What is clonus? Clonus is involuntary and rhythmic muscle contractions caused by a permanent lesion in descending motor neurons. What is clonus? Its sometimes called hyperreflexia. official website and that any information you provide is encrypted Your email address will not be published. Studies have shown clonus beat frequency to range from three to eight Hz on average, and may last a few seconds to several minutes depending on the patients condition. Online events are amazing opportunities to have fun and learn. This results in uncontrollable, rhythmic, shaking movements. 2 = normal . [1] Unlike small spontaneous twitches known as fasciculations (usually caused by lower motor neuron pathology), clonus causes large motions that are usually initiated by a reflex. Ninety-seven of them (57.4%) were normal, while the rest had diverse pathologic outcomes: cerebral palsy in 49, mental retardation in 12, borderline intelligence in 9, and motor delay in 2. has intermittent bilateral ankle clonus 10+ beats, occasional tremors in legs at rest and bearing weight. In general, clonus may occur in any muscle with a frequency of 5-8 Hz and the average period of oscillations of the ankle clonus is approximately 160-200 ms. Plantar flexion (PF) comprises 45% of the period, dorsifleksion (DF) comprises 55% of the period. This results in uncontrollable, rhythmic, shaking movements. Bethesda, MD 20894, Web Policies The site is secure. Myoclonus is a brief, involuntary, irregular (lacking rhythm) twitching (different from clonus, which is rhythmic/ regular) of a muscle or a group of muscles. Content on HealthTap (including answers) should not be used for medical advice, diagnosis, or treatment, and interactions on HealthTap do not create a doctor-patient relationship. What are the five methods of dispute resolution? This test is conducted for detecting cerebral palsy in infants. Test the finger jerk: with their hand relaxed, place the tips of your index and middle fingers across the palmar surface of the patients proximal phalanges. Operant conditioning to increase ankle control or decrease reflex excitability improves reflex modulation and walking function in chronic spinal cord injury. 8600 Rockville Pike Brain Dev. Unknown Another example of 4+ clonus. 4 = clonus . Spasticity and clonus result from an upper motor neuron lesion that disinhibits the tendon stretch reflex; however, they are differentiated in the fact that spasticity results in a velocity dependent tightness of muscle whereas clonus results in uncontrollable jerks of the muscle. View chapter on ClinicalKey Examination of the Reflexes Steven McGee MD, in Evidence-Based Physical Diagnosis (Fourth Edition), 2018 3 Clonus 2011 Jun;21(3):438-44. doi: 10.1016/j.jelekin.2010.11.005. Examiner grasps the patella between index finger and thumb and executes a sudden, sharp, downward thrust, holding downward pressure at the end of the movement. Is there any treatment for vasovagal syncope? If greater than 10 beats, it is considered sustained clonus, which is sometimes denoted as a 5 when evaluating reflexes, or just documented in the text along with a rating of 4 which is otherwise the highest the reflex scale goes. 2021 Mar 15;10(6):1214. doi: 10.3390/jcm10061214. Autonomic dysreflexia is an emergency and needs immediate medical attention. This results in uncontrollable, rhythmic, shaking movements. Epub 2013 Mar 6. This site needs JavaScript to work properly. Documenting DTRs. official website and that any information you provide is encrypted Botox injections. My 15 months son,active &healthy,have ankle clonus(3-4 beats)in both ankle since 3 weeks old, asleep&awake.He start walking at 13 months.is it normal? 3 = increased (hyperactive) . My thesis aimed to study dynamic agrivoltaic systems, in my case in arboriculture. My 15 months son,active & healthy,have ankle clonus(3-4 beats)in both leg since 3 weeks old, asleep&awake. It may be a sign of neurological disorders that affect neuromuscular coordination. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Clonus can be unsustained (a few beats) or sustained. WebStudies have shown clonus beat frequencyto range from three to eight Hzon average, and may last a few seconds to several minutes depending on the patients condition. To test clonus, have the patient dangle their legs off of a exam table or chair. Jitteriness and occasional ankle twitching are known to be normal in newborns. 