Table 1.

Comparison between the NINDS myotatic reflex scale and British scale

Scale	NINDS scale (0–4)	Scale	British scale (0–5+)	Description
0	Reflex absent	0	Reflex absent	No perceptible response
1	Reflex small, less than normal, includes a trace response or a response brought out only with reinforcement	1+	Reflex small, less than normal, includes a trace response or a response brought out only with reinforcement	Contraction barely perceptible but can be enhanced with Jendrassik manoeuvre
2	Reflex in the lower half of a normal range	2+	Brisk, within the median normal range	Contraction perceptible
3	Reflex in the upper half of a normal range	3+	Reflex enhanced, high normal or hyperreflexia	Vigorous contraction is apparent from across the room
4	Reflex enhanced, more than normal, includes clonus if present, which optionally can be noted in an added verbal description of the reflex	4+	Reflex enhanced, more than normal, includes intermittent clonus	Reflex ‘beats’ multiple times at the end of the arc. The only reflex that is always abnormal is clonus
		5+	Sustained clonus

Notes: The ‘+’ after the number is to distinguish from muscle testing. The Jendrassik manoeuvre is a reinforcement technique, whereby the patient attempts to pull the hands apart with fingers hooked together. The effects last 1 sec–6 sec and is maximal for only 300 msec