Anatomy (NEURO) Primitive Reflexes

What are primitive Reflexes?

The first bodily reflexes presented at birth and further development

Why are primitive reflexes tested?

Presence/absence/strength of reflexive response gives us early clinical info about the CNS

AKA

Emerges

Integrates

Elicitation

Presentation/Function

Also known as (AKA)

When reflex first starts (Emerges)

When the brain takes over the reflex & leads to voluntary control (Integrates) *Reflex fades away*

Position/stimuli required to see reflexive response (Elicitation)

Motor response to observe (Presentation/Function)

What are all the primitive reflexes? (12)

1) Palmar

2) Plantar

3) Babinski

4) APNR

5) Galant

6) Root

7) Suck-Swallow

8) Stepping

9) Placing

10) Clonus

11) Crawling

12) Moro

Palmar

Emerges:

• Birth

Integrates:

• 4-6 mo

Elicitation:

• Pressure on ulnar surface of palm

Presentation:

• Hand closes/Fingers flex around stimulus

Function:

• Grasping objects

Plantar

Emerges:

• Birth

Integrates:

• 4-9 mo

Elicitation:

• Firm pressure on ball of foot (Near the toes)

Presentation:

• Toes flex (curl up under finger)

Babinski

Emerges:

• Birth

Integrates:

• 12-14 mos

Elicitation:

• Stroke outer side of foot from bottom to top with one finger (Like tickling the side of foot)

Presentation:

• Toes Splay (Dorsiflex) —> Toes fan out

ARNR

AKA: Asymmetric Tonic Neck Reflex

Emerges:

• Birth

Integrates:

• 4-6 m/os

Elicitation:

• Passively rotate infants head to the side

Presentation:

• Arms & legs extend on the side the infant’s head is turned towards —> Cotralateral arm & leg flex

Galant

AKA: Spinal Galant

Emerges:

• Birth

Integrates:

• 3-9 m/os

Elicitation:

• Hold infant in prone above surface (holding baby faced down in one arm)

• Tap just to right or left side of spine from head to pelvis

Presentation:

• Spine curves towards stimuli (LITTLE DANCE)

Function:

• Important during birth

• Helps facilitate movement of the hips when descending the birth canal

Root

Emerges:

• Birth

Integrates:

• 3 mos

Elicitation:

• Light touch to cheek/near mouth

Presentation:

• Opens mouth and turns towards stimulus

Function:

• Feeding & object exploration

“If you put the root of a beat on their cheek, they will turn and try to suck on it”

Suck-Swallow

Emerges:

• Birth

Integrates:

• 2-5 m/o

Elicitation:

• Light touch in oral cavity (roof of mouth/tongue) Put your finger in there

Presentation:

• Close mouth, sucks, and swallows

Function:

• Feeding

Stepping

Emerges:

• Birth

Integrates:

• 2 mos

Elicitation:

• Holding infant in supporting standing (Grab baby so feet hang)

Presentation:

• Legs alternate in flexion with appearance of taking steps

Function:

• Alternate movements of the legs in preparation for walking

(EARLY WALKING)

Placing

AKA: Proprioceptive placing

Emerges:

• Birth

Integrates:

• 4-6 mos

Elicitation:

• Hold baby upright; place top of feet/arms under a surface ( like a table)

Presentation:

• Infant lifts feet/arms and place them on the top of the surface

Clonus

Emerges:

• Birth

Integrates:

• 2 mos

Elicitation:

• Flex and hold infant’s leg (Lift tip of foot up as leg is dangling)

• shake/slightly bounce the tip/toes as you flex the foot

Presentation:

• Foot beats back towards stimulus (POSITIVE CLONUS) *NOT NORMAL*

• Negative Clonus: Foot goes to resting position

• Alternating between plantarflexion & Dorsiflexion

Function:

• Might move a little with newborns BUT ABNORMAL with older children

• Sign of alternate neurological dysfunction

Crawling

Emerges:

• Birth

Integrates:

• 2 mos

Elicitation:

• Place infant in prone (belly) position on a flat surface

• May/May not need to gently tap bottom of foot

• Place palm on the bottom of one leg (push up)

Presentation:

• Infant should act like they are crawling

• Legs alternate in flexion as if crawling

Function:

• Alternating movement of the LEs in preparation for crawling

Moro

Aka: Startle Reflex

Emerges:

• Birth

Integrates:

• 4-6 mos

Elicitation:

• Dropping head <30 degrees in extension

Presentation:

• Arms extend, hand open

• THEN

• Arms and hands flex & come back in

• Has to be both reactions

Function:

• Fight or flight reaction

(SCARIEST TO ASSESS) —> “Casi me MUERO”

Which reflex takes longest to integrate?

Babinski (12-14 mos)

Which reflexes integrate the earliest? (6)

Root (3 mos)

Suck-Swallow (2-5 m/os)

Stepping (2 m/os)

Clonus (2 m/os)

Crawling (2 m/os)

Summary of Primitive Reflexes

1) Palmar

2) Plantar

3) Bibinski *12-14 mos*

4) ARNR

5) Galant

(1-5 Body movement)

6) Root

7) Suck- Swallow

(6/7: MOUTH Stuff)

8) Stepping

9) Placing

10) Clonus

(8-10 Leg movement)

11) Crawling

12) Moro