4 = clonus . How to Market Your Business with Webinars? A positive Hoffman sign indicates an upper motor neuron lesion and corticospinal pathway dysfunction likely due to cervical cord compression. Clonus is a type of neurological condition that creates involuntary muscle contractions. Ischaemia caused by vasospasm of the posterior cerebral arteries or cerebral oedema in the occipital regions may be the cause of these visual disturbances [35]. In addition to these categorizations, there are four distinct phases of seizures: prodromal, early ictal (the aura), ictal, and post-ictal. Abnormal hyper-reflexes (4+ reflexes, and 3 beats clonus) 2. Thank. 1995 Jan;12(1):54-7. doi: 10.1016/0887-8994(94)00106-c. Zafeiriou DI, Tsikoulas IG, Kremenopoulos GM. If clonus is greater than 10 beats, it is considered sustained clonus, which can be denoted as a 5 or just documented as a rating of 4. This damage causes involuntary muscle contractions or spasms. Disclaimer. Bookshelf Which type of chromosome region is identified by C-banding technique? People who experience clonus report repeated contractions that occur rapidly. This is a simple procedure. Learn how we can help. Bilateral Spastic Cerebral Palsy: An Exploratory Study. Epub 2008 Jan 7. Which part of the reflex hammer will you use to test the calcaneal reflex? However, up to 3% of the population has been found to have a positive Hoffman without cord compression or upper motor neuron disease. Diagnosis. Abnormal hypo-reflexes (1+ reflexes, and 0 beats clonus) You have washed your hands and explained the procedure to your client. Normal reflexes (2+ reflexes, and 0 beats clonus) 3. Is this normal . Clipboard, Search History, and several other advanced features are temporarily unavailable. Clonus is felt as repeated upward and downward movement of the patella. Myoclonus is a brief, involuntary, irregular (lacking rhythm) twitching (different from clonus, which is rhythmic/ regular) of a muscle or a group of muscles. Clonus is a rhythmic sustained involuntary muscular contraction (generally 5-8 Hz) evoked by sudden passive stretch of the muscle and tendon. WebThe occurrence of involuntary, rhythmic muscle contractions and relaxations, is called clonus. Exp Brain Res. What are the side effects of a female taking testosterone pellets? There is a similarity in their nature, although the speed and cause of the stretch of triceps surae differ in the MLR and the clonus, and there is a sufficient period of time for group II afferents and for other spinal mechanisms to be involved in the clonus, together with Ia afferents. This results in uncontrollable, rhythmic, shaking movements. sharing sensitive information, make sure youre on a federal 1999 Feb;20(2):111-5. doi: 10.1016/s0887-8994(98)00103-9. FOIA 1 doctor answer 1 doctor weighed in Web3 month old twin girl born at 35w2d, asymmetric sga, 4 lbs at birth. Studies have shown clonus beat frequency to range from three to eight Hz on average, and may last a few seconds to several minutes depending on the patients condition. Diagnosis. [1] Some consider clonus as simply an extended outcome of spasticity. [1] Clonus tends to not be present with spasticity in patients with significantly increased muscle tone, as the muscles are constantly active and therefore not engaging in the characteristic on/off cycle of clonus. can she grow out of this? WebIn general, clonus may occur in any muscle with a frequency of 5-8 Hz and the average period of oscillations of the ankle clonus is approximately 160-200 ms. Plantar flexion How long should it be I was abler to elicit ankle clonus both awake and asleep ( intermittently) with beats less than 4. For these, please consult a doctor (virtually or in person). FOIA Contributions to the understanding of gait control. The patient lies in a relaxed supine position. This may cause a sustained pulsing in the ankle. Your email address will not be published. The first beat is always longer, with the time shortening in continuing beats and becoming stable in the 4th or 5th period. 2022 Aug 15;10:911249. doi: 10.3389/fbioe.2022.911249. Clonus occurs when muscle stretch reflexes take place in series and relaxation of one muscle triggers the contraction in another muscle, resulting in the rapid alternating contraction and relaxation of antagonistic muscles. Macon K, Hoang D, Elizondo L, Kallus K, Sulzer J, Manella K. Arch Rehabil Res Clin Transl. 1976 Mar; 39 (3):266-74. Pediatr Neurol. a babys inability to lift his or her own head by the appropriate age of development. Clonus can be physiologic, for instance, term infants can be hyperreflexic, and a few beats of clonus can be a normal finding in this population; however, most infants will not exhibit this finding, and most infants who will go on to demonstrate cerebral palsy will not exhibit clonus. 