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The reflexes -Practicals
- 2. Definition • Reflexs is an involuntary (automatic ) response to a stimulus which depends on the integrity of a particular nervous pathway .i.e.reflex arc 30/6/2020 2Dr.Divya.A.J.
- 3. Aim • To demonstrate reflex • To identify whether the reflex are normal or abnormal{increased or decreased response} (UMN,LMN lesion). 30/6/2020 3Dr.Divya.A.J.
- 4. APPARATUS • Knee Hammer, 30/6/2020 4Dr.Divya.A.J.
- 5. APPARATUS • Cotton wool • pen torch • small cardboard • tongue depressor 30/6/2020 5Dr.Divya.A.J.
- 6. Types of reflexes A. SUPERFICIAL REFLEXES B. DEEP TENDON REFLEXES C. ORGANIC / SPHINCTERIC / VISCERAL REFLEXES 30/6/2020 6Dr.Divya.A.J.
- 8. SUPERFICIAL REFLEXES • Reflexes based on spinal nerves 1. Plantar reflex 2. Abdominal reflex 3. Scapular reflex 4. Anal reflex 5. Cremastic reflex 6. Bulbocavernous reflex • Reflexes based on cranial nerves 1. Conjuctival reflex 2. Corneal reflex 3. Visual reflexes a) Pupillary reflex b) Accomodation reflex 4. Palatal reflex 30/6/2020 8Dr.Divya.A.J.
- 9. SUPERFICIAL REFLEXES • Stimulus is applied to superficial structure like SKIN or MUCOUS MEMBRANE • Results in the contraction of underlying muscle. • Polysynaptic reflexes:pathway picture • Main characteristic features – excitability varies with the subject – has significances in unilateral lesion - where you can compare the reflex with normal side. 30/6/2020 9Dr.Divya.A.J.
- 11. Flexsor withdrawal reflex 30/6/2020 11Dr.Divya.A.J.
- 12. PLANTAR REFLEX L5S1 • POSITION : Supine position and foot out off the couch • Exposure: from foot to knee exposed • INSTRUMENT: blunt end of knee hammer or blunt key • PROCEDURE: Gentle continous stroke on plantar surface as shown in the figure 30/6/2020 12Dr.Divya.A.J.
- 13. PLANTAR REFLEX L5-S1 30/6/2020 13Dr.Divya.A.J.
- 14. PLANTAR REFLEX NORMAL -FLEXSOR RESPONSE ABNORMAL RESPONSE-EXTENSOR OR BABINSKI SIGN 30/6/2020 14Dr.Divya.A.J.
- 18. ABDOMINAL REFLEX T7-T12 • POSITION : Supine position with knee flexed Exposure :The abdomen exposed from ziphi sternum to pubis symphysis • INSTRUMENT: blunt end of knee hammer or blunt key • PROCEDURE: Gently stroke towards midline from periphery in all four quadrant. 30/6/2020 18Dr.Divya.A.J.
- 20. SCAPULAR REFLEX C5-T1 • POSITION : Siting or Standing Back of the trunk fully exposed • INSTRUMENT : blunt end of knee hammer or blunt key • PROCEDURE: Gently stroke on inner curve of the scapula or intrascapular space in back of the trunk. 30/6/2020 20Dr.Divya.A.J.
- 24. CONJUNCTIVAL REFLEX Afferent : trigeminal nerve Efferent : facial nerve conjunctiva Cornea30/6/2020 24Dr.Divya.A.J.
- 25. Afferent : trigeminal nerve Efferent : facial nerve • response : blinking of eye 30/6/2020 25Dr.Divya.A.J.
- 26. CORNEAL REFLEX Afferent : trigeminal nerve Efferent : facial nerve 30/6/2020 26Dr.Divya.A.J.
- 27. Afferent : trigeminal nerve Efferent : facial nerve • response : blinking of eye 30/6/2020 27Dr.Divya.A.J.
- 28. DIRECT LIGHT REFLEX Afferent : optic nerve Efferent : occulomotor nerve 30/6/2020 28Dr.Divya.A.J.
- 30. INDIRECT LIGHT REFLEX Afferent : optic nerve Efferent : occulomotor nerve 30/6/2020 30Dr.Divya.A.J.
- 32. ACCOMDATION REFLEX Afferent : optic nerve Efferent : occulomotor nerve 30/6/2020 32Dr.Divya.A.J.
