An enhanced reflex that includes clonus would be graded at which reflex grade?

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Clonus signals a reflex that is not only brisk but unusually hyperactive, which places it at the top end of the reflex grading scale. In most systems, the sequence runs from absent, to diminished, to normal, to brisk, and finally to a hyperactive reflex with clonus. The presence of clonus elevates the reflex to that highest category, reflecting an upper motor neuron involvement rather than just a strong but non-clonus response. Therefore, an enhanced reflex that includes clonus is graded as the top level on the scale.