Okay now, deep tendon reflexes, these are
kinda fun too because you get the hammer,
This is when you finally get to use that little
hammer, usually it has a triangle of rubber,
kind of a reddish color and then
it's got a hammer handle around it.
Now deep tendon reflexes, we use these
assessments for other things besides just neuro.
So this is worth your time learning this skill.
Now I can talk you through in a video but
you really need to practice these hands on.
So if you wouldn't mind, write yourself a note
that says, "go back and practice this in person"
We don't have time for you to do all this with a
video - unless you have time, you're welcome to.
But I'm gonna talk you through this.
Deep tendon reflexes usually
includes these four reflexes.
Triceps, biceps, brachioradialis, and patellar.
Okay so these are pretty common ones.
You've probably had the patellar one done at the
doctor's office but let's walk through each of them.
the really cool part, we gave you a chart right
there so you can see the biceps reflex,
what it tells us about the spinal nerve roots
involved and all the way down those other reflexes
We've told you which spinal cord nerve roots are
involved, so I'm not gonna read them to you,
but that's a great reference
for you to have on hand.
So let's talk about, how do you
assess deep tendon reflexes.
Now we've got a hammer there, it has a blue triangle -no
problem, we got a little fancy with the color there,
but you can see how they have in the
graphic, how the leg will move.
The lighter part is where the leg will
start, the darker part is where it ends up
So you test it with a reflex
hammer, we grade it from 0 to 5+
0 is no reflex.
Not a good sign.
2+ is normal
5+ is, "what the heck is going on?", that
is, hyperreflexia, wth clonus like (sound),
Yeah, again, you don't wanna be 0, you don't
wanna be 5, we've got big problems going on there
So, you see in this picture, the lighter is where
the foot starts and then once we hit the hammer,
you have that reflex that's normal,
you'll see it jump forward,
Okay, so let me talk you through
how to do these with biceps,
your patient's arm should be flexed
slightly with the palm facing up.
Now you wanna hold their arm with
your thumb in the antecubital space
Remember this is the antecubital space.
So you want that over the biceps
tendon, then you strike your thumb
Okay, so my thumb is here, use the hammer to
strike your thumb and the arm should flex slightly.
That's the biceps deep tendon reflex
Now the triceps, oohh I hate this in the
gym, I think my triceps are really weak,
but the patient's arm should be flexed 90
degrees, you wanna support the arm and strike it
just above the elbow between the epicondyles.
So you can't really do this to yourself
because we don't have the flexibility but
grab your roommate, grab your
friend, grab your kid and try it.
So you do it between the epicondyles and
the arm should extend at the elbow,
that's what we're looking for for triceps,
For brachioradialis, the patient's
arm should be flexed slightly
and arm wrestling on the lap
with their palm facing down.
You wanna strike the outer forearm
about 2 inches above the wrist
and the palm should turn upward as the forearm
rotates laterally, so that's brachioradialis.
Now patellar, that's the fun one where
you're sitting on the edges of something
and your legs are dangling, which mind
you, in most chairs that I sit in.
But when your patient's legs are
dangling if possible, that's the best
put your hand on one thigh, and
strike the leg just below the kneecap
Okay, so the leg should - if this was my
knee, the leg should extend out like that
Okay so have their legs dangling if you
can, strike just below the kneecap,
pretend this elbow is a knee, cause there's no way
I could get my knee up to that camera right now,
but pretend this was your knee, strike
it right there, and it should do that.
Just like we showed you on the previous slide.
Okay, so that's a quick review of four of the deep
tendon reflexes and how you should assess them
Now I promise this is worth your time.
Grab a friend, grab a kid, grab a roommate, grab a
family member and practice these four reflexes,
this will pay off in your health assessment
class, this will pay off in patient care.
So make sure you practice this because just reading
those, your brain can't process it very well.
If you actually try it over and over and over again, then you'll have it
down pat, and you won't have to relearn it in all your other classes
Now, this one is kinda fun.
This is tested in a comatose patient,
so that part's not very fun.
But also, if someone has a suspected injury to
lumbar or sacral areas of their spinal cord
So we've got good pictures of the toes there for you.
You stimulate the sole of the foot, now you can use a tongue
blade or like a tongue depressor, whichever you call it,
looks like a giant popsicle stick
or the handle of a reflex hammer
and you wanna start at the heel and move up the foot in
a continuous motion along the outer aspect of the sole.
and then across the ball and
across the base of the big toe
So I wanna try it on both sides of the foot.
Okay, I'll tell you what we're looking for.
A normal response if someone would do that
with their foot, is the toes would curl.
See that picture there,
we see the toes, oohh
when soeone touches your foot like that,
that's normally what would happen
If you see the toes make a different response, if you see the toes
when you come up the heel of the foot and then the toe goes like this
that's called the Babinski's response
That is not a good sign in an adult patient.
Now little babies do this and it's okay, so younger
than 2 years, it's kinda cute and it's not a problem.
It's not cute in an adult.
If we do this reflex and their toes do
that, that's called the Babinski sign.
It's babinski wether you're a child, or an adult
but it's normal in children younger than 2 years,
it's abnormal in an adult.
So make sure you remember, remind yourself whatever
your system works for to know the Babinski sign -
Normal in little guys, abnormal in adults.