muscle stretch reflex assessment

muscle stretch reflex assessment

Table 1, and see reflex, deep tendon
Table 1: Assessment of the motor system of the lower limb
ModalityAssessment
InspectionVisual assessment of the patient's posture, gait, coordination, voluntary and involuntary movements whilst the patient is unaware of being observed
PalpationManual assessment of individual and muscle groups for indications of hypertonia (high resistance to movement followed by a sudden 'give', often indicative of an UMN lesion) or hypotonia (flaccidity, often indicative of LMN and cerebellar lesion)
PowerAssessment of resisted movement (using the MRC grading - see Table 2)
ReflexesPatellar (knee jerk) tendon stretch reflex (quadriceps muscle stretch) and the Achilles (ankle) tendon stretch reflex (gastrocnemius muscle stretch), reinforced as necessary by Jendrassik's manoeuvre. Muscle stretch reflexes are noted as brisk (indicative of an UMN lesion), normal, normal/slow (indicative of underactive thyroid), reduced or absent (indicative of an LMN lesion)
Babinski's reflex (extensor plantar response) is indicative of an UMN lesion
Coordination• Heel-shin test (left heel to slide down right shin and vice versa)
• Fingertip test: where the patient places the index finger on the examiner's finger as this moves apparently at random in front of the patient
Failure to perform in these tests indicates a cerebellar lesion
MovementActive dorsiflexion and plantarflexion, inversion and eversion, and adduction and eversion of the foot against resistance imposed by the examiner:
• Lead pipe rigidity indicates a basal ganglia disorder
• Clasp knife rigidity indicates an extrapyramidal disorder
• Clonus indicates an UMN lesion

UMN, upper motor neurone; LMN, lower motor neurone.

Table 2: Medical Research Council (MRC) muscle-grading scale
GradeMRC grade of muscle strength
0No movement
1Flicker of movement only
2Movement possible when assisted by gravity or gravity is eliminated
3Movement possible against gravity but without imposed resistance
4Weak movement possible against gravity
5Normal movement against gravity and against imposed resistance