University of Santo Tomas

College of Nursing

Assessment of
Neurologic
System
 Anatomy and Physiology

Nervous System

Central Nervous System Peripheral Nervous System

(Brain and Spinal Cord) (Cranial and Spinal Nerves)

Somatic Autonomic
(Voluntary) (Involuntary)

Sympathetic Nervous System Parasympathetic Nervous System

Neurons
Neuroglia
 Neurotransmitters
Acetylcholine Major areas of the brain; Usually excitatory
autonomic nervous system

Serotonin Brain stem, hypothalamus, Inhibitory; helps control

dorsal horn of spinal cord mood and sleep

Dopamine Substantia nigra and basal Usually inhibitory;

ganglia affects behavior and
fine motor
Norepinephrine Brain stem, hypothalamus Usually excitatory

Gamma- Spinal cord, cerebellum, Inhibitory; muscle and

aminobutyric basal ganglia nerve transmission
acid (GABA)
Enkephalin, Nerve terminals in the spine, Excitatory; pleasurable
Endorphin brain stem, thalamus, sensation; inhibits pain
pituitary gland transmission
CENTRAL NERVOUS SYSTEM

Brain
Brain

 It is approx. 2% of the total body weight

 It weighs approx. 1400 g in an average
young adult
 In weighs an average of 1200 g in the
elderly
 It is divided into three major areas:
cerebrum, brain stem and the cerebellum
Cerebrum
 Cerebrum

 It consists of two hemispheres that are incompletely

separated by the great longitudinal fissure
 It is separated into right and left hemispheres by sulcus
 It is joined at the lower portion by corpus callosum
 It has wrinkled appearance due to presence of folded
layers or convolutions called gyri
 It has an external of outer portion made up of gray
matter approx. 2 to 5 mm in depth and is made up of
billions of neurons and cell bodies
 It has an innermost layer made up of white matter and
is composed of nerve fibers and neuroglia
 Four Lobes of the Cerebrum

Frontal Lobe
 Largest lobe

 Controls concentration, abstract thought,

information storage or memory, and motor
function
 Contains Broca’s area, a speech association
area that participates in word formation
 Responsible for large part of individual’s
affect, judgment, personality and inhibitions
Parietal Lobe
 Predominantly a sensory lobe

 Contains primary sensory cortex, which

analyzes sensory information and relays the
interpretation of this information to the
thalamus and other cortical areas
 Controls awareness of the body in space,
orientation in space and spatial relations
Temporal Lobe
 Contains auditory receptive areas

 Contains a vital area called interpretative

area, which provides integration of
somatization, visual and auditory areas

Occipital Lobe
 Contains visual areas, which play
important role in visual interpretation
Other Areas of Cerebrum

Corpus Callosum
 Thick collection of nerve fibers that
connects the two hemispheres of the brain
and is responsible for the transmission of
information from one side of the brain to
the other
 Information transferred is sensory,
memory and learned discrimination
Basal Ganglia
 Masses of nuclie located deep in the
cerebral hemispheres
 Responsible for motor control of fine body
movements
Thalamus
 Lies on either side of the third ventricle

 Acts primarily as a relay station for all

sensation except smell
 All memory, sensation and pain impulses
pass through this section
Hypothalamus
 Located anterior and inferior to the thalamus

 It includes the optic chiasm and mamillary

bodies
 Plays a role in the regulation of pituitary
secretion of hormones that influence
metabolism, reproduction, stress response and
urine production
 Called as hunger and satiety centers

 Regulates sleep-wake cycle, blood pressure,

aggressive and sexual behaviors, and emotional
responses
Pituitary Gland
 Located at the sella turcica at the base of
the brain
 Divided into anterior and posterior sections
which secrete hormones necessary in
maintaining life
Brain Stem
 Brain Stem

 Contains the midbrain, pons and medulla

oblongata
 The midbrain contains sensory and motor
pathways and serves as the center for auditory
and visual reflexes
 The pons contains motor and sensory
pathways, and controls the heart, respiration
and blood pressure
 The medulla oblongata transmits both
sensory and motor fibers, and is the body’s
respiratory center
Cerebellum
Cerebellum

 Separated from the cerebral hemispheres

by a fold of dura matter, the tentorium
cerebelli
 Has both excitatory and inhibitory actions
and is largely responsible for coordination
of movement
 Controls fine movement, balance, position
sense and integration of sensory input
Structures Protecting the Brain

