Aa
Quix--reflexes and muscle tone
Hiya. Could you give us a quick and dirty explanation of how reflexes and muscle tone are measured? Are they quantifiable? What is "normal?"
Many thanks,
essie
Many thanks,
essie
interesting page.
I beeen examined to have hyper reflexia in my knees, almost absent in ankles.
then elbows wrists relex mostly norm, but hyptoniaa arms(floppy) . My neck and trunk are floppy too. I fall over just sitingg.
Spacticity seems more prevalllant... are there many out there with HYPOtonia?
amo
I beeen examined to have hyper reflexia in my knees, almost absent in ankles.
then elbows wrists relex mostly norm, but hyptoniaa arms(floppy) . My neck and trunk are floppy too. I fall over just sitingg.
Spacticity seems more prevalllant... are there many out there with HYPOtonia?
amo
I could tell my reflexes were very brisk at my exam last week. My last neuro gave me a 4+, but I'm not sure if that may have been for muscletone...
Sometimes when I am wearing heels in my car and step on my brake pedal, I get the repititious movement of my leg. I find this quite amusing. I am very easy!
Zilla*
Sometimes when I am wearing heels in my car and step on my brake pedal, I get the repititious movement of my leg. I find this quite amusing. I am very easy!
Zilla*
I have purplish blotches on my lower legs as well. It's called Livido Reticularis, and is seen in people with Autoimmune disease. There's nothing that they can do about it, it's just a symptom that hangs around. My doc told me to elevate my legs when I'm resting and take a low-dose aspirin once a day (but this is not medical advice...your doctor will have to help you with that. This is just FYI.)
When I last went to my old doc and he did the reflex test and had to do it for some time because of little or no movement at all, but said nothing but hmm and was never told what it meant and I have blotch's on the back of my lower calves up by my knees
I just guessing if I should be concerned about this as my new doc had noticed this on my legs
Cowboy
I just guessing if I should be concerned about this as my new doc had noticed this on my legs
Cowboy
thanks Quix. I have lots of 4/5 in my lower extremities. So that is abnormal? I didn't know.
Craig
Craig
Yes, but I am not content with just a summary, lol. A lot of people enjoy knowing the whole story, so if I am going to take the time I try to teach the whole enchilada. But,.....I suppose....that I could be a little less long-winded. (OH, I do love to hear myself talk)
Usually Q & D means I'm doing it mostly off the top of my head.
Quix.
p.s. There is a support group for people who talk too much - it's called "ON-AND-ON ANON"
Usually Q & D means I'm doing it mostly off the top of my head.
Quix.
p.s. There is a support group for people who talk too much - it's called "ON-AND-ON ANON"
Wow. If that is Quick and Dirty, I can't imagine what a 'comprehensive' response would cover. Probably more than my poor brain could take in. Thanks so much, Quix. I'm filing this away for future reference.
I look forward to Muscle Tone 101. Just a summary will be fine.
essie
I look forward to Muscle Tone 101. Just a summary will be fine.
essie
This is going to be really Q &D!!! but, Here goes...
The tendon reflexes are lower level "stimulus -> reaction" effects. Each muscle group contains stretch-receptors that, when stimulated quickly cause the muscle to contract. Large muscles come together at one end in the form of a tendon that then attaches the muscle to a bone. Examples that you can actually see in your body are the large patellar tendon that attaches at the thigh end to the quadriceps and passes over and around the patella (kneecap) to attach to the top of the tibia (shin bone). Another is the Achilles tendon which gathers the calf muscles in and then travels to attach to the underside of the heel. Another is the biceps tendon which passes in the bend of the elbow. You can feel the biceps tendon like a hard cord when you flex your biceps.
When the tendon is tapped briskly, it quickly pushes in on the tendon and places a tiny, but quick stretch on the muscle that that tendon tethers done to the bone. The Patellar tendon is the easiest to see and describe. You always do a tendon test when the muscle is slightly stretched, so usually this is done while sitting with knee bent at 90 degrees and the lower leg able to swing freely. When the tap is done, just below the kneecap, the normal reaction of the quadriceps is to contract. When it does it causes the knee to extend (the lower leg to swing out). The nerve loop that controls a tendon reflex is a stretch receptor that travels up to the spinal cord and immediately loops over to a motor nerve that travels down and activates the proper muscle.
The evaluation of the reflexes is done on a numercial scale, but it is subject to the interpretation of the examiner, so it is not quantified. The more experience, the more reproducible the test will be between examiners, but it is still really a qualified measurement. If it were to be quantified it would be by electromyography and would be a research test.
