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Practical 8 reflexes
- 1. Practical 06: HumanReflexes Dr Shamshad Majamaah University KSA
- 2. 1. Classify thehuman reflexes and give example for each type. 2. Describe components of stretch reflex arc. 3. Discuss the types, center and clinical significance of tendon jerks. 4. Perform accurately various types of tendon jerk. Objectives
- 3. Defn: Involuntary ,quick ,protectiveresponse to a stimulus which depends on the integrity of a particular nervous pathway. Components: Reflex arc:
- 5. I:Depending on synapsesinvolved Monosynaptic(Stretch) Polysynaptic Jaw jerk, Patellar(knee ) jerk, Ankle reflex Withdrawal reflex Superficial Deep Plantar, Abdominal ,Cremastric, Corneal, conjunctival Muscle stretch reflexes/Tendon reflexes, II
- 6. III Physiological Pathological Jaw jerk,Patellar(knee ) jerk, Ankle reflex Withdrawal reflex, Plantar, Abdominal ,Cremastric, Corneal, conjunctival Tendon reflexes, Babinski , rooting gasping , reversion of primitive reflexes IV: Other: Clonus
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- 8. National Institute ofNeurological Disorders And Strokes (NINDS) grading of reflexes Grade Response 0 Absent reflex, no reaction 1 Small reflex, or less than normal, or obtained with reinforcement 2 Lower half of normal reflex 3 Upper half of normal reflex 4 Increased reflex, clonus may be present, and always pathological
- 9. Reflex Process Responseroot level Jaw Ask the subject to partially open the mouth Place your finger firmly on the chin and tap briskly Closure of the jaw Vth Cranial N Knee/ Patellar Ask the subject to be supine or sit with legs near edge of bed hanging freely or one leg crossed over other Tap the patellar tendon briskly Extension of leg Contraction of quadriceps muscle L2-4 Femoral N Ankle/ Achilles Ask the subject stand and place the leg In everted position . Slightly dorsiflex the foot and tap the achilles tendon briskly Contraction of calf muscle S1-2 Tibial N
- 10. Reflex Process ResponseSpinal cord root level Biceps Ask the subject to flex the elbow at right angle in semiprone position Place your thumb or index finger on the Bisceps tendon Contraction of Bisceps C5,6 Musulocutaneous N Triceps Ask the subject to flex elbow and rest the forearm across the chest Tap briskly on tendon Contraction of triceps C6,7,8 Radial N Supinator/ Brachiradialis Ask the subject to flex the elbow at right angle in semiprone position Tap briskly upon styloid process of radius Contraction of BR muscle and supination of elbow C5,6 Radial N
- 12. Jendrassik or reinforcementmanoeuvre : Importance: Used to augment hypoactive reflexes Technique: Subject is asked to lock the hands and pull forcefully apart Or Ask the subject to clinch the teeth with force Dr. Erno Jendrassik
- 13. Clinical Significance ofreflexes Assess the integrity of the motor system Decreased • LMN lesion • Peripheral nerve lesions, entrapment , monoeuropathy • Diabetes Mellitus, Hypothyroidism, Muscle diseases • Spinal cord injury with spinal shock, • Cerebellar diseases Bilateral absent of ankle jerk in cauda equina syndrome
- 14. Significance Increased Lesion injury involvingUMN (Brain ,brain stem, spinal cord) • Severe chronic cases clonus with spasticity present • Common in stroke, • spinal cord injury, • cerebral palsy, • multiple sclerosis Clinical Significance of reflexes
- 15. Grade 0-4 Reflex RightLeft Biceps Triceps Supinator/ Brachiradialis Knee Ankle Jaw Inference : Report :
- 16. Reference: Pflanzer: Experimental andApplied Physiology Laboratory Manual, 7th edition 2003 chapter 10 Neuromuscular reflexes of the spinal cord and brain stem 119 – 132. Internet: Medscape Text book of Manual of practical physiology : Prof A.K.Jain