MODULE 4
Human Reflexes
Reflexes are rapid, predictable, involuntary motor responses to stimuli. They are
mediated over neural pathways called reflex arcs. Reflex movements are movement
initiated by sensory receptors, which, by having synaptic contacts within the spinal cord,
are a basic level of regulation of muscles or glands. The spinal reflex is the basic of all
reflexes, but other parts of the CNS also contain reflex pathways. Example include the
vestibulo-ocular reflexes, the vestibular reflexes affecting the body musculature in the
control of balance, and the autonomic reflexes that regulate the diameter of the pupil or
the degree of accommodation of the lens of the eye. But it is conventional to start in the
spinal cord.
Reflexes includes glandular secretion and contraction of all three types of muscles. In
this activity, the somatic reflexes will be studied. Somatic reflexes involve the somatic
nervous system and this reflex is traditionally called spinal reflexes, although some
visceral reflexes also involved the spinal cord, and some somatic reflexes are mediated
more by the brain than the spinal cord.
Somatic reflex functions by means of a reflex arc, in which signals travels along the
following pathway; (1) somatic receptors in the skin, a muscle or a tendon, (2) afferent
nerve fibers, which carry information from these receptors into the dorsal horn of the
spinal cord, (3) interneurons, which integrate information; these are lacking from some
reflex arc, (4) efferent nerve fibers, which carry motor impulses to the skeletal muscle,
and (5) skeletal muscles, the somatic effectors that carry out the response.
Reflex arc can be; (1) monosynaptic – contain only two neurons (a sensory and a motor
neuron) and, (2) polysynaptic – multiple interneurons (also called relay neurons) that
interface between the sensory and motor neurons in the reflex pathway.
Reflex testing is an important diagnostic tool for assessing the condition of the Nervous
System. Distorted, exaggerated, or absent reflex responses may indicate degeneration
or pathology of portions of the Nervous System, often before other signs are apparent. If
the spinal cord is damaged, the easily performed reflex test can pin point the area
(level) of the spinal cord injury. Motor nerves above injured area may be unaffected,
whereas those at or below the lesions it may be unable to participate in normal reflex
activity.
Objectives:
1. Demonstrate stretch or deep tendon reflexes on humans.
2. Determine specific components of the reflex arc are involved in the different
reflexes tested.
3. Differentiate superficial and deep tendon reflexes.
4. Understand the importance of the reflex testing in assessing the condition of the
Nervous System.
Materials:
Reflex hammer
Procedure:
Reflex testing. Using a reflex hammer, deep tendon reflexes are elicited in all
extremities. Note the extent or power of reflex, both visually and by palpitation of the
tendon or muscle in question. Use just enough force to get a response. Response is
graded as follows:
0 = no response, always abnormal
1+ = a slight but definitely present response; may or may not be normal
2+ = a brisk response; normal
3+ = a very brisk response; may or may not be normal
4+ = a tap elicits a repeating reflex (clonus); always abnormal
1. Jaw Jerk (CNS)
a. Place the tip of your index finger on a relaxed jaw, one that is about one-
third open.
b. Tap briskly on your index finger and note the speed as the mandible
flexed.
2. Biceps reflex (C5 – C6)
a. The forearm should be supported, either resting on the patient’s thighs or
resting on the forearm of the examiner. The arm is midway between
flexion and extension.
b. Place your thumb firmly over the bicep’s tendon, with your fingers curling
around the elbow, and tap briskly. The forearm will flex at the elbow.
3. Brachioradialis reflex (C5 – C6)
a. The patient’s arm should be supported. Identify the brachioradialis tendon
at the wrist. It inserts at the base of the styloid process of the radius,
usually about 1cm lateral to the radial artery. If in doubt, ask the patient to
hold the arm as if in a sling-flexed at the elbow and half way between
pronation and supination and then flex the forearm at the elbow against
the resistance from you. The brachioradialis and its tendon will then stand
out.
b. Place the thumb on the hand supporting the patient’s elbow on the bicep’s
tendon while tapping the brachioradialis tendon with the other hand.
c. Observe three potential reflexes as you tap. (1) Brachioradialis reflex:
flexion and supination of the forearm. (2) Biceps reflex: flexion of the
forearm. You will feel the biceps tendon contract if the biceps reflex is
stimulated by the tap on the brachioradialis tendon. (3) Finger jerk: flexion
of the fingers. The usual pattern is for only the brachioradialis reflex to be
stimulated. But in the presence of a hyperactive biceps or finger jerk
reflex, these reflexes may be stimulated also.
4. Finger jerk (C6 – C8)
a. Position the subjects’ hand in a supinated position with fingers slightly
flexed.
b. Place the examiner’s index and middle fingers across the tips of the
patient’s fingers flexor muscles is a positive response.
5. Triceps reflex (C7 – C9)
a. Support the patients forearm by cradling it with yours or placing it on the
thigh, with the arm midway between flexion and extension.
b. Identify the triceps tendon at its insertion on the olecranon, and then tap
just above the insertion. There is extension of the forearm.
6. Patellar reflex (Knee jerk) (L2 – L4)
a. Let the lower legs dangle freely to flex the knee and stretch the tendons.
b. Place your handle on the thigh to palpate the contraction of the quadriceps
when reflex response is elicited.
c. Strike the tendon directly just below the patella. Extension of the lower leg
is the expected response.
7. Ankle jerk (Achilles reflex) (L5 – S2)
a. With the patient sitting, place one hand underneath the sole and dorsiflex
the foot slightly.
b. Tap on the Achilles tendon just above its insertion on the calcaneus.
8. Plantar reflex (L4 – S2)
a. With the end of the reflex hammer, draw a light stroke up to the lateral side
of the sole and across the ball of the foot, like an upside-down J.
b. The normal response is plantar flexion of the toes and sometimes of the
entire foot.
