ASSESSING THE REFLEXES o Efferent neuron

o Effector
➢ can be done for both pediatric
and adult clients Bell-Magendie Law
➢ assesses the neurologic
➢ Charles Bell and Francois
function (sensory-neuro)
Magendie, French doctors
➢ The spinal nerves’ anterior
roots consist of the motor
Anatomy and Physiology of a fibers while the
Reflex posterior/dorsal roots would
➢ basic unit of an integrated contain the sensory fibers.
reflex activity ➢ The movement of nerve
impulses go only in ONE
DIRECTION.
➢ States that:
o Dorsal roots =
SENSORY
o Ventral roots = MOTOR

➢ important areas in the CNS in

the affectation any
stimulation that might be
occurring to the patient
➢ neural pathway = reflex arc
➢ sensory neuron enters via the
dorsal column/horn of the Different
spinal cord Reflexes/Manifestations
➢ Afferent neurons = sensory
1. Stretch Reflex
neurons
➢ Efferent neurons = motor
neurons

Reflex Arc
➢ Consists of:
o Sense organ
o Afferent neuron
o Central integration
station
 ➢ When a skeletal muscle with o Characterized by:
an intact nerve supply is ▪ Contraction
stretched, it contracts. (flexor muscles)
➢ Typified (represented) by the ▪ Inhibition
knee jerk reflex (extensor
➢ Using reflex hammer, muscles)
checking on the reflexes in ▪ Extension of
the upper and lower opposite limb
extremities (crossed
➢ Ex. Deep tendon reflex extensor
response)

2. Withdrawal Reflex
Measuring reflexes (Degree of
activity)
➢ Grading the Reflex

➢ Typical response to a painful

stimulation of the skin or Deep Tendon Reflexes
subcutaneous tissues and N: +1, +2, +3
muscles
➢ Ex. Touching the flame of a ➢ Unless asymmetric (di-
candle pantay ang strength ng reflex
➢ Prepotent response of both extremities) or drastic
o Permits an individual difference between arms and
to inhibit their legs appears.
impulses and
AbN: 0, +4, +5
natural/dominant
behavioral response
o Pre-empts other reflex
activities taking place Abnormalities in Reflexes
at the moment 1. Hyperactive
o Similar to an override
o Increases chance of ➢ Suggests CNS disease
survival or getting ➢ Sustained clonus confirms it
away from nociceptive o Clonus – muscular
stimuli spasm involving a
 repeated and often tested by raising the
rhythmic contraction limb very slightly
▪ Spasms are ▪ You may raise
involuntary and the limb with
caused by your non-
permanent dominant hand
damage to the o Testing arms:
nerve fibers that ▪ Clench teeth
communicate ▪ Squeeze one
between the thigh with the
brain and the opposite hand
muscular system • In testing
for
2. Diminished or absent
brachio-
➢ Relevant spinal segment radialis
damage reflex
➢ Peripheral nerve damage o Testing legs:
➢ Muscle disease ▪ Lock fingers
➢ Neuromuscular junction (pulling one
problems (Myasthenia hand against the
Gravis, Guillain-Barre other)
Syndrome, and other ▪ During DTR
autoimmune syndromes that testing in lower
affect nerves) limbs

