Reflex reinforcement technique

Definition:
Also known as the Jendrassik manoeuvre, reinforcement technique is a further method of testing for normal reflex response where it has been found to be absent by conventional reflex testing.

Test procedure:
Where a reflex appears to be absent in the lower limb ask the patient to interlace the fingers and pull apart, thereby recruiting upper limb muscular contraction, whilst simultaneously re-testing for the reflex. For an upper limb reflex, ask the patient to grit the teeth whilst re-testing.

Test findings:
Where a reflex is absent but found to be present with reinforcement, this should be considered a normal reponse, but the need for reinforcement should be recorded in the notes. Where a reflex is still found to be absent despite reinforcement, a true absent reflex should be recorded

Considerations:
Factors affecting reflex responses include the correct use of the hammer and location of contact. Patient tension and focus may interfere with the reflex response: consider using distracting conversation during tests.