Deep Tendon Reflexes
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Transcript Deep Tendon Reflexes
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 DTR grading
Understand how to do a DTR examination
Identify different DTRs
Identify different diseases that may manifest by
an alteration in DTRs
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
Grade 1+
Grade 2+
Grade 3+
Grade 4+
Grading Reflex
0: absent reflex
1+: trace, or seen only with reinforcement
2+: normal
3+: brisk
4+: nonsustained clonus (i.e., repetitive
vibratory movements)
5+: sustained clonus
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
http://www.youtube.com/watch?v=WGNC
Xqa-y3o
http://www.youtube.com/watch?v=hvkT0
8HYEbM
http://video.google.com/videoplay?docid=
4041078352780880433&ei=IijsSoWBBpLiq
gLskeHLAQ&q=deep+tendon+reflexes&hl
=en#
Physical Maturity
Infants
Children
Adults
Examples of Reflexes
Jaw Jerk
Biceps reflex
Triceps reflex
Brachioradialis reflex
Finger jerk
Knee Jerk
Ankle jerk
Testing Reflex
http://www.youtube.com/watch?v=MVH9
qmd-xgc&feature=related
http://www.youtube.com/watch?v=pXNe
Npmw9yE&feature=related
http://www.youtube.com/watch?v=4hOS
kmDYAR4&feature=related
Disease Processes
Absent reflex causes:
– Peripheral neuropathy
– Alcoholism
– Vitamin deficiencies
– Diabetes
Clonus or Hyper-active reflexes
http://www.youtube.com/watch?v=9XWmpBz4BVo
http://www.youtube.com/watch?v=liE9fVMYZPU&feature=rel
ated
http://www.youtube.com/watch?v=bWKTr
Ujxkqs&feature=related
http://www.youtube.com/watch?v=uWzsA
vF7M0k&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