Basic forms of neural activity is reflective activity. Reflex is the response of the nervous apparatus to external stimuli or internal CNS through.
There are many types of reflectors:
Reflex normally go through marrow as tendon reflexes, bone skin, mucosa.
Complex reflex goes through the brain: Classical conditioning of Papho.
Here we study the reflection marrow, mainly going into a examination and evaluation of clinical symptoms.
Meaning, purpose of visit reflex
Check reflex is an important process in the neurological examination because:
There reflex disorder, is definitely physical injury in the nervous apparatus.
To compare the freezing of reflex response to localized radiation disorder, we can know the location of the lesion (see table).
Above normal
Each reflector has a fixed location (region reflex) and mostly symmetrical sides together.
For each reflection, the two sides will have different answers, when stimulus intensity equal.
Each reflector corresponds to the three frozen marrow. By convention, we just used to just crossed between. For example jerk reflex in medullary dorsal L3 respectively.
Delineation marrow: TL2, TL3 (By convention took LT3), TL4.
We subsequently studied the type of tendon reflexes, reflex mucocutaneous, automatic cord reflexes.
The common type of reflector
Tendon reflexes
General principles:
The patient in a comfortable position for each type of expenditure.
Reflex hammer in the prescribed amount (not used any object on hand as the tube listening, hands Kong, knives …), type right into the tendon and periosteum. Do not type in the body itself, as this is the muscle reflex, reflex rather nervous.
Type the reflector pairs symmetrically either side, from top to bottom in a certain order, to avoid omissions.
Before a patient loss of reflexes, to make sure he does not have the muscle initiative (“up near”) to be valid. Must explain to the patient not to the tendon.
Many use cases:
Talk with the patient.
Jen Rassin test is: Patients hook two fingers together, trying to drag two fingers ruling out while we find patella tendon reflexes.
Tap the search engine before nerve reflexes, convulsions ie if the patient does not have the muscle initiative.
How to check a reflection of the
There are a lot of patient posture reflex examination: standing, sitting, lying … usually to the patient lying down as accurate, less sick patients.
When lying down, standing right physician patient, holding the hammer with your thumb and forefinger.
Type gently used primarily weight hammer falls, do not use their best to knock.
Upper limb tendon reflexes.
The bone tendon reflexes:
Posture: There are two ways.
The patient lies, forearms folded, hands to her stomach.
Hand surrender patients, physicians portable patient slightly flexed 45 degrees to the side of the bed.
Location type: Mom turned legs.
Reflexes appear: Fold forearm muscle by long back. Reflex interim head arm:
Posture: The patient lies surrender arms, portable patient physician slightly pulled into the abdomen to lift the arm up and perpendicular to the forearm.
Location type: arms triceps tendon.
Reflexes appear: Stretching the forearm.
Biceps reflex.
Posture: As the search radius reflex.
Location type: Physicians count index finger or thumb on the biceps tendon, and then typing fingers on his cushion.
Tendon reflexes of the lower extremities.
Patellar tendon reflexes:
Posture: The patient lying on your back, knees against the legs folded at an angle of 45 degrees, doctors inserted down the left forearm hams and slightly lift up the legs of patients.
Location type: quadriceps tendon (not typed directly into the kneecap).
Reflexes appear: sing out front legs.
Achilles tendon reflex.
Posture: The patient supine, leaning outwards thighs, knees slightly low. Can the patient kneeling to drop two feet out of bed (applies this posture when weak reflections unknown).
Location type: Doctors holding the foot, not the upper bit to stretch Achilles tendon tap into.
Reflexes appear: triceps legs twitching, nose foot pedal down on your hands as a physician.
Pathological changes of bone tendon reflexes
Dysreflexia.
Standardization.
Seizures limb circuit, suddenly.
Expenditure of large amplitude shock.
At a higher dysreflexia can:
Reflex spread: Type misplaced regulations also reflective. Examples of increased patellar reflex, type in the tibia and leg jerked.
Reflex multi-activity: Type a spending shock 3-4 times.
Continuous foot shock and patella (clonus): Hold the feet of patients yanked the few vertically from orang up and kept folded up position of the foot, the foot will jerk constant (Piet du clonus ) or horizontal hold the kneecap, pushing down some three, and remain in position to push down, the patella will continuous seizures (clonus de la rotule).
Value symptoms of dysreflexia.
There are bunch tower damage means damage nerve cells central.
Dysreflexia often coupled with increased muscle tone. But there are also cases where reduced muscle tone increased tendon reflexes (soft case transferred to spastic paralysis).
