Reflexes and Special Senses

REFLEXES

 Reflex - a rapid, predictable and involuntary motor response to stimuli. Sources of Stimulus and Classification of Reflexes A) internal environment - Autonomic / Visceral reflex B) external environment - Somatic reflex

Reflex Arc Mechanism Components

Receptor organ ( w/ Afferent / Sensory Neuron) Communication network (Interneurons / Association Neurons)) Effector organ (w/ Efferent / Motor Neuron)

Monosynaptic and Polysynaptic Reflex Arcs

Somatic: Spinal Stretch Reflexes

A. Patellar (or Knee-Jerk) Reflex: Purpose: L2-L4 Assessment Procedure:

Somatic: Spinal Stretch Reflexes

B. Achilles (or Ankle-Jerk) Reflex: Purpose: Assessment of sacral segments 1 and 2 Procedure:

Results of Spinal (Stretch) Reflexes

Hyperflaxia (exaggerated response) resulting from damaged or diseased motor areas in the CNS. Hypoflaxia (inhibited response) resulting from the degeneration of the nerve pathways, voluntary motor control, and other factors

Somatic: Superficial Cord Reflex

A. Plantar Reflex: Purpose: Assessment of corticospinal tract damage Procedure:

Somatic: Cranial Nerve Reflex

A. Corneal Reflex: Purpose: Assessment of trigeminal nerve (cranial nerve V) or brain stem dysfunction Procedure:

Autonomic Reflex: Pupillary Reflexes

Components: a) Receptor: Retina of the eye b) Afferent Fibers: Optic Nerve (Cranial nerve II) c) Efferent Fibers: Oculomotor Nerve (Cranial nerve III) d) Effector: Smooth muscles of iris

Autonomic : Pupillary Reflex

A. Photopupillary (or Pupillary Light) Reflex: Purpose: Assessment of optic nerve or brain stem dysfunction B. Consensual Reflex: Purpose: Assessment of oculomotor nerve or brain stem dysfunction Procedure:

Autonomic : Pupillary Reflex

Results of Photopupillary and Consensual Reflex:

Special Senses

A. Visual Function Tests

Retina to Brain

retina

optic nerve

lateral geniculate nucleus

visual cortex

A.1. Blind Spot Test

Examples of Blind Spot Test Charts

Blind Spot Chart

A.2. Refraction,Visual Acuity and Astigmatism Tests

A.1.1. Near Point of Accommodation

Definition: The ability of the eye to adjust its focus in relation to changes in distance of an object being viewed (less than 20 feet) Procedure:

Principle of Near Point of Accommodation

Accommodation Test

Accommodation Test
Interpretation of Results / Clinical Diagnosis:
Normal vision 10 cm; emmetropia Abnormal: a) Myopia (Nearsightedness) failure of the parallel light rays to reach the retinal surface. b) Hyperopia (Farsightedness) the parallel light rays are focused behind the retina. Ageing Patients: presbyopia old vison

Treatment:
Myopia concave lenses Hyperopia Convex lenses

A.1.2. Visual Acuity Test

Definition: The clearness and sharpness of an image Procedure:

Visual Acuity Test (Snellens Chart)

Visual Acuity Charts

Visual Acuity
Interpretation of Results:
Ratio is <1 = a person has greater than normal visual acuity Ratio is >1 = a person has less than normal visual acuity

Sample Problem: Patient 1: 20/20

Patient 2: 20/70 >1 Ratio (myopia = nearsightedness)

Clinical Diagnosis:

A.1.3. Astigmatism Test

Definition: the abnormal curvature in some parts of the lens and/or cornea Astigma not a point Procedure:

Astigmatism Test Chart

Astigmatism Test Chart

Test for Astigmatism

Interpretation of Results:
Normal eyes all radiating lines are equally dark and distinct. Astigmatic Eye some lines are blurred or appear less dark than the others

A.1.4. Color Blindness Test

Photoreceptors
Rods peripheral region of retina; dim light; black and white Cones fovea; bright light; colored; types a) absorbs red b) absorbs blue c) absorbs green

