1. Kimberly Victorian, RN, BSN Sheeba Jacob, RN, BSN
Deep Tendon Reflexes
Kimberly Victorian, RN, BSN
Sheeba Jacob, RN, BSN

2. Objectives Understand and define Deep Tendon Reflexes
Distinguish between hyper and hypo-tonic Deep Tendon Reflexes
Gain a basic knowledge of Deep Tendon Reflex grading
Understand how to do a Deep Tendon Reflex examination
Identify different Deep Tendon Reflexes
Identify different diseases that may manifest by an alteration in Deep Tendon Reflexes

3. 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

4. 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

5. Grading Grading based on varied degree of response Grade 0 Absent
Grade 1+decreased but still present
Grade 2+normal or physiologic
Grade 3+ increased and may be normal
Grade 4+ hyperactive with transient
sustained clonus
Grade 5+ hyperactive with
Grade 0 – absent, no evidence of contract
Grade 1+ or + - hypoactive, decreased but still present, “hyporeflex”
Grade 2+ or ++ - “normal” or physiologic
Grade 3+ or hyperactive without clonus, increased and may be normal
Grade 4+ or hyperactive with clonus, marked hyperactive with sustained clonus

6. Clonus Definition : Clonus is the alternate involuntary muscular
contraction and relaxation in rapid
Succession

7. 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

8. Method of Eliciting Reflexes
Assure that the patient is RELAXED
Knee reflex for example:
would include having patient seated, then have the patient cross their legs after which, the examiner can hold the hammer with the mallet at the bottom, and then lets it swing into the patellar tendon

9. Physical Maturity
Infants
Children
Adults

10. Examples of Reflexes Jaw Jerk Biceps reflex Triceps reflex
Brachioradialis reflex
Finger jerk
Knee Jerk
Ankle jerk

11. Disease Processes Absent reflex causes: Peripheral neuropathy
Alcoholism
Vitamin deficiencies
Diabetes

12. Clonus or Hyper-active reflexes
Upper motor neuron lesion

13. Summary Definition Hypo VS Hyper-active reflexes Grading Examination
Examples
Diseases

14. 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

15. Answer 1 C.

16. DTR Test
True or False
A hypo-tonic deep tendon reflex is indicated by an absent or diminished response to tapping

17. Answer
True

18. DTR Test
True or False
There are 5 grades of Deep tendon reflexes

19. Answer 3
True

20. 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

21. Answer 4 B.

22. DTR Test Identify which of the following is not a DTR A. Ankle jerk
B. Jaw jerk
C. Finger jerk
D. Ear skip

23. Answer 5 D.

24. DTR Test
True or False
Diabetes is associated with absent or hypo-tonic DTRs

25. Answer 6
True

26. Resources
Walker, K . (1990). Clinical Methods, The History, Physical, and Laboratory Examinations. Retrieved October 20, 2009 from