- 33. ACCOMDATION REFLEX or Near reflex 1. constriction of pupil 2. convergence of eye ball, 3. increase in anterior curvature of lens 30/6/2020 33Dr.Divya.A.J.
- 34. ACCOMDATION REFLEX Afferent : optic nerve Efferent : occulomotor nerve 30/6/2020 34Dr.Divya.A.J.
- 35. PALATAL REFLEX Afferent : glassopharngeal nerve Center : pons Efferent : vagus nerve • Light touch to soft palate should lead to ipslateral deviation of uvula and elavation of thr soft palate 30/6/2020 35Dr.Divya.A.J.
- 40. DEEP TENDON REFLEX 1. Biceps jerk 2. Triceps jerk 3. Supinator jerk { Brachioradialis jerk} 4. Knee jerk { Patellar jerk /Quadriceps jerk/Femoris jerk} 5. Ankle jerk {Gastronemius and soleus jerk} 6. Jaw jerk 30/6/2020 40Dr.Divya.A.J.
- 41. • Appropriate use of pointed end and broad end of hammer at appropriate place • encourage patient to be relax and body position is proper • hold reflex hammer loosely b/w thumb and index • swing it freely in an arc • rapid wrist movement -i.e. quick ,direct,not glancing • observe the response and grade it. 30/6/2020 41Dr.Divya.A.J.
- 42. Grading of Reflexes Grade Response 0 Absent 1 Present(as a normal ankle jerk) 2 Brisk(A normal knee jerk) 3 Very Brisk 4 Clonus 30/6/2020 42Dr.Divya.A.J.
- 43. ? REFLEX TELLS YOU • NORMAL • INCREASED 1. Physiological:anxiety or nervousness 2. Pathological: Upper motor neuron lesion,Thyrotoxicosis,Tetanus • DECREASED / ABSENT Physiological:During sleep, if subject watches it Pathological: Lower motor neuron lesion(LMNL) • PENDULLAR KNEE JERK : Cerebellar disorders. 30/6/2020 43Dr.Divya.A.J.
- 44. REINFORCEMENT TECHINQUE- Jendrassik manouver • for upper limb : clenching of teeth • squeezing thigh • for lower limb : locking the fingers and pulling against from one another. 30/6/2020 44Dr.Divya.A.J.
- 47. BICEPS JERK C5-6 Musculocutaneous nerve Pointed end of reflex hammer to be used 30/6/2020 47Dr.Divya.A.J.
- 48. • response: • Flexsion at elbow and contraction of biceps muscle 30/6/2020 48Dr.Divya.A.J.
- 49. TRICEPS JERK C6-7, Radial nerve Broad end of reflex hammer has to be used sitting position: elbow in flexsion with forearm of chest supine positon forarm resting of chest with flexsion at elbow 30/6/2020 49Dr.Divya.A.J.
- 50. sitting position with forearm hanging freely with palm down. 30/6/2020 50Dr.Divya.A.J.
- 52. SUPINATOR JERK C5-6 radial nerve sitting position,forearm resting on thigh 30/6/2020 52Dr.Divya.A.J.
- 53. response : contraction of brachioradials muscle, supination at elbow supine position sitting positon 30/6/2020 53Dr.Divya.A.J.
- 54. KNEE JERK L2,3,4 Femoral nerve sitting positing : On edge of the bed ,legs freely hanging ,not touching the floor 30/6/2020 54Dr.Divya.A.J.
- 55. SUPINE POSITION :USE THE BROAD END OF KNEE HAMMER 30/6/2020 55Dr.Divya.A.J.
- 56. • response : a brief contraction of quadriceps muscle • resulting in extension of knee 30/6/2020 56Dr.Divya.A.J.
- 57. ANKLE JERK S1,2 tibial nerve dorsiflex and evert the foot 30/6/2020 57Dr.Divya.A.J.
- 59. Response: : A sharp contraction of calf muscles reslting in plantar flexion 30/6/2020 59Dr.Divya.A.J.
- 61. JAW JERK cranial nerve 5 Center and spinal segment :Pons, fifth cranial nerve sitting or supine positon jaw relax and slightly open Place finger on the top of chin and tap on the finger( pointed of knee hammer) Response : contraction of masster muscle resulting in closure of mouth. 30/6/2020 61Dr.Divya.A.J.
