An erratum will appear in the print version of the julyaugust 2003. Clinical evaluation of the patellar reflex is one of the most frequent diagnostic methods used. The scale is odd in the fact that normal is in the middle of the scale and not on the high or low end of the scale. The reflex is graded based on the amplitude of the response. The babinski test plantars can be abnormal in the present of upper motor neuron damage. Classification and assessment of the patelar reflex response. The myotatic stretch reflexes also known as deep tendon reflexes are spinal reflexes important for proprioception. Deep tendon reflex tests, such as the patellar tendon reflex ptr, are. Previous studies have demonstrated the usefulness of quantified measurement. For example, the triceps reflex evaluates c7 to c8, and the brachioradialis reflex evaluate c5 to c6. Assessmentmyotatic stretch reflexes queensland ambulance.
This scale measures the response magnitude assigning a different number of. Assessment of patellar tendon reflex responses using second. Myotomes, dermatomes and reflexes the emergency physio. Discussion of reflex testing concludes this series on the six primary. Examine and grade the resultant muscle response observed as muscle twitch and. In a university department of neurology two or three physicians judged the biceps, triceps, knee, and ankle tendon reflexes in two groups of 50 patients using either scale. Cultivating expert technique in dtr assessment is possible.
Mayo and ninds scales for assessment of tendon reflexes. There should be a reflex contraction of the gastrocnemius muscle plantar flexion. The deep tendon and the abdominal reflexes journal of neurology. Deep tendon reflex also usually refers to this sense.
All of the commonly used deep tendon reflexes are presented here in a group. Deep tendon reflex tests, such as the patellar tendon reflex ptr, are widely accepted as simple examinations for detecting neurological disorders. The purpose of this study was to assess the between observer reliability of two standard notation scales for grading tendon reflexes, the mayo clinic scale and the ninds scale. The physician in testing the knee jerk is in fact, testing the stretch. The technique of evoking a deep tendon reflex is not as easy as it looks. Although nurses perform deep tendon reflex assessments regularly, it is difficult to incorporate theoretical principles in these assessments because of scant medical literature, a. The scale used at wscc clinics is the national institute of neurological disorders and stroke ninds 1991 muscle stretch reflex scale. By convention the deep tendon reflexes are graded as follows.
Grading scale there are a number of accepted scales for grading deep tendon reflexes. Deep tendon reflexes clinical methods ncbi bookshelf. Assessment of patellar tendon reflex responses using. Clinical signs in neurology deep tendon reflex, history, reflex hammer. An erratum will appear in the print version of the july august 2003. A stretch reflex, when the stretch is created by a blow upon a muscle tendon. Although the reflex has a sensory and motor component, deep tendon reflex testing primarily assesses the integrity of the motor system.
When these reflexes are disrupted, hyperreflexia disease induced or hyporeflexiaareflexia drug induced occurs. Despite common acceptance, the grading scales remain subjective. A common example is the standard patellar reflex or kneejerk response. The patellar reflex is a deep tendon reflex, mediated by the spinal nerves from the. In addition to clonus, other signs of hyperreflexia include spreading of reflexes to other muscles not directly being tested. Pdf mayo and ninds scales for assessment of tendon. When the reflexes are absent try eliciting it after reenforcing jendrassik maneuver0, by asking the patient to interlock and pull flexed fingers. Check the deep tendon reflexes using impulses from a reflex hammer to stretch the muscle and tendon. Deep tendon reflexes should be graded on a scale of 04 as follows. In a screening examination you will usually find it more convenient to integrate the reflex examination into the rest of the examination of that part of the body. Pdf deep tendon reflexes demonstrate the homeostasis between the cerebral cortex and the spinal. In 1833, marshall hall 17901857 from england described the reflex as an excitomotor system of the spinal. Eliciting the deep tendon reflexes is one of the main components of the clinical. The purpose of this study was to assess the between observer reliability of two standard notation scales for grading tendon reflexes, the mayo clinic scale and.
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