So how hard do you hit in order to determine if someone is hyperreflexive (patellar)? I mean if you hit hard enough, everyone will get a big reflex. Can't find any good videos online.
3+ is often a judgement call. You look for asymmetry between sides, you check for spread to another joint or into the contralateral limb, and you seek other signs of hyperreflexia (upgoing toes, Hoffmans).
Look for clonus. sustained v non-sustained. you can also try the quad tendon just suprapatellar and move proximally. also try the crossed adductor response.