Neuro Reflexes

Question 1

Reflex Arc

What does the reflex arc consist of?

Answer 1

–Stretch receptor

–Afferent peripheral nerve fibers

–Anterior horn cell

–Efferent nerve fibers

–Neuromuscular junction

Question 2

Reflex Arc

Reflexes and Spinal Levels

Biceps

Answer 2

•C 5 & 6

Question 3

Reflex Arc

Reflexes and Spinal Levels

Brachioradialis

Answer 3

•C 5 & 6

Question 4

Reflex Arc

Reflexes and Spinal Levels

Triceps

Answer 4

•C 6 & 7

Question 5

Reflex Arc

Reflexes and Spinal Levels

Knee/Patellar

Answer 5

•L 2, 3, & 4

Question 6

Reflex Arc

Reflexes and Spinal Levels

Ankle

Answer 6

•S 1

Question 7

Reflex Arc

Reflexes and Spinal Levels

Plantar response (Babinski)

Answer 7

•L5, S1

Question 8

Grading Deep Tendon Reflexes

Absent

Answer 8

0 – 4+ scale or “sustained clonus”

0 Absent

Question 9

Grading Deep Tendon Reflexes

Reflex present with reinforcement

Answer 9

0 – 4+ scale or “sustained clonus”

1+ Reflex present with reinforcement

Question 10

Grading Deep Tendon Reflexes

Reflex present without reinforcement

Answer 10

0 – 4+ scale or “sustained clonus”

2+ Reflex present without reinforcement

(normal)

Question 11

Grading Deep Tendon Reflexes

Brisker than average

Answer 11

0 – 4+ scale or “sustained clonus”

3+ Brisker than average

Question 12

Grading Deep Tendon Reflexes

Very brisk, with beats of clonus

Answer 12

0 – 4+ scale or “sustained clonus”

4+ Very brisk, with beats of clonus

Question 13

Grading Deep Tendon Reflexes

What is normal?

Answer 13

0 – 4+ scale or “sustained clonus”

2+ Reflex present without reinforcement

(this is the normal state)

Question 14

Grading Deep Tendon Reflexes

What should you do if the patient sustains clonus?

Answer 14

0 – 4+ scale or “sustained clonus”

Sustained clonus (document # of beats)

Question 15

Alternate involuntary contraction & relaxation in rapid succession.

Answer 15

clonus

Question 16

Deep Tendon Reflexes

Which side of the hammer?

Biceps

Answer 16

Point

Question 17

Deep Tendon Reflexes

Which side of the hammer?

Triceps

Answer 17

Point

Question 18

Deep Tendon Reflexes

Which side of the hammer?

Brachioradialis

Answer 18

long edge

Question 19

Deep Tendon Reflexes

Which side of the hammer?

Ankle

Answer 19

long edge

Question 20

Deep Tendon Reflexes

Which side of the hammer?

Patellar

Answer 20

point

Question 21

Deep Tendon Reflexes

When testing the ankle reflex, you should _______ the foot

Answer 21

slightly dorsiflexes the foot when testing ankle reflexes

Question 22

If clonus is present, what are you assessing for?

Answer 22

•Assesses for CNS (UMN) disease

Question 23

How do you test for clonus?

Answer 23

• Sharply dorsiflex the foot & hold in flexion
• Observe & feel for rhythmic oscillations between dorsi- and plantar flexion

Question 24

What does the Plantar-“Babinski” reflex test for?

Answer 24

–Assesses upper motor neuron dysfunction

Question 25

Plantar-"Babinski" test responses?

Answer 25

ABN = Fanning and abduction of toes. Babinski Response **_present_** or “toe upgoing” \_\_\_\_\_\_\_\_ –Normal =toes down going/flexion of toes and foot. “**_absent_**” or “toes downgoing”

Question 26

**_Superficial Abdominal Reflexes_** What is the test, what is normal?

Answer 26

* Patient supine; stroke each quadrant with reflex hammer –In upper quadrants, stroke “up and out” –In lower quadrants, stroke “down and out” \_\_\_\_\_\_\_\_\_\_\_ Umbilicus should move **_TOWARD_** stimulation

Question 27

**_Cremasteric Reflex_** Test and normal

Answer 27

* Male Patient * Stroke the inner thigh from proximal to distal (down) \_\_\_\_\_\_\_\_\_\_\_\_ •The testicle and scrotum should rise on the side of the stimulus \_\_\_\_\_\_\_\_\_\_\_\_ (if reflex is absent, may have testicular torsion, spinal injury or disease of neuromuscular junction)

Question 28

**_Cremasteric Reflex_** What if the reflex is absent?

Answer 28

(if reflex is absent, may have testicular torsion, spinal injury or disease of neuromuscular junction) \_\_\_\_\_\_\_\_\_\_\_\_\_ * Male Patient * Stroke the inner thigh from proximal to distal (down) \_\_\_\_\_\_\_\_\_\_\_\_ •The testicle and scrotum should rise on the side of the stimulus \_\_\_\_\_\_\_\_\_\_\_\_