HIV Neuropathy Screening Exam with Grading Reflexes
These are the instructions for evaluating perceptionof vibration. Use a 128 hertz tuning fork. SOUND Hit the tuning fork hardenough so that the sides touch. And make sure that the subjectknows the type of sensation. Do you feel this asa vibration or a buzzing? gt;gt; Vibration. gt;gt; As a vibration, very good.
Now repeat the procedurein the feet. Again, strike the tuningfork hard enough so that the sides touch andimmediately put the tuning fork on the distalinterphalangeal joint. Count the number of seconds. Ask the subject to tell youwhen the vibration stops. gt;gt; Now. gt;gt; It stopped now?
Good. And repeat the procedureto the opposite side. Again, the tuning fork goeson the distal interphalangeal joint. Make sure you strikethe tuning fork hard enough so that the sides touch. For evaluating deeptendon reflexes, with the subject seated,examiner should use the hand
to gently dorsiflex the footat about 90 degrees. Press upwards slightlyon the sole of the foot. Use a reflex hammer, preferablya longhandled reflex hammer. A tomahawk hammeris also acceptable. And strike the Achillestendon just behind the heel. Contraction of the gastrocnemiusmuscle will be both seen and felt. Repeat the procedurewith the opposite leg.
Have to do now is showthe discrepancy between the knee reflex and the ankle reflex. Many patients with HIVdisease have both central and peripheral nervoussystem disease. So one may see a mix ofhyperreflexia at the knee and reduced reflexes,or hyporeflexia or areflexia at the ankles. So now we'll attemptto demonstrate this.
So here first for the patellareflex, the knee reflex, this would be graded as a 3plus, there is hyperrefelxia and spread of the reflexto other muscles. In the same patient,ankle reflexes are reduced significantly outof proportion to knee reflexes. So these are the differentgradings for ankle reflexes. Absent means that with a strongpercussion of the Achilles tendon, there is no contractionof the gastrocnemius.