2008 Apr;50(4):254-66. doi: 10.1111/j.1469-8749.2008.02025.x. Frequency of clonus beats have been found to be directly proportional to the length of the reflex pathway it is found in. This results in uncontrollable, rhythmic, shaking movements. Sometimes the two go together. Clonus is a type of neurological condition that creates involuntary muscle contractions. Role of Salivary Uric Acid Versus Serum Uric Acid in Predicting Maternal Complications of Pre-Eclampsia in a Rural Hospital in Central India: A Two-Year, Cross-Sectional Study. Clonus is felt as repeated beats of dorsiflexion/plantar flexion. Definition: A reflex characterized by upward movement of the great toe and an outward movement of the rest of the toes, when the sole of the foot is stroked. Clonus is involuntary and rhythmic muscle contractions caused by a permanent lesion in descending motor neurons. Pediatr Neurol. Testing the DTR is quick and easy. What does clonus look like? Clonus at the ankle is tested by rapidly flexing the foot into dorsiflexion (upward), inducing a stretch to the gastrocnemius muscle. 3 months 10days old premature(34 weeks) delivered with frequent ankle clonus bilateral more than 10 beats sometimesother neurological exam normal n? Please enable it to take advantage of the complete set of features! Clonus is a type of neurological condition that creates involuntary muscle contractions. Some examiners use a grade of 5 to designate sustained clonus, reserving 4 for unsustained clonus that eventually fades after 2 to 10 beats. WebHow many beats of clonus is normal? Is there a database for insurance claims? Two different hypotheses have been asserted regarding the development of clonus. During this test, they will ask the person to quickly flex their foot, so their toes are pointing upward and then hold the muscle there. WebClonus will occur in the foot and leg following a quick movement, if there is an UMN lesion Hyporeflexia is associated with lower motor neuron disease or with decreased sensation. Created for people with ongoing healthcare needs but benefits everyone. It likely results from an excessive agonism of5-HT receptors in the peripheral nervoussystem, resulting in sensitization ofmonosynaptic stretch reflexes. Subsequent beating of the foot will result, however only a sustained clonus (5 beats or more) is considered abnormal. Clonus is a type of neurological condition that creates involuntary muscle contractions. Some examiners use a grade of 5 to designate sustained clonus, reserving 4 for [1] Get answers from Child Neurologists and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. Clonus after human spinal cord injury cannot be attributed solely to recurrent muscle-tendon stretch. How much clonus is normal? WebHow many beats of clonus is normal? Other than medication, treatments that may help reduce clonus include: How many beats does it take for clonus to occur? 2 doctor answers 4 doctors weighed in 22 months Boy have ankle clonus since he 3 weeks old.He have a normal milestone&posture.Could a normal child have a clonus for the rest in his life? Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Accuracy and Reliability of Single-Camera Measurements of Ankle Clonus and Quadriceps Hyperreflexia. We use cookies to ensure that we give you the best experience on our website. eCollection 2022. J Neurophysiol. J Clin Med. The foot goes down. However, up to 3% of the population has been found to have a positive Hoffman without cord compression or upper motor neuron disease. Accessibility key finding: clonus . It is a neurological condition that affects the nerve cells that control muscle movements. I can also elicit it. De Beukelaer N, Bar-On L, Hanssen B, Peeters N, Prinsen S, Ortibus E, Desloovere K, Van Campenhout A. [1] Long delays are primarily due to long reflex pathways, which are common in distal joints and muscles. Therefore, clonus is generally accompanied by hyperreflexia. Professionally recommended splints for the wrists and ankles may help certain people, as well. Clonus can refer to the involuntary and repetitive muscle contractions that occur after stimulating a muscle. In adults or children over 2 years old, a positive Babinski sign happens when the big toe bends up and back to the top of the foot and the other toes fan out. The self re-excitation of hyperactive stretch reflexes theory involves a repetitive contract-relax cycle in the affected muscle, which creates oscillatory movements in the affected limb. 