Meninges
 Fibrous connective tissues that cover the
brain and spinal cord
 Provides protection, support and
nourishment to the brain and spinal cord
 Composed of dura mater, arachnoid and pia
mater
Dura mater
 Outermost layer

 Tough, thick, inelastic, fibrous and gray in

color
 Has four extensions: falx cerebri,
tentorium, falx cerebelli and
diaphragma sellae
Arachnoid
 Middle membrane

 Extremely thin, delicate membrane which

resembles a spider web
 Appears white because of absence of blood
supply
 Contains the choroid plexus, which
produces the cerebrospinal fluid (CSF)
 Contains arachnoid villi, which absorb CSF
Pia mater
 Innermost membrane

 Thin, transparent layer that hugs the brain

closely and extends into every fold of the
brain’s surface
 Cerebrospinal Fluid (CSF)
 Clear and colorless fluid with a specific gravity of
1.007
 Cushions and nourishes the brain
 Produced in the ventricles and is circulated around
the brain and the spinal cord by the ventricular
system
 The organic and inorganic contents of CSF are
similar to those of plasma but differs in
concentration
 Analyzed for presence of protein, glucose, chloride
and immunoglobulins
 Normally contains minimal number of WBCs and
no RBCs
Cerebral Circulation
 The brain requires 20% of the oxygen of
the body
 The brain requires 65-70% of the glucose
in the body
 The brain requires 1/3 of the cardiac output
 The brain does not store nutrients and has
a high metabolic demand that requires high
blood flow
 The brain lacks additional collateral blood
flow, which may result in irreversible
damage when blood flow is occluded
Arterial Supply

 The arterial blood supply to the brain is

provided by two internal carotid arteries
and two vertebral arteries
 At the base of the brain, a ring is formed
between the vertebral and internal carotid
arterial chains called circle of Willis
 The arterial anastomosis along the circle of
Willis is a frequent site of aneurysms
Clipping of Aneurysm
Craniotomy
Venous Drainage
 The veins of the brain reach the brain’s
surface and join larger veins which empty
into the dural sinuses
 Dural sinuses are vascular channels lying
within the tough dura mater
 The network of the sinuses carries venous
outflow for the brain and empties into the
internal jugular veins, which return the
blood into the heart
 Cerebral veins and sinuses are unique
because they don’t have valves
Blood-Brain Barrier

 Formed by the endothelial cells of the brain

capillaries, which form continuous tight
junctions, creating a barrier to macro
molecules and many compounds
 All substances entering the CSF must filter
through the capillary membranes of the
choroid plexus
 Often altered by trauma, cerebral edema
and cerebral hypoxemia
Spinal Cord
 Spinal Cord
 Serves as a connection between the brain and
the periphery
 Approx. 45 cm (18 in) long and about the
thickness of a finger
 Extends from the foramen magnum at the base
of the skull to the lower border of the first
lumbar vertebra, where it tapers to a fibrous
band conus medullaris
 Below the second lumbar space are nerve roots
that extend beyond the conus, which are called
cauda equina
 Contains gray matter, located at the center,
and white matter on its sides
Sensory and Motor Pathways:
The Spinal Tract
 Fiber bundles with a common function are
called tracts
 There are six (6) ascending tracts
conducting sensation such as perception of
touch, pressure, vibration, position and
passive motion from the same side of the
body
 Ex. Spinocerebellar tracts - conduct
sensory impulses from muscle spindles,
providing necessary input for coordinated
muscle contraction
 There are eight (8) ascending tracts, seven
of which are engaged in motor function
 Examples:
1. Corticospinal tracts (2)– voluntary muscle
activity
2. Vestibulospinal tracts (3)– autonomic
functions such as sweating, pupil dilation and
circulation
3. Corticobulbar tract – voluntary head and
facial muscle movement
4. Rubrospinal and reticulospinal tracts -
involuntary muscle movement
Vertebral Column
 Surrounds and protects the spinal cord and
consists of 7 cervical, 12 thoracic, 5
lumbar and 5 sacral
 Nerve roots exit from the vertebral column
through the intervertebral foramina
 Separated by disks, except for the first and
second cervical, sacral and coccygeal
vertebrae
 Each vertebra has a ventral solid body and
a dorsal segment or arch, which is posterior
to the body
PERIPHERAL NERVOUS SYSTEM