Deep Tendon Reflexes THE REFLEXES

Principles: Adult Reflexes
➢ Use just enough force 1. Biceps Reflex
needed to provoke a definite 2. Triceps Reflex
response 3. Supinator or (Brachioradialis
➢ Check BOTH sides to se Reflex)
symmetry 4. Abdominal Reflex
➢ Differences between sides 5. Knee or Patellar Reflex
are usually easier to assess 6. Ankle Reflex
than symmetric changes 7. Plantar Reflex
➢ Quality of equipment also
matters! Spinal Root Involvement
➢ The motion of wrist should
bounce back. Dili mag Reflex Main Spinal Roots
Involved
martilyo (Jaictin, 2021).
Biceps C5, C6
➢ Example of reinforcement:
Brachioradialis C5, C6
o To have proper result Triceps C7, C8
o Have patient gently Abdominal T8-T12
contract muscle being Above umbilicus T8-
T10
 Below umbilicus ➢ Strike in line with the thumb
T10-T12 ➢ Strike radius about 1 -2
Patellar L2,L3,L4 inches above the wrist
Achilles S1 ➢ Watch for flexion and
Tendon (Ankle) supination of the forearm
Plantar L5,S1
response 3. Abdominal Reflex
➢ T8, T9, T10, T11, T12
1. Biceps Reflex ➢ Can also be done to pedia
clients
➢ C5, C6 ➢ Elicit reflex by lightly but
➢ Arm should be partially briskly stroking each side of
flexed at the elbow with palm the abdomen above and
down below the umbilicus
➢ Strike aimed directly o Abdominal muscles
through your digit toward should react
the biceps tendon
➢ Observe for flexion of the
elbow
➢ Watch and feel for the
contraction of biceps muscle
➢ Hit near the antecubital
space
2. Triceps Reflex
➢ C7, C8
➢ Better if client is in sitting
position (can be done lying
down) ➢ Use key, wooden end of
➢ Flex arm at the elbow with cotton applicator, tongue
palms towards the body blade twisted and split
➢ Pull it slightly across the longitudinally
chest ➢ T8 – T10 = ABOVE
➢ Strike just above elbow UMBILICUS
➢ If with difficulty getting ➢ T10 – T12 = BELOW
patient to relax, try UMBILICUS
supporting the arm ➢ Note contraction of the
➢ Triceps muscle, extension at abdominal muscle and
the elbow deviation of umbilicus
3. Supinator (Brachioradialis) towards the stimulus
Reflex ➢ Obesity may mask
abdominal reflex
➢ C5, C6
4. Knee (Patellar) Reflex
➢ Hands should rest on the
abdomen or the lap ➢ L2, L3, L4
➢ With the forearm partly
pronated
 ➢ Patient may be either sitting
or lying down as long as the
knee is flexed.
o Usually done while
client is sitting,
➢ Briskly tap the patellar
5. Plantar Response
tendon
➢ Wider portion of the reflex
hammer = Brachioradialis
➢ Pointed portion of reflex
hammer = Patellar, biceps,
triceps
➢ A hand on the patient’s
anterior thigh let’s you feel
this reflex
o Hold the popliteal area
o Tap on the patellar
bone (the knee cap)
Further Testing
1. Test for ankle clonus
➢ Noe the contraction of the
quadriceps with extension of
the knee
5. Ankle Reflex
➢ Primarily S1
➢ If patient is sitting, dorsiflex
the foot at the ankle.
➢ If patient is lying down, flex
one leg at both hip and knee
and rotate it externally so
that the lower leg rests
across the opposite shin.
➢ Strike the Achilles tendon
➢ Watch and feel for plantar
flexion at the ankle.
➢ Note speed of relaxation
➢ Slowed relaxation phase of
reflexes in
HYPOTHYROIDISM is often
easily seen and felt in the
ankle reflex.
➢ L5, S1
➢ Elicit reflex by stroking the
lateral aspect of the sole
o Stroking by forming an
inverted J
➢ From heel to the ball of the
foot, curving medially across
the ball
➢ Use pointed object in
stroking
➢ Inverted “J” stroke
➢ AbN: Babinski Reflex – toes
fan out just like that of the
infants
o N: For infants below 1
year old
➢ If reflexes are hyperactive,
test for ankle clonus
➢ Support knee in partially
flexed position
➢ Dorsiflex and plantarflex foot
alternately a few times
(using your other hand)
➢ Then sharply dorsiflex foot
and maintain it.
 ➢ Look and feel for 1. Sucking reflex
rhythmic oscillations
between dorsiflexion and
plantar flexion
o Clonus if present
when the foot is still
shaking or moving
even though you are
not dorsiflexing and
plantarflexing
anymore.
➢ N: Ankle does not react to
➢ A feeding reflex that occurs
this stimulus
when infant’s lips are
o A few clonic beats
touched.
may be seen and
➢ Persists throughout infancy
flet, especially when
o 0-1 year old
patient is tense or
➢ Newborns cannot yet see
exercised.
➢ To test if baby can latch on
➢ AbN: Sustained clonus
to mother’s breast for
o Indicate CNS
breastfeeding
disease
2. Rooting reflex
➢ A feeding reflex elicited by
Newborn Reflexes touching the baby’s cheek
1. Sucking reflex causing the baby’s head to
2. Rooting reflex turn to the side that was
3. Moro (or Startle) reflex touched.
4. Palmar grasp reflex ➢ Disappears after 4 months
5. Plantar reflex ➢ Also tests for breastfeeding
6. Tonic Neck (or Fencing) reflex 3. Moro (Startle) reflex
7. Stepping (or Walking/Dancing)
reflex ➢ Let go of baby (but support
8. Babinski reflex head)
9. Blinking reflex
10. Neck righting reflex
11. Landau reflex
12. Parachute reflex
 “Ma, ngano ko nimo gibuy-
an?!” 5. Plantar reflex
“From the top, make it drop!” ➢ Similar to the palmar grasp
➢ Often assessed to estimate reflex, an object placed just
the maturity of the CNS beneath the toes causes them
➢ A loud noise, a sudden to curl around it.
change in position, an o Can also be done by
abrupt jarring of the crib stroking the soles
elicits this reflex. ➢ Disappears after 8 months
➢ N: Baby should be startled
(makuratan) 6. Tonic Neck (or Fencing) reflex
o Arms should extend up ➢ A postural reflex
as if falling ➢ When a baby who is lying on
o Legs should also its back turns its head to the
extend RIGHT SIDE, for example the
➢ Infant reacts by extending LEFT SIDE of the body shows
both arms and legs outward flexing of the left arm and the
with the fingers spread, then left leg.
suddenly retracting the ➢ Disappears after 4 months.
limbs.
➢ Often the infant cries at the
same time
➢ Disappears after 4 months
4. Palmar Grasp reflex
➢ Occurs when a small object is
placed against the palm of
the hand, causing the fingers
to curl around it.
➢ Disappears after 3 months

“BUY-I AKONG ULOOO!”

7. Stepping (or Walking/Dancing)
reflex
➢ Hold the baby upright so that
the feet touch a flat surface.
 ➢ The legs then move up and 10. Neck Righting reflex
down as if the baby were
➢ Head to turned to side where
walking
body is rotated
➢ Disappears after 2 months

“Ma! Uli na ta!”

11. Landau reflex
8. Babinski Reflex
➢ Suspend horizontally against
➢ Sole of the foot is stroked, the truck and neck flexed, leg
big toe rises and the other will flex and be drawn up to
toes fan out the trunk
o Inverted “J”
➢ (+) Babinski
➢ After age 1, the infant
exhibits a (-) Babinski
o Toes curl downward
➢ (+) Babinski after age 1
indicates brain damage
9. Blinking reflex
➢ Occurs in the presence of a
light or loud noise
➢ Baby blinks when there is a
noise

“Swimming lessons, ganern?”

“Pre, naka lima ko na botilya
kagabii – botilya sa gatas.”
 ➢ When neck is pushed down,
baby will place legs down
also
12. Parachute reflex
➢ Baby is held prone and
lowered quickly towards a
surface
➢ Arms and legs will extend (as
if trying to break a fall)

“Pa, kung ako mahag-bong bantay

jud kang Mama!”

God bless and good luck sa exams!

“Hardwork + Prayer = Success”