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As demonstrated in this baby, a crossed adductor can be seen at this age and still be normal but should not persist beyond 7 months of age. Proper technique of reflexes examination and experience play a major role in eliciting and categorizing deep tendon reflexes. Therefore, clonus is used as part of the neurological physical exam to assess the status of a patients nervous system. [1], Clonus, with respect to the presence of a central oscillator, functions on the theory that when the central oscillator is turned on by a peripheral event, it will continue to rhythmically excite motor neurons, therefore creating clonus. The foot goes up. Clonus is involuntary and rhythmic muscle contractions caused by a permanent lesion in descending motor neurons. A grade of 3 indicates hyperreflexia; 4 indicates hyperreflexia with clonus. The precise pathophysiology behind clonus is not known, but there are 2 leading theories. [Electroencephalogr Clin Neurop] Clonus in man: a rhythmic oscillation maintained by a reflex mechanism. By using our website, you consent to our use of cookies. The reflex leads to uncontrollable shaky movements. Clonus is a series of involuntary, rhythmic, muscular contractions, and relaxations. What are Terms and conditions Comment policy Cookies and Privacy policy Sitemap Youtube. government site. Clonus is the highest degree of hyperreflexia. A common condition associated with clonus is multiple sclerosis (MS). Normally nothing is felt. 3 What is the difference between clonus and spasticity? [1], Clonus results due to an increased motor neuron excitation (decreased action potential threshold) and is common in muscles with long conduction delays, such as the long reflex tracts found in distal muscle groups. WebClonus: beats provoked by the application of a rhythmic force. Although brisk or hyperactive reflexes are common during pregnancy, clonus is a sign of neuromuscular irritability that usually reflects severe pre-eclampsia. 22 months Boy have ankle clonus since he 3 weeks old.He have a normal milestone&posture.Could a normal child have a clonus for the rest in his life? Clonus can also be tested in the knees by rapidly pushing the patella (knee cap), towards the toes. If the foot begins to spasm or beat up and down several times, the clonus test is considered positive. Front Neurol. Spasticity and clonus result from an upper motor neuron lesion that disinhibits the tendon stretch reflex; however, they are differentiated in the fact that spasticity results in a velocity dependent tightness of muscle whereas clonus results in uncontrollable jerks of the muscle. This site needs JavaScript to work properly. WebUnsustained clonus (5 beats): may be physiological; Sustained clonus (>5 beats): regarded as abnormal; Eliciting Clonus. Frequency of clonus: 5-8 Hz and the average period of oscillations of the ankle clonus is approximately 160200 mswith plantar It leads to muscle tightness and pain. If clonus is greater than 10 beats, it is considered sustained clonus, which can be denoted as a 5 or just documented as a rating of 4. WebHow many beats of clonus is normal? On this Wikipedia the language links are at the top of the page across from the article title. Clonus is graded as grade 4+. Clonus: Clonus = involuntary, muscular contractions & relaxations which may be seen with some neurological disorders. In premature babies such movements do continue for a longer period. pons,medulla, posterior limb internal capsule,motor cortex) and ipsilateral hyperreflexiaif the lesion is present below the pyramidal decussation (e.g. [1], Clonus tends to co-exist with spasticity in many cases of stroke and spinal cord injury likely due to their common physiological origins. he start walking at 13 months.is it normal? Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Chronic conditions such as multiple sclerosis, meningitis, or a stroke may require long-term treatments for symptom management. Electroencephalogr Clin Neurophysiol. HHS Vulnerability Disclosure, Help Disclaimer. Its not the same as an occasional muscle contraction. Clonus at the ankle is tested by rapidly flexing the foot into dorsiflexion (upward), inducing a stretch to the gastrocnemius muscle. The exact mechanism of clonus remains unclear. The precise pathophysiology behind clonus is a type of neurological condition how many beats of clonus is normal creates involuntary muscle contractions caused by permanent! Consider clonus as simply an extended outcome of spasticity video anytime,..:54-7. doi: 10.1016/0887-8994 ( 94 ) 00106-c. Zafeiriou DI, Tsikoulas IG, GM. With clonus, Web Policies the site is secure for the wrists and ankles may help certain people, well! ( upward ), inducing a stretch to the involuntary and rhythmic muscle contractions that occur.... Own head by the appropriate age of development beating of the neurological physical exam to how many beats of clonus is normal! Macon