Cranial Nerves
 There are 12 pairs of cranial nerves that
emerge from the lower surface of the brain
and pass through the foramina in the skull
 Three (3) are entirely sensory ( CN I, II,
VIII), five (5) are motor (CN III, IV, VI)
and four (4) are mixed (CN V, VII, IX, X)
 They are numbered in the order in which
they arise from the brain
 Cranial Nerves
Cranial Nerves Functions Abnormal Findings

I. Olfactory Smell Anosmia

(absence of smell)

II. Optic Vision Papilledema; blurred

vision; scotoma;
blindness
III. Oculomotor Pupil constriction; Anisucuria; pinpoint
elevation of upper lid pupils; fixed, dilated
pupils
IV. Trochlear Eye movement; Nystagmus
controls superior
oblique
V. Trigeminal Controls muscles of Trigeminal neuralgia
mastication; (Tic douloureux)
sensations for the
entire face
VI. Abducens Eye movements; Diplopia; ptosis of the
controls the lateral eyelid
rectus muscle

VII. Facial Controls muscles for Bell’s palsy; ageusia

facial expression; (loss of sense of taste)
anterior 2/3 of the on the anterior 2/3 of
tongue the tongue

VIII. Acoustic/ Cochlear branch Tinnitus; vertigo

Vestibulocochlear permits hearing;
vestibular branch
helps maintain
equilibrium
IX. Glossopharyngeal Controls muscles of the Loss of gag reflex;
throat; taste of posterior drooling of saliva;
1/3 of the tongue dysphagia; dysphonia;
posterior third ageusia
X. Vagus Controls muscles of the Loss of gag reflex;
throat; PNS stimulation drooling of saliva;
of thoracic and dysphagia; dysarthria;
abdominal organs bradycardia; increased
HCl secretion
XI. Spinal Accessory Controls Inability to rotate the
sternocleidomastoid and head and move the
trapezius muscles shoulders

XII. Hypoglossal Movement of the tongue Protrusion of the

tongue; deviation of
the tongue to one side
of the mouth
Spinal Nerves
 Composed of 31 pairs of spinal nerves: 8
cervical; 12 thoracic; 5 lumbar; 5 sacral;
and 1 coccygeal
 The dorsal roots are sensory and transmit
impulses from specific areas of the body, known
as dermatomes, to the dorsal ganglia
 The sensory fibers maybe somatic, carrying
information about pain, temperature, touch, and
position sense (proprioception) from the
tendons, joints and body surfaces
 Fibers can also be visceral, carrying information
from the visceral organs
 The ventral roots are motor and transmit
impulses from the spinal cord to the body
 These fibers can either be somatic or
visceral
 The visceral fibers include autonomic
fibers that control the cardiac muscles and
glandular secretions
 AUTONOMIC NERVOUS SYSTEM:
Sympathetic Nervous System vs.
Parasympathetic Nervous System
Structure or Activity PNS SNS

Pupil of the Eye Constricted Dilated

Circulatory System:
Rate and force of heart beat Decreased Increased
Blood Vessels
In the heart muscle Constricted Dilated
In skeletal muscle * Dilated
In abdominal viscera and skin * Constricted
Blood pressure Decreased Increased
Respiratory System:
Bronchioles Constricted Dilated
Rate of breathing Decreased Increased
 Structure or Activity PNS SNS

Digestive System:
Peristalsis Increased Decreased
Muscular sphincters Relaxed Contracted
Secretion of salivary gland Thin, watery Thick, viscid
Secretions of stomach, Increased *
intestine and pancreas
Conversion of liver * Increased
glycogen to glucose
Genitourinary System:
Urinary bladder
Muscular walls Contracted Relaxed
Sphincters Relaxed Contracted
 Structure or Activity PNS SNS
Integumentary System:
Secretion of sweat * Increased
Pilomotor muscles * Contracted
Adrenal Medullae * Secretion of
catecholamines
Neurologic Assessment
 Developmental Considerations
Infants and Children
 The growth of the nervous system is rapid
during the fetal period
 During infancy, the neurons mature, which
allows more complete actions to take place
1. cerebral cortex thickens
2. brain size increases
3. myelinization occurs
 The advances in the nervous system are
responsible for the cephalocaudal and
proximodistal refinement of development,
control and movement
 The neonate has several reflexes at birth:
sucking, stepping, startle (Moro) and
Babinski reflexes
 Babinski and tonic neck reflexes are normal
until two (2) years of age
 By about one (1) month of age, the reflexes
begin to disappear
Pregnant Women
 The pressure of the growing uterus on the nerves of the
pelvic cavity produces neurologic changes in the legs
 As pressure is relieved in the pelvis, the changes in the
lower extremities are resolved
 As the fetus grows, the center of gravity of the female
shifts, and the lumbar curvature of the spine is
accentuated
 This change in posture can place pressure on roots of
nerves, causing sensory changes in the lower extremities
 Hyperactive reflexes may indicate pregnancy-induced
hypertension (PIH)
Older Adults
 Impulse transmission decreases

