Reflex Grading Tool

Deep Tendon Reflex (DTR) Grading Tool

Uses the NINDS Scale (0 to 4+) for standard clinical assessment.

Select the observed response:

0

Absent / Areflexia

1+

Hyporeflexia (Low Normal)

2+

Normal / Average Response

3+

Hyperreflexia (Brisk)

4+

Clonus / Hyperactive

4+ (Sustained)

Sustained Clonus

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NINDS DTR Grading Scale Reference

Grade	Description	Clinical Interpretation
0	No response; absent reflex.	Pathological (Severe LMN lesion)
1+	Slight response; diminished, low normal.	Hyporeflexia (Often LMN involvement or systemic disease)
2+	Brisk response; average, normal.	Normal
3+	Very brisk response; exaggerated, slightly hyperactive.	Hyperreflexia (Suggests UMN lesion)
4+	Clonus; often sustained. Hyperactive.	Pathological (Severe UMN lesion)

Reflex Checklist (Example)

To help correlate findings, here are the key reflexes:

Reflex	Nerve Root	Test Site
Biceps	C5, C6	Biceps Tendon
Brachioradialis	C5, C6	Radial Styloid
Triceps	C7, C8	Triceps Tendon
Patellar	L2, L3, L4	Patellar Tendon
Achilles	S1, S2	Achilles Tendon

Reference: O'Sullivan, S. B., Schmitz, T. J., & Fulk, G. (2019). *Physical rehabilitation*. FA Davis. (NINDS scale).