Papillary Light Reflex

Procedure for testing Pupillary Light Reflex: The Swinging light test (for the afferent pupillary defect)
- The Physiological basis of this test is the consensual light reflex. In normal or healthy eyes, both pupils must
constrict equally regardless of which eye is stimulated by the light. And when the light source is taken away, the
pupils of both eyes enlarge equally. If there is any abnormality within the said organ, there is less pupil
constriction in the eye with the retinal or optic nerve disease.

Steps:
 In a semi-darkened room, ask the patient to look at a distant object, which can either be a Snellen chart, or a
picture. This is to prevent the near-pupil response (a constriction in pupil size when moving focus from a distant
to a near object). While performing the test, take care not to get in the way of the fixation target.
 Move the whole torch deliberately from side to side so that the beam of light is directed directly into each eye. 
 Make sure to not swing the beam from side to side around a central axis because this can stimulate the near
response.
 Keep the light source at the same distance from each eye to ensure that the light stimulus is equally bright in both.
 Keep the beam of light steadily on the first eye for at least 3 seconds to allow the pupil size to stabilize.
 Move the light quickly to shine in the other eye. Again, hold the light steady for 3 seconds.
 Take note whether the pupil being illuminated stays the same size, or whether it gets bigger. Note also what
happens to the other eye.
 As there is a lot to look at, repeat the test, observing what happens to the pupils of both eyes when one and then
the other eye is illuminated
Expected Normal Response:
- When the light is shone into a
normal eye, both of the pupils
will further constrict, due to the
afferent pathway of the eye being
intact and less damaged than the
other eye.
KNEE JERK REFLEX ALSO KNOWN AS PATELLAR REFLEX

Procedure:
 The patient will sit on the exam table with his/her knee bent and foot hanging down, not touching the floor.
 Using a small hammer, the doctor will tap firmly on the tendon just below the patient’s kneecap.

Expected normal response:

- The patient’s knee will extend and lift the foot a little (a sudden kicking movement).

Abnormal Response:
- Exaggeration or absence of the reaction suggests that there may be damage to the central nervous system. The
knee jerk can also be helpful in recognizing thyroid disease.
Plantar Reflex
Procedure:

 Take the sharp end of a reflex hammer

 Stroke the sole of the patient’s foot, starting at the lateral aspect of the heel and moving along the lateral border of
the foot to the base of the fifth metatarsal bone and then onwards to the base of the big toe at the medial aspect of
the foot.
 Take note to not dig into the sole, but stroke.

Expected normal response:

- flexion of the toes and withdrawal of the foot

The abnormal response

- A slow extension of the big toe, combined with spreading of the other toes and flexion of knee and hip.
- This indicates the Babinski’s sign wherein it signifies a (severe) central disorder.

References:
Broadway, D. (2012)..How to test for a relative afferent pupillary defect (RAPD).Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3588138/
Ombregt L. (2013). Clinical examination of the cervical spine. Retrieved from
https://www.sciencedirect.com/topics/medicine-and-dentistry/plantar-reflex#:~:text=To%20test%20the%20plantar
%20reflex,toe%20at%20the%20medial%20aspect
Knee-jerk reflex(n.d.).Retrieved from https://www.britannica.com/science/knee-jerk-reflex