 Reflexes diminish and coordination weakens

 Senses decrease (hearing, vision, smell, taste

and touch)
 Muscle mass decreases

 Gait becomes short, shuffling, uncertain and

unsteady
Focused Interview

General Questions:
 Explain what brings you here today.

 Have you had a change in your ability to

carry out your daily activities?
 Do you have any chronic disease such as
diabetes mellitus or hypertension?
Questions Related to Illness, Infection or
Injury:
 Have you ever been diagnosed with a
neurologic illness?
 Have you ever had an infection of the
neurologic system?
 Have you ever had an injury to your head
or back?
Questions Related to Symptoms or
Behaviors:
 Do you have fainting spells? Do you have a
history of seizures or convulsions?
 Has you vision changed in any way?

 Do you have numbness or tingling in any

part of your body?
Mental Status
 Orientation to four (4) spheres: person,
time, place and event
 Memory: Immediate recall, recent memory
and remote memory
Immediate recall: Ask client to repeat your
questions.
Recent memory: Ask the client about events
that occurred few minutes, few hours.
Remote memory: Ask the client about
events in the remote past, or historical
events that can be answered by the general
population.
Level of Consciousness

 It is the most sensitive indicator of the

changes in neurologic status of the client
 The center of wakefulness is ascending
reticular activating system (ARAS)/reticular
formation
 Assess both the wakefulness and content of
thought
Tools for Assessment of Mental
Status

Mini-Mental State Examination

 Assesses cognitive status via interview

Addenbrooke’s Cognitive Examination

 Determines early dementia

Confusion Assessment Method

 Assesses for delirium

Cornell Scale for Depression in Dementia

 Assesses behavioral problems
 Level of Consciousness
 Level I: Conscious, cognitive, coherent ( 3 C’s)
 Level II: Confused, drowsy, lethargic, obtunded,
somnolent
 Level III: Stuporous, responds only to noxious, strong
or intense stimuli (e.g. sternal pressure, trapezius pinch,
pressure at the base of the nail, and very strong light or
very loud sound)
 Level IV:
Light Coma: Response is only grimace or withdrawing of
limb from pain; primitive and disorganized response to
painful stimuli
Deep Coma: Absence of response to even the most
painful stimuli
 LEVEL OF
CONSCIOUSNESS
LEVEL Response

Alert Responds fully & appropriately to

stimuli
Lethargic Drowsy, responds to questions then
fall asleep
Obtunded Open eyes, responds slowly,
confused
Stuporous Arouses from sleep only from painful
stimuli
Comatose Unarousable with eyes closed
Glasgow Coma Scale (GCS)

 It is an objective measure to describe level

of consciousness
 It is based on the client’s response in three
areas: eye opening, motor response and
verbal response
 Glasgow Coma Scale (GCS)

Score
Eye Opening Spontaneous opening 4
To verbal command 3
To pain 2
No response 1

Motor Response Obeys verbal commands 6

Localizes pain 5
Withdraws from pain 4
Flexion (decorticate rigidity) 3
Extension (decerebrate rigidity) 2
No response
1

Verbal Response Oriented 5

Confused 4
Inappropriate words 3
Incoherent 2
No response 1
Decerebrate Posturing versus
Decorticate Posturing
Cranial Nerve Testing

CN I (Olfactory):
 Usually
neglected/omitted
 Ask patient to sniff a
mild stimulus
(e.g. coffee, cigarette)
 Inferior frontal lobe
disease (e.g.
meningioma)
 Significant if unilateral
anosmia is detected
CN II (Optic):
 Check visual acuity
using Snellen’s
chart
 Optic disk should
be examined

Further Tests:
1. Perimetry
2. Tangent screen
3. Visual evoke
potential
CN II (Optic):
 Optic disk
examination
CN III, IV, VI (Oculomotor,
Trochlear, Abducens):

Minimum Requirement:
1. Describe size & shape of
pupils
2. Check reactivity of pupils
to light and
accommodation
3. Check extraocular
movements and observe
for any paresis and
nystagmus

