Parkinson's Exam

The glabellar reflex is a primitive reflex - normally present in infants and absent in adults. In the case of frontal lobe damage, ‘frontal release' signs such as glabellar, grasp, suck, snout and palmomental reflexes will be present.

The Patient

Around the Room

Mobility devices
General Features

Age, gender, general comfort
Orientation

To time / place / person
Tremor

Resting pill-rolling tremor

Look at the hands, legs, tongue, lips, jaw

Gait Assessment

Gait

Shuffling gait with reduced arm swing and difficulty turning
Pull Test

Stand behind patient and pull them backward

The Face

Mask-Like Facies

Expressionless, with reduced blinking
Smell

Take Hx, test with common smells
Speech

Hypophonia
Glabellar Reflex

Tap between the eyebrows
Eye Movements

Impaired downward gaze is suggestive of progressive supranuclear palsy (PSP)

The Upper Limbs

Hand Movements

Bradykinesia / hypokinesia, micrographia
Tone

Passive movement of shoulders, elbows, wrists, hands
Blood Pressure

Sitting and standing

Glabellar Reflex

Overview

- How to Elicit
- Percuss repeatedly between the eyebrows, looking for reactive blinking.
- Interpretation
- Decreased - no blinking in response to stimulusOphthalmic nerve (V1) / facial nerve (VII) palsy, pons / medullary lesion
- Normal - up to five blinks and then no further blinking following habitualization
The glabellar reflex is a primitive reflex - normally present in infants and absent in adults. In the case of frontal lobe damage, ‘frontal release' signs such as glabellar, grasp, suck, snout and palmomental reflexes will be present.

Last updated on April 19th, 2019

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Around the Room

General Features

Orientation

Tremor

Gait

Pull Test

Mask-Like Facies

Smell

Speech