Deep Tendon ReflexesKimberly 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=W
GNCXqa-y3o http://www.youtube.com/watch?v=hv
kT08HYEbM http://video.google.com/videoplay?do
cid=-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=M
VH9qmd-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 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 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 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