Although one generally finds it easy to elicit the reflexes after one has acquired some experiences it is necessary to make sure that the patient relaxes his limbs and that his attention is distracted from the tests. One should strike the tendon and not the muscle, because in the latter case one tests myotatic irritability and not the tendon reflex. For the deep reflexes it is well to place the limb or muscle in the half way position between contraction and relaxation. Where the reflex is difficult to obtain, reinforcement (shunting of inhibition) is used. This is accomplished by having the patient to innervate actively a corresponding muscle, tightly grip his own hands or another object on a given command and striking the tendon at the same instant. Sometimes the reflex contraction is not seen, but can be felt. Occasionally upper motor neuron (pyramidal tract) disease is accompanied by hyperactive deep reflexes which cannot be elicited because the limb is too spastic and held rigid either in flexion or extension. A percussion hammer is used for obtaining the deep reflexes and a pinwheel a dull pin or toothpick for the superficial.

The patient opens his mouth so that the lower jaw hangs a little. A wooden tongue depressor is placed on the molars and struck a sharp blow. Result: Palpable or visible contraction of the masseter and rising of the jaw itself. Another way of eliciting the reflex is by placing the finger or thumb on the side of the lower jaw and striking it with the hammer. The jaw is mediated through the trigeminal nerve, and the reflex center is in the Pons.

The pectoral reflexes. The arm is placed halfway between adduction and abduction and the finger on the muscle tendon near the humerus.