How will you grade the deep tendon reflexes

Grading of deep tendon reflexesis done as follows

grade 0: absent

grade 1: sluggish

grade 2: normal—normal ankle

grade 3: brisk—normal knee

grade 4: exaggerated

grade 5: clonus

What are the methods of reinforcement in upperlimb and lowerlimb

Upper Limbs

While eliciting reflex in upperlimb patient may be asked to

Clench  teeth

Or clench the fist on the other side

Lower Limbs

This reinforcement may be done by

Clenching teeth

Jendrassik's maneuver is  performed asking the patient to pull the two arms apart.

It act by increasing  the gamma efferent activity

What are the fallacies in testing the tendon reflex?

You should ask the patient to hold the two hands apart and apply pressure only

when the tendon reflex is checked

Difference between brisk reflexes and exaggerated reflexes

Brisk reflex may be a normal varient

Here there is only  increase in amplitude without  increase in duration.

Exaggerated reflexes

There is increase in amplitude and duration of reflex.

Exaggerated reflexes may be seen in the following conditions

Corticospinal tract lesion

Anxiety

Thyotoxicosis

Aways look for clonus if the reflexes are exaggerated,
Condition where you get hyporeflexia 

LMN lesions is associated with hyporeflexia
AHC disease
Lesions of root ,plexus ,nerve
Neurological shock
Severe extrapyramidal rigidity
Contracture