HIV Neuropathy Screening Exam with Grading Reflexes

HIV Neuropathy Screening Exam with Grading Reflexes


These are the instructions for evaluating perception
of vibration. Use a 128 hertz tuning fork. [SOUND] Hit the tuning fork hard
enough so that the sides touch. And make sure that the subject
knows the type of sensation. Do you feel this as
a vibration or a buzzing?>>Vibration.>>As a vibration, very good. Now repeat the procedure
in the feet. Again, strike the tuning
fork hard enough so that the sides touch and
immediately put the tuning fork on the distal
interphalangeal joint. Count the number of seconds. Ask the subject to tell you
when the vibration stops.>>Now.>>It stopped now? Good. And repeat the procedure
to the opposite side. Again, the tuning fork goes
on the distal interphalangeal joint. Make sure you strike
the tuning fork hard enough so that the sides touch. For evaluating deep
tendon reflexes, with the subject seated,
examiner should use the hand to gently dorsiflex the foot
at about 90 degrees. Press upwards slightly
on the sole of the foot. Use a reflex hammer, preferably
a long-handled reflex hammer. A tomahawk hammer
is also acceptable. And strike the Achilles
tendon just behind the heel. Contraction of the gastrocnemius
muscle will be both seen and felt. Repeat the procedure
with the opposite leg. Have to do now is show
the discrepancy between the knee reflex and the ankle reflex. Many patients with HIV
disease have both central and peripheral nervous
system disease. So one may see a mix of
hyperreflexia at the knee and reduced reflexes,
or hyporeflexia or areflexia at the ankles. So now we’ll attempt
to demonstrate this. So here first for the patella
reflex, the knee reflex, this would be graded as a 3
plus, there is hyperrefelxia and spread of the reflex
to other muscles. In the same patient,
ankle reflexes are reduced significantly out
of proportion to knee reflexes. So these are the different
gradings for ankle reflexes. Absent means that with a strong
percussion of the Achilles tendon, there is no contraction
of the gastrocnemius. Now you may see some mechanical
bounce of the muscle but this is not the same
as a contraction. Reduced is where there is
a visible contraction of the gastrocnemius. So here we’re seeing
a visible contraction. Increased is where there’s
a strong contraction of gastrocnemius with spread
to other muscle reflexes. Here I’m going to
attempt to demonstrate the different gradings of ankle
reflex in the same individual. Obviously this is artificial,
but it gives you an idea of the degree of movement
of the gastrocnemius after percussion of
the Achilles tendon. So first, absent ankle reflexes,
percussion of the Achilles elicits no
contraction of gastrocnemius. Be graded as a zero. Reduced reflexes implies
that there is contraction of gastrocnemius but
it’s reduced compare to normal. This would be
an example of reduced. May take several percussions
to elicit a small contraction. If you ask the patient
to reinforce, and if we go up to include the knee. Can we pan up to the knee? I want you to bring
your arms down. Bring your arms down like that. Reinforcement may be necessary
to bring out a reduced reflex. Reinforcement here just by
asking the subject to play tug of war with her hands. The normal reflex is a brisk
contraction of gastrocnemius, it’s reproducible but doesn’t
spread to other muscle groups. And the last and
final grading is hyperreflexia or
increased reflexes, where there is a brisk
contraction and some spread of reflexes. And finally,
ankle [INAUDIBLE] with a brisk upward movement of the foot
into dorsiflexion, with [INAUDIBLE] there will be a
repetitive movement of the foot. So here we’re gonna demonstrate
the discrepancy between knee reflexes and ankle reflexes. I’m gonna touch the patient’s
foot here, the knee reflexes are very brisk and
will be graded as three plus. You’ll notice that there
is spread of reflex to other muscle groups other
than just the quadriceps. Again, very brisk knee reflexes. Now focusing on the ankle,
there’s really no appreciable contraction of
the gastrocnemius muscle. So the Achilles
reflex is absent. Now to confirm that, I’ll ask
the patient to reinforce. We don’t need to look at that. Could you put your hands
together please, and play tug of war? Like this. Excellent, and one,
two, three, pull. So even with reinforcement
there’s no contraction of the gastrocnemius. On close up this is
the knee reflex with an excessive contraction
of the quadriceps. Notice the spread of reflexes
to abductor and aductor groups. I’ll do it one more time, okay. This will be graded as a three
plus because there is spread of reflexes. Okay. Now, a close up of
the gastrocnemius with an absent ankle reflex. No appreciable contraction
of the gastrocnemius. Notice that there’s
sometimes a little bit of bounce within the muscle but
this is not true contraction. This is just from the mechanical
percussion of the reflex hammer, again this is not
a true contraction. This would be graded as zero,
no reflexes.

7 Replies to “HIV Neuropathy Screening Exam with Grading Reflexes”

  1. I found this neuropathy treatment “gowo shocking plan” (Google it)for my mommy who suffers from the pain of neuropathy. I took a chance reading the guide and instruct her to follow it. My mother felt an improvement immediately. I am just happy that her condition has improved because if it. This is an excellent guide, and I am glad that she finally discovered the solution to her neuropathy!

  2. My feet and hands are affected with neuropathy. And finally I found something which works. And you know, I was kind of doubtful about it in the beginning, being that I tried pretty much everything. But absolutely nothing worked. But this neuropathy treatment solution “gowo shocking plan” (Google it),this stuff is effective. It truly amazed me.

  3. I'm researching best natural cure for neuropathy and found an awesome website at Nats Neuro Site (google it if you are interested)

Add a Comment

Your email address will not be published. Required fields are marked *