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How will you grade the deep tendon reflexes

Grading of deep tendon reflexesis done as follows
grade 0: absent
grade 1: sluggish
grade 2: normal—normal ankle
grade 3: brisk—normal knee
grade 4: exaggerated
grade 5: clonus
What are the methods of reinforcement in upperlimb and lowerlimb
Upper Limbs
While eliciting reflex in upperlimb patient may be asked to
Clench  teeth
Or clench the fist on the other side
Lower Limbs
This reinforcement may be done by
Clenching teeth
Jendrassik's maneuver is  performed asking the patient to pull the two arms apart.
It act by increasing  the gamma efferent activity
What are the fallacies in testing the tendon reflex?
You should ask the patient to hold the two hands apart and apply pressure only
when the tendon reflex is checked
Difference between brisk reflexes and exaggerated reflexes
Brisk reflex may be a normal varient
Here there is only  increase in amplitude without  increase in duration.
Exaggerated reflexes
There is increase in amplitude and duration of reflex.
Exaggerated reflexes may be seen in the following conditions
Corticospinal tract lesion
Aways look for clonus if the reflexes are exaggerated,
Condition where you get hyporeflexia 
LMN lesions is associated with hyporeflexia
AHC disease
Lesions of root ,plexus ,nerve
Neurological shock
Severe extrapyramidal rigidity