Encyclopedia of Ayurvedic Medicinal Plants

Reflex pathway - Observation

Leg is jerked up due to sudden contraction of quadriceps.

Centre: Lumbar 2nd, 3rd and 4th segments.

If the jerk cannot be elicited, apply some reinforcement method to elicit the jerk. (Jendrassik’s Manoeuvre). Ask him to do some strong voluntary muscular effort with the upper limbs, like hooking the fingers of the two hands together and pulling them apart against one another as forcibly as possible or clenching the teeth.

Ankle jerk:

Place the lower limb on the bed so that it is slightly flexed at hip and knee and also everted. With one hand slightly dorsiflex the ankle and with the other hand tap on theAchille’s tendon using a knee hammer. Sudden contraction of calf muscles result in plantar flexion of the foot.

Centre: Sacral 1 st & 2nd segments are involved.

Clonus: can be elicited when the tendon reflexes are exaggerated, as in pyramidal tract lesions. Sudden stretch of a muscle and if the stretch is sustained, a regular series of alternate contractions and relaxations of the muscle results. This is called clonus.

Ankle clonus: Make the subject to lie down comfortably with the lower limbs well relaxed. Bend the knee slightly and support the calf using the left hand. Grasp the forepart of the foot with the other hand and suddenly dorsiflex the foot and maintain the pressure for some time.

Look for alternate contractions and relaxations of the calf muscles.

Patellar clonus: Keep the knee in the extended position, grasp the patella firmly. Give a sudden downward push and maintain the push for some time. Look for upward and down ward movements of the patella due to clonus of quadriceps muscle.

Grading of deep tendon reflexes:

Reflex just present : +

Reflex normally present : ++

Reflex exaggerated

Reflex associated with clonus

Reflex absent : 0

Alterations in tendon reflexes

(1) Absent or decreased in lesions affecting any part of the spinal reflex arc.

eg: (1) Tabes dorsalis - Posterior root is affected

(2) Poliomyelitis -Anterior horn cells are affected

(3) Peripheral neuropathies - Sensory or motor neuron affected

(2) Hyper reflexia:

Exaggerated tendon reflexes are present in upper motor neuron lesion. eg: Hem iplegia. Hypereflexia is unilateral and associated with other signs of UMN lesion. Hyper reflexia may also occur in anxiety, nervousness and thyrotoxicosis, but usually bilateral in these cases.

(C)VISCERAL REFLEXES (Organic reflexes):

Ask the subject about the history of micturition and defecation and sexual function:

Micturition - Ask about any abnormalities like

- Frequency,

- Urgency

- Hesitancy

- Precipitancy! dribbling

- Incontinence

Defecation - Diarrhoea

Constipation

Incontinence

Sexual function -