphragm and gently tap the two fingers using your right forefinger and middle finger together. Is there any wavelike movement in the abdomen? Describe and grade the response.
    Tapping diaphragm

    Diaphragm percussion
    Phrenic nerve (C4)

    Diaphragm muscle C4 level

    Wavelike movement in the abdomen

    Diaphragm muscle

    C5 Deltoid (pectoralis) reflex


    Ask the subject to lift his arm slightly and put your thumb in anterior fold of axillary fossa. Locate the deltoid muscle and pull up slightly to stretch the pectoralis tendon (reference point: axillary region). Tap using a reflex hammer. Grade the response.

    Pectoralis reflex
    Pectoral Nerve Tapping axillary region

    Pectoralis C5 level

    Pectoral muscle contraction

    Pectoralis

    C6 Biceps reflex and Brachioradialis reflex


    A. Biceps Reflex Ask the subject to either sit or recline. Tap your thumb over the biceps tendon (reference point: antecubital fossa, opposite to elbow joint). Grade the response

    A. Biceps reflex
    Musculocutaneous N. Tapping biceps tendon (antecubital fossa)

    B. Brachioradialis reflex
    Ask the subject to sit with arms flexed while resting on the arm rest of the chair. Hold the wrist (dorsal position) and elevate the forearm slightly and tap over the brachioradialis tendon (reference point: dorsal side of the forearm) on the medial aspect of the forearm and midway between elbow and wrist. Grade the response.

    biceps tendon C6 level

    Biceps Bicep muscles connected towards the elbow contract.

    B. Brachioradialis reflex
    Tapping Brachioradialis tendon
    (dorsal side of the forearm)

    Radial N.

    Brachioradialis tendon C6 level

    Brachioradialis muscles connected towards the elbow contract

    Brachioradialis

    C7-C8 Pronator (wrist) reflex


    Ask the subject to sit, arm flexed and slightly pronated. Tap the radial prominence on the palmar surface while holding the subjects hand; feel and observe the pronation.

    Pronator / Wrist reflex


    Median N. Tapping the radial prominence

    Pronator quadratus C7, C8

    Forearm pronates

    Pronator quadratus

    C6-C8-T1 Finger-flexor reflex


    Ask the subject to sit and rest his arm on supine position. Place the fingers in slightly flexed position. Place your finger across the palmar surface of the subjects finger. Tap your finger while observing the flexion response of each subjects finger.
    Tapping palmar surface

    Finger-flexor reflex
    FDS Median N. FDP Ulnar N.

    - Flexor digitorum superficialis (FDS) - Flexor digitorum profundis (FDP)

    C6-C8-T1

    Flexion of fingers

    FDS/ FDP

    T1-T8 Thoracic expansion


    Ask the subject to inhale and exhale at normal breathing. Note the movement of the chest, and symmetry of chest in equal or deviated symmetry. Ask the subject to inhale deeply and exhale at his maximum. Again, note the chest observations.
    Inhalation / Exhalation

    Thoracic expansion
    Intercostal N./ Phrenic N .C4

    Thoracic M. Diaphragm M. T1-T8, C4

    Contraction of thoracic M/ diaphragm Raised rib/ diaphragm lowered Relaxation of thoracic M/ diaphragm lowered rib/ diaphragm raised

    Thoracic M. Diaphragm M. inhalation

    exhalation

    T9-T10 Upper abdominal reflex


    Ask the patient to lie on supine position. Using one of your hands place on top of the subjects upper abdomen, pull down the abdomen and laterally to one side of the subjects body. Tap your fingers (percussion) over the hand and feel the contraction underneath. Is it hypoactive or hyperactive contraction?

    Upper abdominal reflex


    T7, 8, 9, 10 Tapping upper abdomen

    Upper Abdominal Muscles

    T7, 8, 9, 10

    Contraction of abdominal muscles

    Upper Abdominal muscles

    L1-L2 Lower extremity adductor reflex


    Ask the subject to recline with arms supporting in laid back position. Relax and extend his legs. Place a hand over the medial lower thigh, place your hand over the muscle and tap over your fingers. Observe for the thigh adduction.
    Tapping medial lower thigh

    Adductor reflex
    Obturator N.

    Adductor M. L1, L2

    Adducts the thigh at the Hip joint

    Adductor M.

    L3-L4 Quadriceps or patellar reflex


    Ask the subject to either sit or recline. Support your hand on the lower thigh, tap below and above the patella (suprapatellar) and observe leg extension. Grade the response.

    Patellar reflex
    Femoral N. Tapping patellar tendon

    L5-S1 Hamstring reflexes


    Ask the subject to recline with one leg hanging, slightly externally or internally rotate and flex the subjects leg, place your finger over the medial or lateral tendon (the tendons are boundaries of the popliteal fossa or alak-alakan). Tap just above the popliteal fossa. Grade the response.

    Quadriceps femoris L2, L3, L4

    Extension of leg

    Quadriceps femoris

    Hamstring reflex
    .Tibial N, Tapping popliteal fossa

    S1 - Achilles reflex (ankle jerk)


    Ask the subject to sit or recline, partially dorsiflex the ankle with one hand, tap the Achilles tendon. Observe the reflex excursion. Grade the response.

    Hamstring L5, S1

    Leg flexion

    Hamstring

    Achilles reflex
    Tibial N. Tapping Achiles tendon

    Gastrocnemius -soleus S1

    Plantar flexion of the foot

    Gastrocnemius -soleus

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