- 65. ORGANIC REFLEX / Sphincteric Reflexes
- 66. ORGANIC REFLEX / Sphincteric Reflexes • Concerned with respiration ,deglutition,micturition and defacation 1. Deglutition Reflex 2. Micturition Reflex and 3. Defacation Reflex 30/6/2020 66Dr.Divya.A.J.
- 67. DEGLUTITION REFLEX • No history of dysphagia, • No swallowing difficulty for solids and liquids 30/6/2020 67Dr.Divya.A.J.
- 68. MICTURITION • No history of incontinence of urine , • no history of increse or decrease of urine frequency, • no history of burning micturition 30/6/2020 68Dr.Divya.A.J.
- 69. • Atonic bladder-destruction of sensory fibres – traumatic spinal cord injury – overflow incontinence • Automatic bladder:spinal cord injury above sacral region – here micturition reflex in intact but uncontrolled 30/6/2020 69Dr.Divya.A.J.
- 70. DEFAECATION REFLEX • No history of constipation , • no history of incontinence of faeces 30/6/2020 70Dr.Divya.A.J.
- 71. Report writing • Name :xyz • Age: ww years • Gender: male • Address: Human being , x door no,y cross, z layout, D nagar A Supeficial reflexes based on spinal nerves Right side response Left side response Remarks √ 1. Plantar reflex plantar flexion of toes and foot plantar flexion of toes and foot L 5S1 √ 2. Abdominal reflex contraction of abdominal muscle contraction of abdominal muscle T7-T12 √ 3. Scapular refex contraction of scapular muscle contraction of scapular muscle C5-T1 30/6/2020 71Dr.Divya.A.J.
- 72. B Superficial RefLexs based on cranial nerves Right side response Left side response Afferent nreve Efferent nerve √ 1 . Conjunctival reflex rapid closing of eyes seen rapid closing of eyes seen trigermin al(cr-5) facial (cr- 7) √ 2 . Corneal reflex rapid closing of eyes seen rapid closing of eyes seen trigermin al(cr-5) facial (cr- 7) √ 3 . Pupillary light reflex a. Direct light reflex constriction of pupil in same eye seen constriction of pupil in eye seen optic (cr- 2) occulomot ort (cr-3) √ √ b.Indirect light reflex constriction of pupil in opposite eye seen constriction of pupil in opposite eye seen optic ( cr- 2) occulomot ort (cr-3) √ 4 . Accomdation reflex constriction of pupil convergence of eye ball,increase in anterior curvature of lens constriction of pupil convergence of eye ball,increase in anterior curvature of lens optic (cr- 2) occulomot ort (cr-3) 5 . Palatal reflex elevation of palate ,contraction of palatal muscle elevation of palate ,contraction of palatal muscle trigermin al(cr-5) vagus (cr- 10)30/6/2020 72Dr.Divya.A.J.
- 73. C DEEP TENDON REFLEX RIGHT SIDE RESPONSE LEFT SIDE RESPONSE REMARK 1. Biceps jerk Grade 1 Grade 1 C5-C6 2. Triceps jerk Grade 1 Grade 1 C6-C7 3. Supinator jerk Grade 1 Grade 1 C5-C6 4. Knee jerk Grade 2 Grade 2 L2,3,4 5. Ankle jerk Grade 1 Grade 1 S1-S2 6. Jaw jerk Grade 1 Trigeminal nerve D VISCERAL REFLEX 1. Deglutition reflex No history of dysphagia,No swallowing difficulty for solids and liquids 2. Micturition reflex No history of incontinence of urine ,no history of increse or decrease of urine frequency, no history of burning micturition 3. Defecaion reflex No history of constipation ,no history of incontinence of faeces 30/6/2020 73Dr.Divya.A.J.
- 74. TELL ME ? 30/6/2020 74Dr.Divya.A.J.
- 75. TELL ME ? 30/6/2020 75Dr.Divya.A.J.
- 76. Assignment 1. Difference between monosynaptic and polysynaptic reflex 2. Draw neat labelled diagraw of relex arc and mention its component. 3. What is reinforcement and how does it work? 4. What happens to reflexes ( superficial and deep ) in upper motor neuron(UMN) lesion and lower motor neuron(LMN) lesion? 5. What happens to response of knee jerk in hypothyroidism? 6. Define Clonus 30/6/2020 76Dr.Divya.A.J.