NMS
5/24/99

1.	DTR—normal—5 Achilles, patellar, biceps, triceps, brachioradialis
•	absent—0 
•	below—1+
•	normal—2+
•	hyper—3+
•	clonus—muscle continues to twitch
•	0, 1, 2, 3, clonus (muscle won't stop twitching)
•	lower numbers is LMN
•	higher numbers are UMN—extrapyramidal pathway
•	hypothyroidism—difficult to elicit reflexes
•	muscular young males are difficult to elicit reflexes; sarcomeres are shorter
•	hypertonic muscles pull on GTO which fire and inhibit—have to overcome to elicit response
2.	superficial
•	stimulate the skin or mucous membranefree nerve endingssignal to brainsignal to associated LMNneuron firesmuscle under the skin contracts
•	either present or absent
•	any lesion anywhere will wipe it out (UMN or LMN lesion)
•	abdominal, cremasteric, anal
•	corneal (blink) reflex, gag reflex, sneeze reflex, cough reflex, swallowing reflex, 
•	vagal reflexes go down in pt's w/strokes
3.	pathologic—abnormal—primitive
•	when these reflexes are present there is a problem (UMN lesion)
•	Plantar reflexes—flexor 
•	babinski—rub the bottom of the foot
•	gordon—squeeze Achilles tendon
•	oppenheim
•	chaddock
•	grasp—touch the palm of the hand and child grasps your finger (senile dementia)
•	glabella—tap b/w the eyes a child blinks always, adult blinks twice
•	sucking—stimulate the lips

Left cortical lesion
•	sensory—post central gyrus—paretial lobe
•	right side deficits
•	pain—discriminated—diminished 
•	proprioception—discrimination—akinesthesia, 
•	motor—pre central gyrus—frontal lobe
•	pyramidals—weakness/paralysis
•	extrapyamidals—increased tone
•	right side deficits
•	reflex
•	right side
•	DTR hyper
•	superficial—absent
•	pathological--present