Reflexes

Yara George Abdou

Date: 15. 04.2009
Lecture: physiology lab
Done by: Yara George Abdou

In this lab, we will talk about reflexes and demonstrate some of them..

 What is a reflex, and whats a reflex arc?

Reflex is a fast, spontaneous response to a stimulus.

Reflex arc or reflex circuit consists of:

1. Sensory receptor
2. Sensory neuron
3. Integration centre (spinal chord or brain stem)
4. Motor neuron
5. Effector (muscle)

 Types of reflexes:

We have two types of reflexes, depending on where you elicit the reflex:
1. superficial reflexes
2. Deep reflexes

 Lets start with the superficial reflexes:

These are excited by stimulation of a structure on the surface of the body. Their
reflex arc consists of more than one synapse, thus they are considered polysynaptic.

Eg1: Abdominal reflex: scratching the abdomen around the umbilicus will lead to
contraction of the abdominal wall muscles.
Eg2: Cremasteric reflex (in males) : scratching the inner thigh, will lead to elevation of
the scrotum.
Eg3: corneal reflex: touching the cornea will lead to a blinking response, or closure of
the eye.
  Now, we come to the more important reflexes which are the deep reflexes:
Here we are exciting deep structures in the body.

Best example is the stretch reflex ( sometimes called the “tendon jerk” , because we
are striking the tendon). This is the only example in our body, where we have one
synapse, which means there is direct contact between motor and sensory neurons.

Receptor circuit:
1. Receptor (muscle spindle)
2. Sensory neuron
3. Integrating centre
4. Motor neuron
5. Effector

 If you stretch a muscle, this leads to stretching of the muscle spindle, and that
muscle will respond by contraction.
 It is an involuntary spontaneous response to a stimulus. Its reflex circuit consists of
two neurons and one synapse. (Monosynaptic)
 Logically, in real life, we can’t take the muscle and stretch it by our hand, therefore
we use the “hummer” to strike the tendon of the muscle. This striking will lead to
sudden stretching of the muscle and the response will be contraction.
 All skeletal muscles can show this deep/stretch reflexes. Best examples are the
quadriceps muscle, the gastrocnemius muscle, the biceps and triceps muscles.

 Jendrassik maneuver

When reflexes are hard to elicit, we use a mechanism of exaggeration called “the
Jendrassik maneuver”. Eg: if you want to increase the lower limb reflexes, you clasp
your hands and interlock your fingers, then try to pull them apart strongly. This will
increase the lower limb reflexes.
Similarly, to increase the upper limb reflexes, you interlock your legs and press hardly.

Bases of Jendrassik maneuver:

Muscle spindle is the receptor that detects the stretching of the muscle, but at the
same time, it has a contractile element. This contractile element is found at both ends
of the muscle spindle. When they contract, they stretch the middle part of the muscle
spindle, which acts as the receptor. This will increase the action potential generated
from this receptor.
These contractile elements are supplied by the “gamma motor fibers”. And the
extrafusal muscle fibers are supplied by the “alpha motor fibers”. So by contracting the
muscles of the hand for example, we send afferent impulses, that will increase the
alpha motor neuron activity, and this will stretch the muscle spindle, and increase the
sensitivity of the muscle spindle, thus increasing the reflex response

 Abnormalities of deep reflexes

Reflexes are important because they tell us a lot about the nervous tissue.
Reflexes can be increased (exaggerated) or decreased (depressed).

Exaggeration of reflex (hyper reflexia):

sign of upper motor neuron lesion. (area above the synapse with the anterior motor
neuron. see fig 54-1 guyton, pg 674)

Depression of reflex:
Damage in any part of the reflex circuit/arc leads to depression of the reflex.
Now this reflex depression depends on which part of the reflex arc is affected :
 damage in the spinal chord (lower motor neuron lesion, eg: the loss of biceps
reflex: means abnormality in C5-C6 area at the anterior motor neuron synapse)
 damage in the sensory fiber
 damage in the motor fiber
 damage in the muscle itself (myopathy)
 damage in the neuromuscular junction, etc.

Another abnormality is the isolated loss of deep reflex:

Knowing the spinal chord level of the reflex is important, because it gives us an idea
about the level of abnormality.
Eg: loss of biceps reflex: means abnormality in C5-C6
loss of triceps reflex: means abnormality in C6-C7
loss of knee reflex: means abnormality in L2-L4
loss of ankle reflex: means abnormality in L5-S2

Anxiety: if a person is anxious, the reflexes will be increased.

