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Motor System Examination Part-11 | Superficial Reflexes | CNS Examination | Pediatrics — Transcript

by Learning Pediatrics · 1,774 words · 328 segments · language en · Watch on YouTube

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0:00hello everyone this is my 11th video on
0:03the motor system examination in first 10
0:05videos i have already explained how to
0:08assess the bulk pusher tone power and
0:10the deep tendon reflex
0:13today i am going to tell you the details
0:15of superficial or the cutaneous reflexes
0:18there is a long list of the reflexes
0:20under this category
0:22but at least we should assess all these
0:24reflexes in exam
0:26so to remember easily all these reflexes
0:29in superficial
0:31i have arranged all these reflexes in
0:34head to toe manner so first we will
0:36assess the globular tape reflex then
0:38corneal or conjuctival reflex then
0:40palatal and pharyngeal reflex
0:43then celio spinal reflex
0:46then abdominal reflex and after that
0:49cremastric and nl reflex and in last we
0:53will assess the plantar reflex
0:56so first is globular tape reflex and the
0:59nerve supply for the globular tape
1:01reflexes ophthalmic division of the
1:03trigeminal now efferent and the facial
1:06now efferent
1:07for this reflex we have to tape the
1:10glibella or the nasione it will lead to
1:13the blink response in normal person
1:16blink response disappear after three to
1:19four depths
1:20if it persists that means maybe the
1:23child is having degenerative disorder of
1:25the brain
1:26or anterior cerebral artery infarct in
1:29this video you had seen how to assess
1:32the globular tape reflex
1:35second is the corneal or conjuctival
1:38reflex also known as blink reflex
1:41now supply trigeminal afferent and
1:43facial efferent
1:45in this we have to touch the
1:48bulbar conjunctiva or the cornea with
1:51the cotton wick it will lead to the
1:52closure of eyes
1:56normally person will have the closure of
1:58both eyes we label as a blink response
2:02or blink reflex if the patient is having
2:04peripheral trigeminal neuropathy then
2:07there will be no blink occur in both the
2:10eyes when the affected eye is
2:12stimulated
2:14while in the peripheral facial
2:15neuropathy there will be no blink
2:17response in the affected eye when the
2:20affected side is stimulated
2:23now after that
2:26then the palatal and the pharyngeal
2:28reflex
2:29efferent supply for this reflex is
2:31glossopharyngeal
2:33and the efferent both glossopharyngeal
2:35and the vegas now
2:37to perform this reflex we have to touch
2:40the porsche pharyngeal wall and the
2:42pellet with the tongue depressor
2:45there will be response will be
2:47all these three components elevation of
2:50the soft pellet and euler
2:52and the constriction of oropharynx and
2:55the closure of the glottis
2:57if the patient is having peripheral
2:59glossopharyngeal or the vagal nerve
3:01palsy
3:02then the soft palate and the euler will
3:04be deviated toward the normal side
3:10now in the cellulose spinal reflex
3:13in this picture you can see
3:15how to perform the cellulose spinal
3:17reflex in this we have to pinch the side
3:20of the neck or the face
3:22it will lead to the
3:24pupillary dilatation 1 to 2 mm pupillary
3:27dilatation of the ipsilateral side occur
3:30and the efferent for this reflex is
3:32trigeminal or the cervical pain fiber of
3:36the lateral spinothalamic tract and the
3:39efferent
3:40sympathetic fiber from the upper
3:41thoracic and lower cervical
3:44spinal cord and the response will be
3:47rapid dilatation of 1 to 2 mm size of
3:50the ipsilateral pupil
3:53we label exaggerated cellular spinal
3:55reflex when the dilatation is more
3:59or persistent it is seen in the cluster
4:02headache or barbiturate induced coma
4:06absint
4:07will be in the horner syndrome
4:11so here in the neck we have to pinch or
4:14over the face and response will be
4:17dilation of the pupil in this video you
4:20can see
4:22now we have to perform the abdominal
4:23reflex root value for the abdominal
4:25reflexes
4:27at the level of umbilicus t10 and
4:29abodham like us supravlolical
4:32t7 to t10 now supply intercostal now and
4:36below the um like us t10 to t11
4:39intercostal yellow hypogastric and helio
4:42inguinal now
4:43to elicit the
4:45abdominal reflex we have to give the
4:47light stroke or scratch of the anterior
4:50abdominal wall
4:51it will lead to the pulling of amolecus
4:53in the direction of stimulus and this is
4:56the quick flickering contraction
4:59followed by the immediate relaxation
5:01and stimulus should be directed toward
5:04the amolecus
5:05then it will be more sensitive
5:09and dissociation of the abdominal reflex
5:11that means
5:12absent superficial reflex and
5:15exaggerated deep tendon reflex it
5:17suggests that
5:18patient is having
5:20corticospinal tract or pyramidal tract
5:22lesion
5:25absent abdominal reflex can be seen in
5:27the infants those who are having the
5:30legs abdominal tone obese after post
5:33pregnancy
5:34acute abdominal disorder
5:36label as a rosenberg
5:38sign at the site of incision after
5:41abdominal surgery or patient is having
5:43multiple sclerosis
5:45breast abdominal reflux can be seen when
5:48the patient is having congenital
5:49diaplasia or in the some extra pyramidal
5:53disorder and with tension and anxiety
5:56also abdominal reflux will be
5:59brisk
6:01now we have to perform the chrymaestric
6:03reflex root value l1 to l2 elio and
6:05guanalijna femoral now and to perform
6:08this reflex we have to give the
6:11uh
6:12light scratch over the skin
6:15in the inner aspect of the thigh it will
6:18lead to the contraction of creamy string
6:21muscles so the quick elevation of the
6:24ipsilateral testis occur