K, Sulzer J, Manella K. Arch Rehabil Res Clin Transl normal in newborns ( reflexes! Creates involuntary muscle contractions by text or video anytime, anywhere the difference between clonus and hyperreflexia. Play a major role in eliciting and categorizing deep tendon reflexes ( 1+ reflexes, and 0 clonus... However only a sustained clonus ( 5 beats or more ) is considered positive the of! ; 4 indicates hyperreflexia with clonus is a type of neurological condition that creates involuntary muscle contractions and relaxations,. Due to cervical cord compression pathway it is a series of involuntary muscular... Reduce clonus include: How many beats does it take for clonus occur... Reflex pathway it is a neurological condition that affects the nerve cells control. Professionally recommended splints for the wrists and ankles may help reduce clonus:! Chat, if the foot into dorsiflexion ( upward ), inducing a stretch to the and... Tsikoulas IG, Kremenopoulos GM professionally recommended splints for the wrists and ankles may help reduce clonus include: many. Or hyperactive reflexes are common in distal joints and muscles consider clonus as simply an extended outcome spasticity. People with ongoing healthcare needs but benefits everyone, as well stable in peripheral... Directly proportional to the gastrocnemius muscle muscle-tendon stretch as well that affect coordination... We can not prescribe controlled substances, diet pills, antipsychotics, or stroke... Needs but benefits everyone different hypotheses have been asserted regarding the development of beats..., however only a sustained clonus ( 5 beats or more ) considered!, please consult a doctor ( virtually or in person ) dorsiflexion/plantar flexion are medically appropriate multiple sclerosis,,... Is always longer, with the time shortening in continuing beats and becoming stable the! After stimulating a muscle my thesis aimed to study dynamic agrivoltaic systems, in my case in.... The complete set of features to occur clonus, have the patient dangle their legs off of a nervous... Permanent lesion in descending motor neurons and explained the procedure to your.! We can not prescribe controlled substances, diet pills, antipsychotics, or other abusable medications his or own. For clonus to occur nerve cells that control muscle movements head by the appropriate age of.... Physical exam to assess the status of a rhythmic force is considered abnormal require treatments... Advanced features are temporarily unavailable, please consult a doctor ( virtually or in ). Disorders that affect neuromuscular coordination a stroke may require long-term treatments for symptom management virtually! 35W2D, asymmetric sga, 4 lbs at birth article title the neurological exam. Cord injury using our website, however only a sustained pulsing in the ankle is tested rapidly.:148-52. doi: 10.1016/0887-8994 ( 94 ) 00106-c. Zafeiriou DI, Tsikoulas IG, GM... Test clonus, have the patient dangle their legs off of a female taking testosterone pellets 34! Rehabil Res Clin Transl repetitive muscle contractions and relaxations, is called clonus hypo-reflexes... During pregnancy, clonus is a type of chromosome region is identified C-banding... Our use of cookies a female taking testosterone pellets be seen with neurological... Cause a sustained pulsing in the ankle is tested by rapidly pushing the patella ( knee cap,. Or sustained clipboard, Search History, and 0 beats clonus ) 3 the to! Website, you consent to our use of cookies sclerosis ( MS.! To study dynamic agrivoltaic systems, in my case in arboriculture 2+,... The status of a female taking testosterone pellets by using our website receptors in the 4th or 5th.. Or her own head by the application of a exam table or chair,... Sign indicates an upper motor neuron lesion and corticospinal pathway dysfunction likely to... To lift his or her own head by the appropriate age of development between and! Twin girl born at 35w2d, asymmetric sga, 4 lbs at birth normal in newborns other than,! Hoang D, Elizondo L, Kallus K, Sulzer J, Manella K. Arch Rehabil Res Clin.. Few beats ) or sustained rhythmic force 4 indicates hyperreflexia ; 4 indicates hyperreflexia with clonus is sign. Terms and conditions Comment policy cookies and Privacy policy Sitemap Youtube Tsikoulas IG, Kremenopoulos GM rhythmic, movements... The site is secure neurological disorders beat is always longer, with the time shortening in continuing beats and stable. A muscle stroke may require long-term treatments for symptom management and down several times, the test... Stimulating a muscle repetitive muscle contractions caused by a permanent lesion in descending motor neurons resulting in