 Sensory system

 We have many types of sensations (pain, touch, vibration, etc)

 Damage in the sensory tract will lead to sensation lost. These sensations must be
examined to check our sensory system.
Tests performed to check our sensory system:

1. Pain sensation: we elicit a painful stimulus, using a pin. (always compare the two
collateral sides, by eliciting the painful stimulus on both hands.)
2. Touch sensation: use brush or cotton to touch the patient at different parts of
the body.

Dermatome: areas in the skin supplied by certain segments of the spinal chord. Eg:
shoulder is supplied by C4, so if the shoulder shows less sensation, then C4 segment is
affected.
3. Position sensation: ability to tell the exact position of different parts of the
body. Usually the big toe is dorsi flexed, plantar flexed or moved laterally, and
the patient is asked if he can identify the position of his toe.
4. Stereognosis: ability to identify familiar objects by feeling the object, without
looking at them. Astereognosis is the loss of this ability, which suggests a
damage in the parietal lobe.
5. Graphesthesia: ask the patient to close their eyes, and write on the palm of
their hand simple numbers or letters. Agraphesthesia, is when there is no such
sensation.
6. Extinction: gives us an idea about the whole sensory system. Ask the patient to
close their eyes, and touch two different points in his body at the same time.
Then ask the patient to identify where he has been touched. Inability to do so
suggests that extinction is present.

 Two point discrimination test

 Using a caliper, with a certain distance between its two points, we test if the patient
can recognize these two points as two different points.
 This depends on the density of the receptors in that area, the more the density, the
less is the distance required between the two caliper points to be identified as
different points.
 Eg: in the finger tips, a distance of 1cm is needed by the caliper between its 2 parts ,
to identify the two points, this is because there is high concentration of sensory
receptors in that area. While he may feel the pain as one point, in his shoulder for
example, and that’s because of less concentration of receptors there. Thus a greater
distance between the caliper points is needed to be identified as two points in the
shoulder.
 Also damage to an area, leads to loss of its receptors, and this leads to the
requirement of a greater caliper distance.
 This actually depends on whether you are stimulating one or two neurons. If these two
caliper points have fallen on a receptive field of one neuron, then its felt as one point.
If they have fallen on two receptive fields with different neurons, then its felt as two
points.

Reflex demonstration
Demonstrating the reflexes is by striking the tendon of the muscle, which leads to
stretching of the muscle.

1. Knee jerk: the lower leg hanging freely off the edge of the bench, the knee jerk
is elicited by striking the quadriceps tendon directly with the hammer.
2. Ankle jerk: dorsi flex the patient’s foot, and then this reflex is elicited by
striking the Achilles tendon with the hammer and noting plantar flexion.
(contraction of the gastrocnemius)
3. Biceps jerk : semiflex the patient’s arm and then place your thumb on the biceps
tendon, and elicit the reflex by indirectly striking your thumb with the hammer.
4. Triceps jerk: strike the triceps tendon directly, and note the extension of the
arm.
5. Pupillary Light reflex: shine a light on the eye of the patient, and note the
constriction of the pupil.
Its Reflex arc: cons and rods in the retina(receptors)  optic
nerve(sensory)brain stem(center)parasympathetic fibers (motor)
6. Accommodation reflex: focus on a distant object and then shift to a near focus,
then notice the changes in the eye, these changes consist of 3 components :
 Papillary constriction.
 Convergence of the eye ball (it goes medially )
 Increase convexity of the lens.

7. Corneal reflex (superficial): place your finger in the patient’s eye, and notice how
he blinks as a protective reflex.
8. Palatal reflex (superficial reflex): if you stimulate the hard palate, the response
will be closure of the mouth. (also called suckling reflex) but if you stimulate the
soft palate, it will lead to elevation of the uvula.
9. Gag reflex: if you stimulate the pharynx (also superficial)
10. Babinski reflex : scratching the sole of the foot at the lateral border, will lead
to plantar flexion and adduction of the toes. This is a normal negative babinski
response.
An abnormal positive babinski response, is when the patient responds to the
stimuli by dorsiflexion and abduction of the toes (fanning of the toes).
 Positive Babinski reflex is considered normal in children in their first few years ,while
in adults its considered damage to the pyramidal tract fibers.

Done by :
Yara George Abdou