Kimberly Victorian, RN, BSN Sheeba Jacob, RN, BSN Deep Tendon Reflexes Kimberly Victorian, RN, BSN Sheeba Jacob, RN, BSN

Objectives Understand and define Deep Tendon Reflexes Distinguish between hyper and hypo-tonic Deep Tendon Reflexes Gain a basic knowledge of Deep Tendon Reflex grading Understand how to do a Deep Tendon Reflex examination Identify different Deep Tendon Reflexes Identify different diseases that may manifest by an alteration in Deep Tendon Reflexes

Definition Normal process when muscle tendon is tapped briskly Muscle contracts due to a two-neuron reflex arc involving the spinal or brainstem segment that innervates the muscle Afferent neuron innervates the muscle or golgi tendon organ associated with the muscles Cerebral cortex and some brainstem nuclei exert influence over the sensory input of muscle spindles

Hyper VS Hypo-reflexia Hypo – absent or diminished response to tapping. Disease involving one or more of the components of the two-neuron Hyper – hyperactive or repeating (clonic) reflexes. Diseases involving an interuption of corticospinal and other descending pathways that influence the reflex arc due to a suprasegmental lesion

Grading Grading based on varied degree of response Grade 0 Absent Grade 1+decreased but still present Grade 2+normal or physiologic Grade 3+ increased and may be normal Grade 4+ hyperactive with transient sustained clonus Grade 5+ hyperactive with Grade 0 – absent, no evidence of contract Grade 1+ or + - hypoactive, decreased but still present, “hyporeflex” Grade 2+ or ++ - “normal” or physiologic Grade 3+ or +++ - hyperactive without clonus, increased and may be normal Grade 4+ or ++++ - hyperactive with clonus, marked hyperactive with sustained clonus

Clonus Definition : Clonus is the alternate involuntary muscular contraction and relaxation in rapid Succession

Examination Examine upper extremity reflexes with upper examination Abnormality found or suspected take into account the entire group with focus on the technique of the examination Assure patient is relaxed

Method of Eliciting Reflexes Assure that the patient is RELAXED Knee reflex for example: would include having patient seated, then have the patient cross their legs after which, the examiner can hold the hammer with the mallet at the bottom, and then lets it swing into the patellar tendon

Physical Maturity Infants Children Adults

Examples of Reflexes Jaw Jerk Biceps reflex Triceps reflex Brachioradialis reflex Finger jerk Knee Jerk Ankle jerk

Disease Processes Absent reflex causes: Peripheral neuropathy Alcoholism Vitamin deficiencies Diabetes

Clonus or Hyper-active reflexes Upper motor neuron lesion http://www.youtube.com/watch?v=WGNCXqa-y3o http://www.youtube.com/watch?v=lT9XhORYHJ8&feature=related

Summary Definition Hypo VS Hyper-active reflexes Grading Examination Examples Diseases

DTR Test Of the following, what best defines a deep tendon reflex A. a specific bundle of nerve fibers B. an unintended muscle spasm C. a normal process that occurs when the tendon is tapped

Answer 1 C.

DTR Test True or False A hypo-tonic deep tendon reflex is indicated by an absent or diminished response to tapping

Answer True

DTR Test True or False There are 5 grades of Deep tendon reflexes

Answer 3 True

DTR test What portion of the examination is most important to keep in mind? A. The maturity of the patient B. Assure patient is relaxed C. Mental cognition of the patient

Answer 4 B.

DTR Test Identify which of the following is not a DTR A. Ankle jerk B. Jaw jerk C. Finger jerk D. Ear skip

Answer 5 D.

DTR Test True or False Diabetes is associated with absent or hypo-tonic DTRs

Answer 6 True

Resources Walker, K . (1990). Clinical Methods, The History, Physical, and Laboratory Examinations. Retrieved October 20, 2009 from www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cm&part=A2361