PATELLAR REFLEX

- known as “knee jerk” or “quadriceps reflex”

- method:
1. Patient sits with legs dangling freely - tap the patellar tendon just beneath the patella
2. Patient sits with feet flat on the floor. Move legs forward with toes slightly plantar
flexed - tap the patellar tendon just beneath the patella
3. Patient in recumbent position, thighs and legs semiflexed, extremeties rotated
outwards, limbs are held by grasping the foot around the sole of the extremity
beneath the knee - tap the patellar tendon just beneath the patella
4. Patient in recumbent position, hand of the examiner placed beneath the knee - tap
the patellar tendon
5. Push patella downward with the index finger to stretch the quadriceps femoris - Tao
downward on the finger
- response: reflex contraction pulls the patella upward

ANKLE JERK
- also known as the “ankle reflex”, “Achilles reflex” or the “triceps surae reflex”
- Method:
1. Patient sits with legs dangling. Then pressure is exerted upward on the ball of the foot
and tapping the tendon
2. Patient kneeling in the chair with feet hanging over the edge. Use gravity or hand to
properly dorsiflex the foot
3. For recumbent patients: flex the knee and rotate the lower extremity outward so that the
leg is lying partly on its lateral side. Then, grasp the patient’s skin over the scapula or in
the interscapular space
- response: gastrocnemius- soleus is group contract and plantar flex the foot (tapping the
Achilles’ tendon) or contraction of scapular muscle (recumbent position)
BICEPS REFLEX
- method:u
1. Patient’s arm semiflexed at the elbow and moderately pronated. Let the elbow rest on
the examiner’s fingers. The thumb of the examiner is placed over the biceps tendon at
the elbow. Strike the tendon
- response: contraction of the muscle and flexion of the forearm

TRICEPS REFLEX
- method:
1. Flex the patient’s semipronated arm at the elbow and pull the arm across the chest.
Strike the triceps tendon just above the olecranon process.
2. Let the patient clasp his left forearm from above with right hand and his right forearm
from below with the left hand
- response: forearm extends
- stronger grasping and slight extension of forearm reinforces the reflex
** paradoxical reflex (when there is a lower cervical lesion): on striking the elbow, it initiates a
reflex of the forearm flexor muscle innervated at a higher segment in which the forearm flexes
instead of extending

WRIST REFLEX
A. Brachioradial reflex
- method: strike the semipronated forearm just above the styloid process of the radius.
Forearm is flexed and supinated by contraction of the brachioradial muscle. Swing the
hammer vertically
B. Pronator reflex
- Method
1. wrist is held vertically, strike the lower end of the radius from the medial side with a
lateral swing of the hammer
2. tapping of the lower end of the ulna with the hammer swinging medially
- Response: contraction of pronator muscle

CORNEAL REFLEX
- eyes blink when cornea is touched

ABDOMINAL SKIN REFLEX INCLUDING EPIGASTRIC REFLEX

- Method:
1. Scratch over the solid parts of the lower coastal area from outward toward midline
- response: contraction of the epigastric muscles just below the xiphoid process
ABDOMINAL MUSCLE REFLEX
- method:
1. Elicited by a blow that stretches the muscle from the point where they are attached to
the rib margins or other bony origins
2. For upper muscles: percussion along the lower coastal borders of xiphoid area
3. For lower muscles: percussion along the symphysis pubis
4. Middle segments: examiner to tap his index finger, a spoon or a double toungue blade
placed on the abdominal wall
- response: muscle contraction

PLANTAR REFLEX
- testing for babinski sign:
- Method:
1. Stimulation of the sole of the foot with a blunt point: the stimulus is started about the
midpoint of the heel and carried upward and laterally along the outer border of the
sole until the ball of the foot is reached. The stimulus is then direct across the ball of
the foot toward the medial side
2. Stimulus started at midlateral sole and directed downward toward the heel
** stimulus must not be painful
- babinski phenomenon: (pathognomonic of pyramidal tract disease)
• Fanning of the toes
• Dorsiflexon of the great toe
• Dorsiflexion of foot the ankle
• Flexion at the knee and hip
• Associated movement (par of the homolateral mass flexion reflex)

CILIO-SPINAL REFLEX
- reflex which results in pupillary dilation in response to painful stimuli by pinching the neck
on one side
- Pupil will dilate on the homolateral side and to a lesser degree on the contralateral side
- More pronounced during sleep or in comatose state

ACCOMMODATION
- the tendency of the pupils to dilate or constrict alternatingly on exposure to light is called
HIPPUS
- it indicates excessive sympathetic tonus

CONVERGENCE
- tested by asking the patient to follow the finger held at a distance and then brought forward
to a point midline between the eyes
- Response: pupils normally constrict