Systemic involvement
Systemic involvement includes disorders or pathologies that involve organs and/or organ systems. For example, hyperthyroidism, renal dysfunction, portal hypertension, and disorders causing hypernatremia and electrolyte imbalances are associated with hyperreflexia. Additionally, poorly controlled diabetes resulting in diabetic peripheral neuropathies, hypothyroidism and poliomyelitis are associated with hyporeflexia.

Local neuromuscular dysfunction
Local neuromuscular dysfunction includes physiological changes that can occur in muscle cells and tissues (i.e., local muscle or tendon injuries, physiological muscle weakness, muscular dystrophy and exhaustion).