What technique should be used when reflexes are diminished or absent (0 or 1+) to increase reflex activity?

• A. Applying a cold stimulus to the tendon
• B. Reinforcement with isometric contraction of other muscles for 10 seconds
• C. Rapid passive stretch only
• D. Verbal encouragement without movement

Answer: (B)

When reflexes are weak or absent, boosting the reflex requires adding supraspinal facilitation to increase the excitability of the reflex arc. Reinforcement by having the patient perform an isometric contraction of muscles not involved in the reflex for about 10 seconds does exactly that. This keeps the patient actively engaged and increases motor neuron drive to the stretch reflex pathway, often producing a stronger, more detectable reflex through a Jendrassik-type facilitation.

Other approaches don’t provide that additional cortical and spinal facilitation. A cold stimulus to the tendon can slow nerve conduction and isn’t used to enhance reflexes. A rapid passive stretch can trigger a reflex but is less reliable when reflexes are diminished. Verbal encouragement alone may improve attention but doesn’t raise the intrinsic excitability of the reflex pathway.

So, the isometric reinforcement of other muscles for about 10 seconds is the strategy that best increases reflex activity when reflexes are muted.