Decrease or loss of reflex reflector.
Standard:
Loss of reflexes: the no shock at all (when looking reflexes should pay attention to look and touch, not just the attention to detail with shock or not).
Reduced reflection: the main shock, the new look closely to see.
Value symptoms:
Decrease or loss of tendon reflexes have the same values symptoms, lesions demonstrated a certain point on the reflex arc.
Example: Damage to sensory nerve cells, dorsal root, spinal horn before.
As seen in a bunch of sudden injury in the early stages tower: brain bleeding, broken horizontal cord.
Reflex reversal: When I type in regulations, but spent the reverse shock. Value symptoms such as loss or decreased reflexes.
Reflexes, mucocutaneous
Reflex skin:
The ruling body posture in patients comfortable. Use a pointed object, but not too sharp, the incision in the specified area on the skin, will generate reflections.
Abdominal skin reflexes.
Posture: The patient supine leg against up to two abdominal muscles soft.
Location stimulation: There are 3 different centers:
Caucasian belly on: Stimulating above the navel.
Abdominal skin between: Stimulating navel.
Abdominal skin: Stimulation below the navel.
Reflexes appear: The stomach convulsions, looked like contorted navel.
Reflex scrotal skin:
Posture: The patient supine, legs slightly back out.
Location stimulation: excitation of surface on the third lap.
Reflexes appear: co handful scrotal skin, the testicles go upward.
Value symptoms:
When reflective skin that is lost or reduced pathology demonstrated nerve damage.
In the case of paralysis ½ body bone tendon reflexes that do not know for sure what the damage in the skin reflectance at that party is the party lost pathology (ie party lists).
Reflex leather soles and Babinski sign.
Posture: The patient supine, legs exchange out.
Location stimulation: excitation along the outside of the foot, round down to the sole of the foot near the toes folds.
Reflexes appear: Normal reflexes will reply with the thumb and other fingers cropped. In case of illness, will stretch your thumb and fingers of the bat as fan-out (Babinski sign +).
Babinski signs absolute value clinically, can be written according to the following equation:
Babinski (+): There is physical injury bunch of towers.
Thus reflex examination to detect Babinski sign, one should be very cautious:
Examination must visit it again and again, especially in cases of doubt.
For people with thick leather foot into the bottle. Must Heat and hot water soaking the feet to the skin soft and intensity of stimulation.
To distinguish the fake Babinski, expressed as follows:
When stimulated, the thumb is pulled through and then stretch.
Or when the stimulus is too strong, the patient responded dramatically pulled back foot (from the bottom) also stretched under the thumb.
Thus the importance of Babinski sign, we also use many different experimental methods, but are aimed at detecting lesions bunch of towers, with values like symptoms Babinski sign:
Mark Oppeheim: Swipe along the tibia.
Mark Gordon: Apply direct pressure to the leg muscles after.
Mark Schaeffer: Apply direct pressure on the tendon Achilie.
The tests are positive on the structure (tower bundle lesions), the thumb and the finger-utans and the bat as fan-out.
In detail, there are a significant mark as a sign Babinski: the Hoffmann sign.
The patient’s hand to his stomach, head turned a few middle fingers. Hoffmann positive signs (pathological) when each turn so, the thumb and index finger gestures nguoibenh will be closed as the grip.
The reflector prop
Like Babinski sign, reflective prop appears only in pathological states.
Often manifested in the lower extremities, occurs when animals stimulated in the extremities (pinched skin needling). There are three types:
Reflex shortening.
Stretch reflex.
Diagonal stretch reflex.
The most common is the shortening reflex: When stimulated, the phenomenon appears three co: foot bend your legs, bend your legs thighs, bend your legs.
In the upper limb reflexes are rarely resist.
Value symptoms: Reflex prop is automatically marrow phenomenon (so called automatic reflex marrow) cell damage seen in CNS, especially encountered in spasticity due to forced marrow). In this case the phenomenon of three co valuable diagnostic decisions, while also valuable diagnostic forced locations. If irritation (squeezing, pinching) from bottom to top, where all three co phenomenon occurs, that is, within the limits of forced marrow and cord healthy persons.
Table localized tendon reflexes, bone, skin, mainly:
|
Name tendon reflexes |
Reflected rays skin |
Medulla corresponding |
|
The bone |
|
C6 |
|
Arm triceps |
|
C7 |
|
Second top |
Upper |
C5 |
|
Patellar |
|
TL1 |
|
Achilles Tendon |
|
S1 |
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