Introduction
Specific testing strategies are presented for each examination procedure. The clinician, however, can apply the following general examination strategies to all procedures:
- The muscle or muscle group being tested is typically placed in a neutral position, and the tendon of interest is identified via knowledge of surface anatomy, by palpation, and occasionally by asking the patient to sub-maximally contract the muscle to which the tendon is attached.
- The patient and therapist are positioned so that the tendon being examined can be easily struck with a reflex hammer and visually inspected. The test position must account for appropriate patient position, comfort, and support, as well as sound ergonomic principles practiced by the health care provider.
- The patient’s position must allow for easy transition to the contralateral limb and seek to reduce the number of times that the patient must be repositioned during the course of the complete examination.
Reinforcement procedures can be used when a clinician is unable to elicit a reflex. Reinforcement procedures are based on the assumption that in the absence of pathology, increased input into the central nervous system results in increased reflex responses. Examples of reinforcement procedures are as follows:
- Have the patient perform sub-maximal isometric contractions of muscles not being tested (e.g., when testing the quadriceps reflex, have the patient interlock his/her hands and attempt to pull apart).
- Choose a patient position that would tend to facilitate greater central nervous system activity (sitting as opposed to supine).
- Have the patient imagine that they are contracting the muscle being tested.
- Have the patient count backwards from 100 by 3’s or perform a similar cognitive activity.