The reflexes may be dulled by depressant medications. They may be accentuated by stimulants, caffeine, & anxiety. They also may be "reinforced" by either slight active contraction of the muscle/tendon being tested or by having the patient contract another set of muscles forcefully. The usual maneuver for reinforcement is to have the patient grasp the fingers of both hands together in front of the chest and to pull tightly. (Try doing this. First tap on the tendon with grasping the hands. Then do it with the hand-pull. You will normally see a significant increase in the force of the tendon reflex)
The rating scale of tendon reflexes is as follows:
0 - no elicitable movement or contraction of the muscle
1+ - Little movement or only seen with reinforcement - lower end of normal
2+ - Normal (what normal looks like is learned through doing this 100's of times with hundreds of normal people)
3+ - Brisk (more than is normally seen, but not causing injury to the examiner, lol) this is also considered in the normal range.
4+ - Maximum movement and associated with some limited, extra repetitive movement(s) called clonus.
5+ - Major kick with sustained repetitive movements (sustained clonus) Also considered here and in "4+" is if other muscle groups also react with contraction, called "spreading reflex." Clonus is most often seen at the ankle. The doctor will press suddenly up on the toes, dorsiflexing the ankle. With clonus the toes will repeatedly bounce downward if light pressure is kept on the toes.
A note here. I will often be seated with my toes on the ground, but heels up. If I strain to reach or lift something the foot (heel) will begin bouncing up and down and I cannot control it. This is clonus. You can also do this with newborns. You can take a finger and push up on the ball of their foot and casue the foot/toes to repetitively move downward. (taken from "Fun and Games to Play With Your Newborn - activities for bored parents") In babies this is normal.
0, 4, and 5 are abnormal and indicate neurological problems.
Some doctors use a 0 to 4 scale and use 4+ (sustained) for 5+.
How's that? I'll do "Muscle Tone" tomorrow.
Quix
The tendon reflexes are lower level "stimulus -> reaction" effects. Each muscle group contains stretch-receptors that, when stimulated quickly cause the muscle to contract. Large muscles come together at one end in the form of a tendon that then attaches the muscle to a bone. Examples that you can actually see in your body are the large patellar tendon that attaches at the thigh end to the quadriceps and passes over and around the patella (kneecap) to attach to the top of the tibia (shin bone). Another is the Achilles tendon which gathers the calf muscles in and then travels to attach to the underside of the heel. Another is the biceps tendon which passes in the bend of the elbow. You can feel the biceps tendon like a hard cord when you flex your biceps.
When the tendon is tapped briskly, it quickly pushes in on the tendon and places a tiny, but quick stretch on the muscle that that tendon tethers done to the bone. The Patellar tendon is the easiest to see and describe. You always do a tendon test when the muscle is slightly stretched, so usually this is done while sitting with knee bent at 90 degrees and the lower leg able to swing freely. When the tap is done, just below the kneecap, the normal reaction of the quadriceps is to contract. When it does it causes the knee to extend (the lower leg to swing out). The nerve loop that controls a tendon reflex is a stretch receptor that travels up to the spinal cord and immediately loops over to a motor nerve that travels down and activates the proper muscle.
The evaluation of the reflexes is done on a numercial scale, but it is subject to the interpretation of the examiner, so it is not quantified. The more experience, the more reproducible the test will be between examiners, but it is still really a qualified measurement. If it were to be quantified it would be by electromyography and would be a research test.
The reflexes may be dulled by depressant medications. They may be accentuated by stimulants, caffeine, & anxiety. They also may be "reinforced" by either slight active contraction of the muscle/tendon being tested or by having the patient contract another set of muscles forcefully. The usual maneuver for reinforcement is to have the patient grasp the fingers of both hands together in front of the chest and to pull tightly. (Try doing this. First tap on the tendon with grasping the hands. Then do it with the hand-pull. You will normally see a significant increase in the force of the tendon reflex)
The rating scale of tendon reflexes is as follows:
0 - no elicitable movement or contraction of the muscle
1+ - Little movement or only seen with reinforcement - lower end of normal
2+ - Normal (what normal looks like is learned through doing this 100's of times with hundreds of normal people)
3+ - Brisk (more than is normally seen, but not causing injury to the examiner, lol) this is also considered in the normal range.
4+ - Maximum movement and associated with some limited, extra repetitive movement(s) called clonus.
5+ - Major kick with sustained repetitive movements (sustained clonus) Also considered here and in "4+" is if other muscle groups also react with contraction, called "spreading reflex." Clonus is most often seen at the ankle. The doctor will press suddenly up on the toes, dorsiflexing the ankle. With clonus the toes will repeatedly bounce downward if light pressure is kept on the toes.
A note here. I will often be seated with my toes on the ground, but heels up. If I strain to reach or lift something the foot (heel) will begin bouncing up and down and I cannot control it. This is clonus. You can also do this with newborns. You can take a finger and push up on the ball of their foot and casue the foot/toes to repetitively move downward. (taken from "Fun and Games to Play With Your Newborn - activities for bored parents") In babies this is normal.
0, 4, and 5 are abnormal and indicate neurological problems.
Some doctors use a 0 to 4 scale and use 4+ (sustained) for 5+.
How's that? I'll do "Muscle Tone" tomorrow.
Quix
This found its way down the forum list in record time! I'm bumping it up in case you have time to answer. Thanks so much.
essie
essie
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