Deep Tendon Reflexes
Kimberly Victorian, RN, BSN
Sheeba Jacob, RN, BSN
Objectives
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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
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

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

Grading
Grading based on varied degree of
response
 Grade 0
 Grade 1+
 Grade 2+
 Grade 3+
 Grade 4+

Grading Reflex
0: absent reflex
 1+: trace, or seen only with reinforcement
 2+: normal
 3+: brisk
 4+: nonsustained clonus (i.e., repetitive
vibratory movements)
 5+: sustained clonus
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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

Method of Eliciting Reflexes
http://www.youtube.com/watch?v=WGNC
Xqa-y3o
 http://www.youtube.com/watch?v=hvkT0
8HYEbM
 http://video.google.com/videoplay?docid=
4041078352780880433&ei=IijsSoWBBpLiq
gLskeHLAQ&q=deep+tendon+reflexes&hl
=en#
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Physical Maturity
Infants
 Children
 Adults
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Examples of Reflexes
Jaw Jerk
 Biceps reflex
 Triceps reflex
 Brachioradialis reflex
 Finger jerk
 Knee Jerk
 Ankle jerk

Testing Reflex
http://www.youtube.com/watch?v=MVH9
qmd-xgc&feature=related
 http://www.youtube.com/watch?v=pXNe
Npmw9yE&feature=related
 http://www.youtube.com/watch?v=4hOS
kmDYAR4&feature=related

Disease Processes
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Absent reflex causes:
– Peripheral neuropathy
– Alcoholism
– Vitamin deficiencies
– Diabetes
Clonus or Hyper-active reflexes
http://www.youtube.com/watch?v=9XWmpBz4BVo
http://www.youtube.com/watch?v=liE9fVMYZPU&feature=rel
ated
http://www.youtube.com/watch?v=bWKTr
Ujxkqs&feature=related
http://www.youtube.com/watch?v=uWzsA
vF7M0k&feature=related
Summary
Definition
 Hypo VS Hyper-active reflexes
 Grading
 Examination
 Examples
 Diseases

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
Answer 1
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C.
DTR Test
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True or False
A hypo-tonic deep tendon reflex is
indicated by an absent or diminished
response to tapping
Answer

True
DTR Test
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True or False
There are 5 grades of Deep tendon
reflexes
Answer 3
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True
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
Answer 4
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B.
DTR Test
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Identify which of the following is not a
DTR
A. Ankle jerk
B. Jaw jerk
C. Finger jerk
D. Ear skip
Answer 5
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D.
DTR Test
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True or False
Diabetes is associated with absent or
hypo-tonic DTRs
Answer 6
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True
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