This document provides an overview of reflexes, including: 1. It defines reflexes as involuntary responses to sensory stimuli and describes the basic reflex arc components. 2. It classifies reflexes based on various criteria and describes how reflexes are graded from absent to exaggerated. 3. It provides instructions for properly eliciting reflexes and lists examples of deep, superficial, and pathological reflexes as well as signs of exaggerated and diminished reflexes.

1. SHORT TOPIC – REFLEXES
GUIDE- DR. RAM. KAULGUD
STUDENT- DR. RAHUL S. BELAVI

2. Defination: A Reflux is an involuntory response to a
sensory stimulus.
- Dejongs Neurological Examination 7th Edition.

3. REFLEX ARC :It is a basic unit of integrated reflex
activities.
Components of Reflex arc,
 Receptor –Muscle spindle
 Affarent - Ia,II fibres
 Centre - Spinal Cord
 Effarent - Motor nerve
 Effector - Extrafusal fibre.

7. Classification of Reflexes:
 Clinical
 Anatomical
 Number of Synapses
 Functional

8. Clinical classification of Reflexes:
 Deep
 Superficial
 Pathological

9.  Grading of Reflexes:
0 – Absent
1 – Present but diminished
2 – Normal
3 - Exaggerated
4 – Clonus.

10. Prerequisite before eliciting Reflexes;
 Patient should be comfortable and relaxed.
 Optimal positioning.
 Adequate exposure of muscle to be tested.
 Clear instructions to the patient.
 Proper technique -
- A good percussion hammer.
- Examiner with a flexible wrist.
- Adequate stimulus.

11.  Hyperreactive Reflexes;
- Decrease in latency
- Decrease in reflex threshhold
- Exaggeration of range of motion
- Prolongation of muscular contraction
- Extension of the reflexogenic zone

12. Exaggeration of DTRs seen in,
- UMN lesion
- Anxiety
- Fright
- Agitation
- Psychogenic disorder.

13.  Hypoactive Reflexes;
- Decreased range of motion
- Increase in the stimulus intensity needed to elicit
the response.

14. Diminition of DTRs seen in,
- Breach in the reflex arc
- Spinal shock
- Deep coma
- Deep sleep
- Heavy sedation
- Narcosis
- Spinal anaesthesia

15. DEEP REFLEXES
1- The Biceps Jerk:
Segmental innervation – C5, C6
Peripheral nerve – Musculocutaneous nerve.

17. 2- The Supinator Jerk:
Segmental innervation – C5, C6
Peripheral nerve – Radial nerve

19. 3- The Triceps Jerk:
Segmental innervation – C7, C8
Peripheral nerve – Radial nerve

21. 4- The Pectoral Reflex:
Segmental innervation : C5-T1.
Peripheral nerve – Lateral & medial pectoral nerve.

23. 5. The Finger flexion Reflex:
Segmental innervation : C6-T1.
Peripheral nerve – Median nerve.

25. 6- The Knee Jerk:
Segmental innervation – L3, L4
Peripheral nerve – Femoral nerve

29. 7- The Ankle Jerk:
Segmental innervation – S1
Peripheral nerve – Medial popliteal nerve

33. SUPERFICIAL REFLEXES
1- The Abdominal Reflexes,
Segmental innervation: T7-T12

35. 2- The Cremasteric Reflex:
Segmental innervation: L1, L2
3- The Anal Reflex:
Segmental innervation: S4, S5

37. 4 -The Plantar Reflex:
Segmental innervation: L4-S2
Peripheral nerve – Medial popliteal nerve

39. PATHOLOGICAL REFLEXES
1- The Hoffman reflex:
- Upper extremity corticospinal reflex.
- Can be present in some normal individuals.
- they are of clinical significance only when
markedely active.

41. 3 - Tromner Sign :
- equivalent response to Hoffmans reflex.

43. 2 - Wartenberg Sign :
- Normal response is abduction and extension of
thumb.

46. 4- The Rossilomos reflex:
- Plantar flexion of the toes indicates corticospinal
tract lesion.

48. 5- BABINSKIS SIGN:

49. SCHAEFERS SIGN:

50. OPPENHEIM SIGN:

51. CHADDOCK SIGN:

54. CLONUS: It is a series of rhythmic involuntary
muscular contractions induced by a sudden passive
stretching of the muscle.
1- Sustained clonus
2- Ill sustained clonus

57. FRONTAL RELEASE SIGNS:
1- Glabellar tap
2- Palmomental reflex
3- Grasp reflex
4- Snout reflex
5- Sucking reflex.

59. INVERTED REFLEXES:
 It is the contraction of the muscle, opposite of
that expected.
Ex: Inverted supinator reflex
Inverted Biceps reflex
Inverted Triceps reflex
Inverted Knee reflex.

60. Mechanism: In pathological reflexes, the segmental reflex is
absent, but there is an underlying hyperreflexia lowering the
threshold for activation of the antagonistic muscle, perhaps
because of transmitted vibrations.
Seen in- Cervical disc disease
- Syringomyelia
- Cervical neoplasm
- Cervical trauma.

61.  Thank You.

62.  Referances
1 - Dejongs Neurological Examination 7th Edition.
2 – Bickerstaffs Neurological examination in clinical
practice 7th Edition.