Examination of Reflexes

Reflexes Spinal cord reflexes represent the most basic of motor responses. These reflexes are carried out entirely within the spinal cord and are modified by inputs from higher brain centers to generate complex movements.

Nerve cells (neurons) carry the message from the stimulated receptors to the correct effectors. A sensory neuron carries the message from the receptor to the central nervous system (the spinal cord and brain). A motor neuron carries the message from the central nervous system to the effector. This is a reflex arc.

Monosynaptic Reflexes – patellar reflex (knee- jerk reflex) Quadriceps

Patellar Reflex Testing the patellar tendon reflex gives information about the function of the femoral nerve and spinal cord segments L2-L4. The absence or decrease of this reflex is known as Westphal’s sign.

Patellar Reflex

Pathology Reflexes are the most objective part of the neurologic examination and they are very helpful in helping to determine the level of damage to the nervous system. Most of the pathways that descend the spinal cord have a tonic inhibitory effect on spinal reflexes. For this reason, the net result of lesions that damage the descending tracts is facilitation of reflexes that are mediated at only the level of the spinal cord (a classic example being the muscle stretch reflex). With few exceptions, this means that these spinally mediated reflexes become hyperactive. After acute lesions, spinal reflexes often pass through an initial stage of hypoactivity.

Achilles' tendon reflex (ankle jerk reflex) Slightly externally rotate at the hip, and gently dorsiflex the foot, tapping the Achilles tendon with a reflex hammer. There should be a reflex contraction of the gastrocnemius muscle (plantar flexion). The S1 nerve level innervates the Achilles tendon deep reflex.

TENDON REFLEX Grading System GRADEREFLEX ZeroAbsent 1Hypoactive 2“ Normal” 3Hyperactive w/o clonus 4Unsustained Clonus 5Sustained Clonus

Figure 13–19 The Babinski Reflexes Normal in infants May indicate CNS damage in adults

Hoffman Response

Balance and coordination tests Balance is the ability to maintain a position. Coordination is the capacity to move through a complex set of movements. Balance and coordination depend on the interaction of multiple body organs and systems including the eyes, ears, brain and nervous system, cardiovascular system, and muscles. Tests or examination of any or all of these organs or systems may be necessary to determine the causes of loss of balance, dizziness, or the inability to coordinate movement or activities.

Statik Denge Cevabı Denek ayakları bitişik vaziyette ayakta dik durdurulur Bu pozisyonun 2 dk sürdürülebilmesi gerekir. Vücudu bu pozisyonda tutmak için gereken hareketler dikkatle izlenir. Bulgular kaydedilir. Aynı deney gözler kapalı olarak tekrarlattırılır. Bu deney sırasında düşmeye karşı önlem olarak iki kişi deneğin yanında hazır bulundurulmalıdır.

Spasyal (Mekansal) Oryantasyon Denek ayakta durdurtulup kolları yana açılır Sonra işaret parmaklarının uçlarını birbirine değdirmesi istenir Aynı deney gözleri kapalı olarak tekrar edilir. Parmaklar uç uca değdirilinceye kadar aynı hareket üç kez tekrarlanır Aynı denek gözleri kapalı olarak bir döner tabureye oturtulur ve 10 tur döndürülür. Yukarıdaki işlemler tekrarlanır.