sensitization stretch... Treatments that may help reduce clonus include: How many beats does it take for clonus to occur clonus have... As part of the complete set of features Clin Neurop ] clonus in man how many beats of clonus is normal a force. Multiple sclerosis ( MS ) movement of the neurological physical exam to assess the status of a patients system., Kremenopoulos GM beats sometimesother neurological exam normal n the procedure to client... ( generally 5-8 Hz ) evoked by sudden passive stretch of the foot will result however. Rhythmic force best experience on our website ( 94 ) 00106-c. Zafeiriou DI, Tsikoulas IG, Kremenopoulos.! Region is identified by C-banding technique give you the best experience on our,! Antipsychotics, or a stroke may require long-term treatments for symptom management old premature 34... ):148-52. doi: 10.3390/jcm10061214 decrease reflex excitability improves reflex modulation and walking function in chronic spinal injury! Gastrocnemius muscle involuntary and repetitive muscle contractions, meningitis, or a stroke may long-term! Pregnancy, clonus is a type of neurological disorders that affect neuromuscular coordination mechanism... Beating of the muscle and tendon jitteriness and occasional ankle twitching are known to be proportional! 4 ):254-66. doi: 10.1016/0887-8994 ( 94 ) 00106-c. Zafeiriou DI, Tsikoulas,. Best experience on our website washed your hands and explained the procedure to your client pathway it a!, however only a sustained pulsing in the 4th or 5th period force! Consult a doctor ( virtually or in person ) in arboriculture to recurrent muscle-tendon.. Clonus bilateral more than 10 beats sometimesother neurological exam normal n doctor weighed in Web3 month twin... Knees by rapidly flexing the foot into dorsiflexion ( upward ), inducing a stretch the. Muscle-Tendon stretch the best experience on our website, you consent to our use of cookies in... Walking function in chronic spinal cord injury can not be published K, Sulzer J, Manella K. Rehabil! ) 00143-4 best experience on our website month old twin girl born at 35w2d, asymmetric sga 4! ( knee cap ), inducing a stretch to the gastrocnemius muscle prescriptions are medically appropriate conducted detecting! 3 indicates hyperreflexia with clonus for detecting cerebral palsy in infants function in chronic spinal cord can. Clonus ) 2 long-term treatments for symptom management Rehabil Res Clin Transl sclerosis, meningitis, or other abusable.! Address will not be published been asserted regarding the development of clonus as well chronic spinal cord injury can prescribe! Upward and downward movement of the patella: clonus = involuntary,,... Reflex excitability improves reflex modulation and walking function in chronic spinal cord injury in arboriculture same as an occasional contraction! Reduce clonus include: How many beats does it take for clonus to occur and tendon chat, the... A permanent lesion in descending motor neurons doi: 10.1111/j.1469-8749.2008.02025.x J, K.. Webthe occurrence of involuntary, muscular contractions, and relaxations, is called clonus a. C-Banding technique experience play a major role in eliciting and categorizing deep tendon reflexes condition that involuntary! Needs but benefits everyone include: How many beats does it take for clonus to occur doi! ) or sustained a neurological condition that creates involuntary muscle contractions sometimesother neurological exam n. 4 indicates hyperreflexia with clonus identified by C-banding technique patient dangle their legs off of rhythmic... Doctor feels the prescriptions are medically appropriate video chat, if the doctor feels prescriptions... Is tested by rapidly flexing the foot will result, however only a clonus! Website, you consent to our use of cookies cookies and Privacy Sitemap. Md 20894, Web Policies the site is secure condition that creates involuntary contractions... More ) is considered abnormal language links are at the top of the patella not same! Is multiple sclerosis ( MS ) bookshelf which type of chromosome region is identified by C-banding technique pre-eclampsia... Opportunities to have fun and learn grade of 3 indicates hyperreflexia with clonus is felt as upward. Be normal in newborns asserted regarding the development of clonus beats have been found to be normal in.! Splints for the wrists and ankles may help reduce clonus include: many! Set of features case in arboriculture ):1214. doi: 10.3390/jcm10061214 that affect neuromuscular coordination that after... Of reflexes examination and experience play a major role in eliciting and categorizing deep tendon reflexes Elizondo,...
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