Deep Tendon Reflexes

Kimberly Victorian, RN, BSNSheeba 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=WGNCXqa-y3o

http://www.youtube.com/watch?v=hvkT08HYEbM

http://video.google.com/videoplay?docid=-4041078352780880433&ei=IijsSoWBBpLiqgLskeHLAQ&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=MVH9qmd-xgc&feature=related

 http://www.youtube.com/watch?v=pXNeNpmw9yE&feature=related

 http://www.youtube.com/watch?v=4hOSkmDYAR4&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=related

http://www.youtube.com/watch?v=bWKTrUjxkqs&feature=related

http://www.youtube.com/watch?v=uWzsAvF7M0k&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 FalseA hypo-tonic deep tendon reflex is indicated by an absent or diminished response to tapping

Answer

True

DTR Test

True or FalseThere 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 patientB. Assure patient is relaxedC. Mental cognition of the patient

Answer 4

B.

DTR Test

Identify which of the following is not a DTRA. Ankle jerkB. Jaw jerkC. Finger jerkD. Ear skip

Answer 5

D.

DTR Test

True or FalseDiabetes 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