REFLEXES

Dr. Khairul P Surbakti, SpS

Department of Neurology
Reflex is any action performed involuntarily as the
result of an impulse or impression that is
transmitted along afferent fiber, to a nerve center,
thence to afferent fibers and then calls into action
certain cells, muscles or organ.
Lower animals : The instinctive behaviour is
governed
largely by reflexes
Humans : beaviour is more a matter of conditioning
and
act as basic defense mechanism
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Anatomi
Simple reflex arc : - Receptor
- Afferent neuron
- Center
- Interneurons
- Efferent neuron
- Effector
Receptor : special sense organ, cutaneus end-organ, muscle
spindle.
Afferent : transmits the impulse through a peripheral nerve
to the
CNS where the nerve synapsese with a LMN or an
interneuron.
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Interneurons ( intercalated neurons ) : relay the impulse to

the
efferent nerve.
Efferent neuron : passes outward in the nerve and delivers
the
impulse to an effector.
Effector : muscle or gland that produces the response
NOTICE THAT INTERRUPTION OF THIS SIMPLE REFLEX ARC
AT ANY POINT ABOLISHES THE RESPONSE

 Types

of Reflexes
- Superficial ( skin and mucous
membrane ) reflexes
- Deep tendon ( myotatic ) reflexes
- Visceral ( organic ) reflexes
- Pathologic ( abnormal ) reflexes

Types

of reflexes according to the level of

their central representation:
- Spinal
- Bulbar ( postural and righting reflexes )
- Midbrain
- Cerebellar
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Lesions in the motor pathways

Lower- versus upper-motor neuron lesions
___________________________________________________
UMN
LMN
___________________________________________________
Weakness
Flaccid paralysis
Spastic paralysis
Deep tendon reflexes

Decreased or absent

Increased

Babinski55s reflex Absent

Present

Atrophy

Absent or due to
disuse

May be marked

Fasciculations
May be present
Absent
____________________________________________________

Summary of reflexes
_______________________________________________________
Reflexes
Afferent
Center Efferent
_______________________________________________________
1. Superficial reflexes
1.1. Corneal
Cranial V
Pons Cranial VII
1.2. Sneeze
Cranial V
Br stem/upper
V,
VII, IX,X
cord spinal nerves
1.3. Pharyngeal
Cranial IX
Medulla
Cranial X
1.4. Upper abdmn T 7,8,9,10
T 7,8,9,10
T 7,8 9 ,10
1.5. Lower abdmn T 10,11,12
T 10,11,12
T 10,11,12
1.6. Cremaster
Femora sl
L1
Genitofemorl
1.7. Plantar Tibial S1,2 Tibial
1.8. Anal Pudendal
S4,5 Pudendal
_______________________________________________________

_____________________________________________________
Deep reflexes
Afferent
Center
Efferent
_____________________________________________________
2.1. Jaw
Cranial V
Pons
Cranial V
2.2. Biceps
Musculocutan C5,6
Musculocuta
2.3. Triceps
Radial
C7,8
Radial
2.4. Brach-radial Radial
C5,6
Radial
2.5. Patellar
Femora l
L3,4
Femoral
2.6. Achilles
Tibial
S1,2
Tibial
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________________________________________________________
Visceral Reflexes
Afferent
Center
Efferent
________________________________________________________
3.1. Light
Cranial II
Midbrain
Cranial III
3.2. Accomodation
Cranial II
Occip. Cortex Cranial III
3.3. Ciliospinal
Sensory nerve T1,2
Cerv.sympat
3.4. Oculocardiac
Cranial V
Medulla
Cranial X
3.5. Carotid sinus
Cranial IX
Medulla
Cranial X
3.6. Bulbocavernosus Pudendal
S2,3,4
Pelvic autonom
3.7. Bladder & rectal
Pudendal
S2,3,4
Pudendal & auto
nomic
________________________________________________________
Abnormal reflexes
4.1. Extensor plantar Plantar
L3-L5, S1
Ext.hallucis
( Babinski )
longus
___________________________________________________________
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In certain individuals the reflexes may appear

to be markedly
diminished or even absent although no other
evidence of
nervous disease is present.

If any reflex is unobtainable directly ask the

patient to perform
a reinforcement manoeuvre. ( Method of
Jendrassik )
Reinforcement : an attemp to divert the
patients attention and
thus relax the muscles.
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Reflexes can be graded as follows:

3+ = Clonus
2+ = increased
1+ = normal
+/- = obtainable with reinforcement
0
= absent

Method of obtaining the biceps reflex:

Place the patients hands on his abdomen. Place your index finger on
the biceps tendon, swing the hammer on to your finger while
watching the biceps muscle.
Method of obtaining the triceps reflex:
Draw the arm across the chest, holding the wrist with the elbow at
90.
Strike the triceps tendon directly with the patella hammer, watch
the muscle.

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Method of obtaining Knee reflex:

Place the arm under the knee so that the knee is at 90.
Strike the knee below the patella, watch the quadriceps.
Method of obtaining Ankle reflex:
Hold foot at 90 with a medial malleolus facing the ceiling.
The knee should be flexed and lying to the side. Strike the
Achilles tendon directly. Watch the muscle of the calf.

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Pathological Reflexes of the finger and hand

1. Hofmann Signs
2. Tromner sign

Pathological reflexes in the lower extremities

1. Babinski sign
2. Chaddock sign
3. Oppeneim sign
4. Gordon sign

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5. Schaefer sign
6. Gonda sign
7. Ankle clonus
8. Patellar clonus

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Reflex Arc

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