Learning Points:

• The patient must be relaxed and positioned properly before starting.
• Reflex response depends on the force of your stimulus. Use no more force than you need to provoke a definite response.
• Reflexes can be reinforced by having the patient perform isometric contraction of other muscles (Jendrassik's manouevre or clenched teeth).
• If the patient is very hyper-reflexic, consider eliciting finger jerks. With patient's arm pronated, support the flexed fingers with your right hand and strike the back of your own fingers with the patella hammer.
• Reflexes should be graded on a 0 to 4 "plus" scale:

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