Ishiharas Color Blindness Test

Purpose: test for deficiencies in the cones (color photoreceptor cells)

Ischihara Test Kit

= collection of 38 plates filled with colored dots build the base of this test. The dots are colored in different shades of a color and a number or a line is hidden inside with different shades of an other color. = Distance from Subject:30 inches (75 cm)

Ishihara Test

Normal Color Vision Left Top Middle Bottom 25 45 6 Right 29 56 8

Red-Green Color Blind Left Top 25 Right Spots 56 Spots

Middle Spots Bottom Spots

AMRWong

AMRWong

Interpretation of Results:
= Conditions: a) Deuteranopia absence of green-sensitive receptors b) Protanopia - absence of red-sensitive receptors = These tests are never 100% accurate.

Color deficiency People who are "colorblind" tend to be missing some of the color-sensitive cones, so these colors will appear darker. Few people are completely colorblind.

For those that are color deficient, this is a graph showing approximate proportions of each type, based on a study of 5000 Swiss men who wanted to be pilots

AMRWong

BOYS VS. GIRLS

Color deficiency is common in boys Different books give different figures, from 5-8 % of boys, 1 boy in about 12-20, or an average of one boy per classroom has some color deficiency, almost similar to the percentage of people who are left-handed!

 Color deficiency is rare in girls The genes for color vision are on the X chromosome, and because females have 2 X chromosomes, if one is deficient, the other makes up for it. The result is that there are only about 1 in 200+ girls who have color deficiencies, or roughly only one girl in 16 classrooms

More common in Europeans: It is inherited naturally through the mother, who may pass on a defective X chromosome. The actual ratios vary in different populations, and one book reported that color deficiency is more common in European stock, and much less common in Asian and Native American. (Perhaps northern dwellers during the ice ages did not need color vision as much and lost it during a mutation?)

A.1.5. Reflex Activity of the Intrinsic and Extrinsic Eye Muscles

1) Accommodation Pupillary Reflex 2) Convergence Reflex

Procedures:

B. Hearing and Equilibrium Tests

Hearing and Conduction Tests

B1. Rinne Test

compares air conduction to bone-conduction hearing.

Results and Interpretation:

Normal - one will have greater air conduction than bone conduction and therefore hear the vibration longer with the fork in the air. Abnormal: a) Conductive hearing impairment = Bone conduction is the same or greater than the air conduction. b) Sensineuronal hearing loss = Vibration is heard substantially longer than usual in the air. * It would also be prudent to perform an otoscopic examination of both eardrums to rule out a severe otitis media, perforation of the tympanic membrane or even occlusion of the external auditory meatus, which all may confuse the results of these tests. Furthermore, if hearing loss is noted an audiogram is indicated to provide a baseline of hearing for future reference.

B2. Weber Test

A test of lateralization Conductive and Sensorineural Deafness Evaluates whether the sound remains centralized (normal) or lateralized to one side (indicative of some degree of conductive or sensorineural deafness)

Results and Observations

The sound is heard in the center of the head or equally in both ears = equal hearing or equal loss of hearing. Sensorineural deafness of L ear = tone is heard in R ear Conduction deafness = tone is louder in ear with hearing loss

NOTE: If the patient doesn't hear the vibration at all, attempt again, but press the butt harder on the patient's head.

B3. Romberg Test

Equilibrium is a result of: 1. visual confirmation of position, 2. non-visual confirmation of position (including proprioceptive and vestibular input) 3. a normally functioning cerebellum. Result: (+) result means that there is pathology in the proprioceptive pathway if a patient loses their balance after standing still with their eyes closed, but is able to maintain balance with their eyes open.

C. Chemical Senses: Taste and Smell

C.1. Sense of Taste

Taste buds are found on the
Tongue Palate Lips Throat

Sense of Smell (Olfaction)

Olfactory Epithelium and Bulb

C.1. Sense of Taste and Smell

Factors affecting taste and smell: A) Presence/Absence of moisture B) Texture C) Olfactory stimulation D) Temperature