REFLEXES

Dr. Suherman, Sp.S

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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• Anatomy

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

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• 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 ref- Decreased or absent Increased

lexes

Babinski’55s reflex Absent Present

Atrophy May be marked Absent or due to

disuse

Fasciculations May be present Absent

____________________________________________________

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• Summary of reflexes
_______________________________________________________
Reflexes Afferent Center Efferent
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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 Femoral L1 Genitofemorl
1.7. Plantar Tibial S1,2 Tibial
1.8. Anal Pudendal S4,5 Pudendal
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_____________________________________________________

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 Femoral 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 patient’s 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 patient’s 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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