NR: PERRLA
CN V (Trigeminal):

Minimum Essential:
A. Sensory testing- wisp of
cotton
B. Corneal reflex is done if
patient is unable to follow
commands or has altered
sensorium
NR: bilateral blinking
C. Motor Testing – Palpate
masseter and temporalis
muscles as the client
clenches teeth, open and
close mouth
NR: equal muscle strength,
resistance, symmetrical
movement
CN VII (Facial):

 Search for facial

symmetry at rest and
with movement
 Test for the following:
1. eyebrow elevation
2. forehead wrinkling
3. eye closure
4. smiling
5. cheek puff
NR: symmetrical and
resistant to pressure;
can identify taste
CN VIII
(Vestibulocochlear):

 Check ability to hear a

finger rub or whispered
voice with each ear
 Rinne Test (air vs. bone
conduction)
 Weber Test (laterality of
lesion)

Further test: Audiometry

Rinne Test
 Place the stem of
vibrating tuning fork on
the mastoid process
(behind the ear) when
the sound is no longer
heard
 Shift the vibrating end
near the ear canal and
signal again until the
sound is no longer heard
NR: Air Conduction > Bone
Conduction
 Weber Test
 Put the vibrating tuning fork
at the middle of the client’s
head

NR: bilateral tone conduction

through the bone; equal
sounds
AR: Lateralization

Poor ear: conductive hearing

loss
Good ear: sensorineural
hearing loss
CN IX, X
(Glossopharyngeal
& Vagus):

 Position & symmetry of

palate & uvula at rest and
with phonation
 Gag reflex is checked by
stimulating posterior
pharyngeal wall on each
side
NR: uvula, soft palate
midline and symmetrical;
presence of gag reflex; +
taste sensation at the
posterior 1/3 of the
tongue
CN XI (Spinal Accessory):

 Shoulder shrug
 Head rotation to each
side against resistance

NR: movements equally

strong on both sides
CN XII (Hypoglossal):

Minimum requirement is
to inspect:
 tongue for atrophy
 Position with protrusion
 Strength when
extended against inner
surface of the cheek on
each side
NR: no wasting tremors;
able to move tongue
smoothly
Sensory Function

 The center for sensory perception is located

in the parietal lobe, which enables us to
perceive pressure, temperature, texture
and pain
 The ability to perceive sensory stimuli is
called stereognosis
 The inability to perceive sensory stimuli is
called agnosia
Assessment of Sensory Function:
Test for Spinothalamic Tract

1. Assess the client’s ability to identify light

touch.
 Anesthesia: inability to perceive sense of
touch
 Hyperesthesia: increased sensation
 Hypoesthesia: decreased sensation
2. Assess the client’s ability to distinguish the
difference between sharp and dull.
 Analgesia: Absence of pain sensation

 Hypalgesia: Decreased pain sensation

3. Assess the client’s ability to distinguish

temperature.
Test for Posterior Column Tract

4. Assess the client’s ability to feel

vibrations.
 Tuning fork over bony prominences such as
toes, ankle, knee, iliac crest, spinal
process, sternum or elbows.
5. Assess for fine discriminations (fine
touch).
 Test for Stereognosis: ability to identify
objects without seeing them
 Test for Graphesthesia: ability to perceive
writing on the skin
 Test for Two Point Discrimination: ability
to identify the distance between two points
 Test for Topognosis: ability to identify the
area that has been touched
 Test for Position Sense of joint movement:
great toe is dorsiflexed, plantar flexed or
abducted
Test for Stereognosis
Test for Graphesthesia
Test for Position Sense
Motor Function
 The regulating mechanisms for motor
function are as follows:
1. Motor center (frontal lobe): responsible
for voluntary, purposeful, coordinated
movements.
Apraxia: inability to perform fine motor
movements
Agraphia: inability to write
2. Cerebellum: responsible for equilibrium,
sense of posture and direction
Romberg Test: done to assess sense of
equilibrium
 Let the client stand with both feet together
and eyes closed
Ataxia: uncoordinated movement
characterized by wide-base stance and
swaying manner of walking
3. Extrapyramidal System
 It maintains balance, posture and regulates
locomotion
 General appearance: presence of
involuntary, unpurposeful and uncoordinated
movements; asymmetry of the face; muscle
dystrophy
 Muscle power: weakness (paresis);
paralysis (plegia)
 Muscle tone: flaccidity (hypotonicity);
rigidity (hypertonicity)
 Muscle volume: loss of muscle volume
(atrophy); increase in muscle volume
(hypertrophy)
 Movement: slow muscle movement not
associated with weakness (bradykinesia);
absence of muscle movement (akinesia)
 Coordination: assessed by FTNT (finger-
to-nose test) or HKT (heel to knee to toe
test)
 Station and gait: station is posture; gait is
manner of walking
 Motor System
Tone:
Spasticity
 initial resistance to quick movement of a joint which then
diminishes by the end of the movement
Rigidity
 steady resistance through the entire movement of a joint