6:27so
6:28by this arrow you can
6:29understand we have to give the downward
6:32scratch
6:33and ultimately there will be contraction
6:35of chromatic muscle lead to the
6:37elevation of the testis
6:40absent reflex can be seen when the
6:42patient is having hydrocele varicocele
6:45torsion of testes or
6:47or epididymitis
6:49dissociation similar to the abdominal
6:51reflex
6:53absent superficial reflex and
6:54exaggerated dpr such as the pyramidal
6:57tract lesion or corticospinal tract
6:59laser
7:00now to elicit the nl reflex
7:03root value is s2 to s5 inferior
7:06hemorrhoidal now we have to just give
7:08the slight stroke over the perianal skin
7:12it will lead to the contraction of
7:14external anal sphincter
7:16this reflex will be absent whenever
7:18patient is having coda equivalent or
7:20conus medullary syndrome
7:23then the plantar reflex root value l4
7:252s2 tbl now to elicit the plantar reflex
7:29in this image you can see
7:31we have to stroke the plantar surface of
7:33the foot we have to start from the heel
7:36and then we have to forward on the
7:38lateral aspect toward the toes
7:41so in this video you can see how to
7:43perform the plantar reflex
7:45normally
7:46after 12 to 18 months of the age flexor
7:49plantar reflex occur so the flexion of
7:52the foot and the toes occur
7:54we label as a
7:56flexor plantar reflex normally students
8:00just use your terminology babinski
8:02negative or babinski positive which is
8:05wrong
8:06whenever it is flexor we will simply say
8:10flexor plantar reflex once we use the
8:13terminology babinski
8:15response or babinski sign or babinski
8:18positive
8:19that means patient is having abnormal
8:22reflex response which will be extension
8:25of the toes or the dorsiflexion with the
8:28separation or fainting of the lateral
8:30photos
8:32it indicate that patient is having upper
8:34motor neurone or corticospinal tract
8:37lesion
8:38extensor plantar reflex so don't use a
8:42terminology babinski
8:44for normal person
8:48there are various alternative methods to
8:50elicit the plantar reflex there is
8:53basically a long list of the alternative
8:55methods but in this video i am going to
8:58tell you these three important
9:01alternative methods in lower limb and
9:04three alternative methods in upper limb
9:06for the plantar reflex
9:09so these are cheddar sign
9:11and
9:13gordon sign and open him sign
9:16in the jdog sign
9:18we have to stimulate the lateral aspect
9:21of the foot
9:22under the lateral malleolus
9:24so under the lateral malleolus from heel
9:27toward the
9:29little two we will give the stroke
9:31and in response to this there will be a
9:34plantar flexion
9:35occur
9:37and in golden sign we have to squeeze
9:40the calf muscle
9:42and response will be there and in open
9:44hem sign
9:46we have to
9:47uh
9:48drake the our knuckles
9:50from
9:51uh
9:53on the intro medial surface of the tibia
9:56right from the infrapatellar region
9:59towards the ankle
10:01so to remember all these sides there is
10:04a trick
10:06so to remember
10:07for chad oak sign c
10:11and
10:12le below the lateral melees so cl
10:16will be the trick we generally take the
10:18cl
10:19so kids will leave
10:21and for the golden
10:23calf muscle we have to squeeze the calf
10:25muscle so gc we generally use the gc
10:28general condition terminology for all
10:31the patients documentation gc
10:35and then open him
10:37sign
10:38over the tbl chain
10:40so ot it is again very commonly used
10:43terminology in the medical field so this
10:46is the simple trick to easily remember
10:48the site of alternative methods in the
10:51lower limb
10:54so now the alternative method which are
10:57equivalent to plantar reflex in upper
10:59limb again there is a long list of
11:02alternative method in upper limb for the
11:04plantar reflex
11:05but i am going to tell you these three
11:07common reflex we generally perform these
11:10are the hofmann sign
11:12tromner sign and the watenburg sign
11:16so to elicit the hofmann sign we have to
11:19first hold the middle phalanx of the
11:21middle finger of the child between our
11:25index finger and the thumb or between
11:27our index and the middle finger then we
11:30have to give this sharp snap over the
11:32nail of the child
11:34downward
11:36sharp's name and it will lead to the
11:39normally there will be no response but
11:42if the patient is having pyramidal tract
11:44lesion then there will be a flexion of
11:46the fingers and the adduction of the
11:49thumb will occur
11:53now in the tromney sign we have to hold
11:55the
11:56patient's partially extended middle
11:58finger
11:59and then we have to flick the finger pad
12:02in this video you can see we have to
12:04give the upward thirst normally there
12:07will be no response and if the patient
12:09is having corticospinal tract lesion
12:11then the response as seen in the
12:13hoffmann sign there will be flexion of
12:16the fingers and the adduction of the
12:18thumb will occur
12:20then the warten bug sign in this we have
12:23to tell the child to flex the finger
12:25like a glow in this video you can see
12:28and then we have to lock our flax finger
12:30with the child's finger and then we have
12:32to try it pull apart
12:34normally
12:35thumb will be extended in this image you
12:38can see
12:39thumb will remain in the extended
12:41position if the patient is having
12:42corticospinal tract lesion in this video
12:46you can see thumb will be flexed and
12:50adopted so this is watanburg sign
12:54in this slide you can see the root value
12:57and the now supply of the all the
12:59superficial and cutaneous reflexes which
13:01i have already explained
13:04so this is all about the superficial
13:06reflexes thank you so much

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