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Deep Tendon Reflexes

Deep Tendon Reflexes. Kimberly Victorian, RN, BSN Sheeba Jacob, RN, BSN. Objectives. Understand and define deep tendon reflexes Distinguish between hyper and hypo-tonic deep tendon reflexes Gain a basic knowledge of DTR grading Understand how to do a DTR examination Identify different DTRs

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Deep Tendon Reflexes

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  1. 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 DTR grading • Understand how to do a DTR examination • Identify different DTRs • Identify different diseases that may manifest by an alteration in DTRs

  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 Grade 1+ Grade 2+ Grade 3+ Grade 4+

  6. Grading Reflex • 0: absent reflex • 1+: trace, or seen only with reinforcement • 2+: normal • 3+: brisk • 4+: nonsustainedclonus (i.e., repetitive vibratory movements) • 5+: sustained clonus

  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 http://www.youtube.com/watch?v=WGNCXqa-y3o http://www.youtube.com/watch?v=hvkT08HYEbM http://video.google.com/videoplay?docid=-4041078352780880433&ei=IijsSoWBBpLiqgLskeHLAQ&q=deep+tendon+reflexes&hl=en#

  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. Testing Reflex • http://www.youtube.com/watch?v=MVH9qmd-xgc&feature=related • http://www.youtube.com/watch?v=pXNeNpmw9yE&feature=related • http://www.youtube.com/watch?v=4hOSkmDYAR4&feature=related

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

  13. Clonus or Hyper-active reflexes http://www.youtube.com/watch?v=9XWmpBz4BVo http://www.youtube.com/watch?v=liE9fVMYZPU&feature=related http://www.youtube.com/watch?v=bWKTrUjxkqs&feature=related http://www.youtube.com/watch?v=uWzsAvF7M0k&feature=related

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

  15. 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

  16. Answer 1 • C.

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

  18. Answer • True

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

  20. Answer 3 • True

  21. 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

  22. Answer 4 • B.

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

  24. Answer 5 • D.

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

  26. Answer 6 • True

  27. Resources Walker, K . (1990). Clinical Methods, The History, Physical, and Laboratory Examinations. Retrieved October 20, 2009 from www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cm&part=A2361

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