Flaccidity
 markedly diminished tone; suggests lower motor neuron
disease, but may be observed acutely following upper
motor neuron disease, such as stroke
 Assessment of Motor Function

Balance Test (Gait)

 Heel-to-toe walk

Romberg’s Test
 Assess coordination and equilibrium (CN VIII)

 If swaying greatly increases or if the client falls,

disease of the posterior column of the spinal
cord is suspected
Finger-to-nose Test
 With the eyes closed, the client with cerebellar
disease will reach beyond the tip of the nose
because the position sense is affected
Rapid Alternating Action Test
 Inability to perform the task may indicate
upper motor neuron weakness
Heel-to-shin Test
 Inability to perform the test may indicate
disease or lesion of the posterior spinal
tract
 Tests of rapid alternating movements. A. Finger-nose-finger testing.
B. Pinching the thumb and the little finger together (the thumb and the
index finger can also be used). C. Tapping one hand on the back of the
other D. One-hand clapping.
Rapid alternating prone-supine-prone positions of the hand on
the thigh
Lower limb coordination.
A. Heel tapping.
B. Heel sliding.
 Finger-to-nose test.
A. Normal B. Ataxia C. Intention tremor
Reflex Testing

 Reflexes are fast, predictable, unlearned,

innate, and involuntary responses to stimuli
 Occurs at the level of the spinal cord but
interpreted a the brain
 The center for reflex act is the spinal cord
 The cerebral cortex determines the motor
response
Interpretation of Reflexes

0 = No response
1+= Diminished
2+= Normal
3+= Brisk, above normal
4+= Hyperactive
Knee Jerk Reflex
 Types of Reflexes
1. Superficial Reflexes
Pupillary Reflex:
 Direct light reflex is elicited by applying light
stimulus, moved side to side into the pupil; this results
to constriction of the pupils
 Consensual light reflex results to simultaneous
constriction of both pupils even if light is applied to one
pupil only
 Accommodation reflex results to constriction of
pupils when gaze is shifted from a distant object to a
near object
 The pupillary reflexes are represented by PERRLA
(pupils equal, round, reactive to light, accommodation)
 A fixed and dilated pupil in a client who had
previously reactive pupils is a neurologic
emergency. Notify the physician immediately.
Abdominal Reflex (T8,T9, T10 for upper
and T10,T11 for lower): results to
contraction of the side of the abdomen when
stroked with blunt object
Cremasteric Reflex: elicited by downward
stroking of the inner thigh of the male;
elevation of scrotum on the same side occurs
Babinski Reflex: elicited by stroking the sole
of the foot from the heel upwards; plantar
flexion ( - Babinski) is the normal result
among adults
2. Deep Tendon Reflexes
 Ankle jerk reflex (S1) is produced by
tapping the tendon of Achilles; plantar
flexion of the foot occurs
 Knee jerk/patellar reflex (L2, L3, L4) is
produced by tapping the quadriceps femoris
just below the patella; it results to leg
extension
Deep Tendon Reflex
 Reflex muscle contraction mediated by lower
motor reflex arc
 Hyperreflexia = Upper motor neuron lesion

 Hyporeflexia = Lower motor neuron lesion

 Clonus = severe hyperreflexia; repeated

rhythmic contraction elicited by striking a
tendon/dorsiflexing the ankle
3. Reflexes to assess meningeal irritation
Kernig’s sign:
 The client is placed in supine position.

 Flex the knee.

 The client attempts to extend the leg.

 Pain is experienced.
Brudzinki’s sign:
 The client is placed in a supine position

 Passively flex the neck

 Spontaneous flexion of the hips occurs, and

resistance and pain on the neck are
experienced
4. Other Reflexes

Reflex Segment

Biceps C5, C6

Triceps C6, C7

Brachioradialis C5, C6

Plantar L5, S1
Thank You!