How to test reflexes
Other platforms explain it with text and video. In VMS you practice it on the patient.
Reflexes are only useful when the patient is relaxed and both sides are tested the same way.
Step by step
Prepare
Explain, ask the patient to relax and position the limb so the muscle is slightly stretched. [1]
Use the hammer
Hold it loosely at the end and let it swing from the wrist. [1]
Arms
Biceps (C5-C6): your thumb on the tendon, tap the thumb. Brachioradialis (C5-C6): above the wrist on the thumb side. Triceps (C7): just above the elbow at the back. [1]
Legs
Knee (L3-L4): below the kneecap, legs hanging. Ankle (S1): foot slightly bent up, tap the Achilles tendon. [1]
Grade
0 absent, 1+ reduced, 2+ normal, 3+ brisk, 4+ with clonus. [1]
If absent
Ask the patient to clench the teeth or pull their hooked fingers apart while you tap again. [1]
Plantar response
Stroke the outer sole from heel to toes. Toes curl down is normal in adults; big toe up (Babinski sign) suggests an upper motor neuron problem. [1]
Common errors
- Holding the hammer stiffly.
- Tense patient (falsely absent reflexes).
- Comparing sides tested in different positions.
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
Steps adapted from Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. VMS is not affiliated with these organizations. Updated: 2026-10-11.