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We are not big believers in grading reflexes (grading muscle power is much more useful). Nevertheless, if you need something beyond “absent,” “present,” “brisk,” or “hyperactive” then use below.
Lookup how to assess the deep tendon reflexes, their arcs, and how to interpret expected and abnormal responses
A standard scale for grading DTRs is used. Differences in reflexes on the left and right sides are more significant than hyper- or hyporeflexia occurring on both sides (if a spinal cord or brain pathology is not suspected).
Deep tendon reflexes are graded on a scale of zero to four. A score of zero indicates no response, while a score of four indicates a brisk, hyperactive response.
To remove subjectivity from DTR assessment, clinicians use a standardized five-point numerical scale to quantify the muscle response observed. The scale ranges from 0 to 4+ and provides a common language for documenting reflex findings.
How much is a typical DTR score? On a scale of zero to four, deep tendon reflexes are rated. A response of zero denotes no response, whereas a response of four denotes a rapid, agitated response. Two is regarded as the normal score.
The DTR grading system provides a structured approach to identifying neurological deficits. A symmetrical and normal 2+ response across multiple muscle groups is typically reassuring.
Clinicians use a standardized 5-point scale to grade deep tendon reflex responses, providing a consistent way to document and interpret findings. A grade of 0 indicates no reflex response. A 1+ grade signifies a diminished or hypoactive reflex, a slight response less than typical.
To provide a standard scale for evaluating deep tendon reflexes, in 1993, the National Institute of Neurological Disorders and Stroke (NINDS) proposed a grading scale from 0 to 4.
Across the continuum of healthcare disciplines, it is projected that the number of deep tendon reflex grading scales easily exceeds 30 named and anecdotal scales. This said, documenting grades of reflex intensity using a widely accepted scale that offers validated criteria is recommended.