Deep Tendon and Plantar Reflexes – Assessment (Nursing)

by Rhonda Lawes, PhD, RN

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    00:00 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.

    00:14 Now deep tendon reflexes, we use these assessments for other things besides just neuro.

    00:21 So this is worth your time learning this skill.

    00:23 Now I can talk you through in a video but you really need to practice these hands on.

    00:29 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.

    00:39 But I'm gonna talk you through this.

    00:41 Deep tendon reflexes usually includes these four reflexes.

    00:46 Triceps, biceps, brachioradialis, and patellar.

    00:51 Okay so these are pretty common ones.

    00:53 You've probably had the patellar one done at the doctor's office but let's walk through each of them.

    00:57 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.

    01:16 So let's talk about, how do you assess deep tendon reflexes.

    01:20 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.

    01:30 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.

    01:43 Not a good sign.

    01:44 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.

    02:17 Now you wanna hold their arm with your thumb in the antecubital space Remember this is the antecubital space.

    02:25 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.

    02:35 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.

    02:53 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.

    03:01 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.

    03:15 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.

    03:26 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.

    03:34 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.

    03:59 Just like we showed you on the previous slide.

    04:01 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.

    04:12 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.

    04:23 So make sure you practice this because just reading those, your brain can't process it very well.

    04:29 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.

    04:40 Plantar reflex This is tested in a comatose patient, so that part's not very fun.

    04:46 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.

    04:54 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.

    05:13 and then across the ball and across the base of the big toe So I wanna try it on both sides of the foot.

    05:19 Okay, I'll tell you what we're looking for.

    05:21 A normal response if someone would do that with their foot, is the toes would curl.

    05:26 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.

    05:45 Now little babies do this and it's okay, so younger than 2 years, it's kinda cute and it's not a problem.

    05:52 It's not cute in an adult.

    05:54 If we do this reflex and their toes do that, that's called the Babinski sign.

    06:00 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.

    06:08 So make sure you remember, remind yourself whatever your system works for to know the Babinski sign - Normal in little guys, abnormal in adults.

    About the Lecture

    The lecture Deep Tendon and Plantar Reflexes – Assessment (Nursing) by Rhonda Lawes, PhD, RN is from the course Neurological Assessment (Nursing) .

    Included Quiz Questions

    1. The reflex is normal.
    2. There is no reflex.
    3. The reflex is hyperreflexive.
    4. The reflex is hyporeflexive.
    1. Biceps
    2. Triceps
    3. Brachioradialis
    4. Patella
    1. It can be assessed by testing the plantar reflex.
    2. It is normal in clients younger than age 2 years.
    3. It is abnormal in adult clients.
    4. A positive sign is described as a curling under of the toes when testing the plantar reflex.
    5. It can only be tested on clients who are alert and responsive.

    Author of lecture Deep Tendon and Plantar Reflexes – Assessment (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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