PT 535: Developmental Reflexes & Developmental Reactions

what are developmental reflexes?

normal responses though to serve a purpose

persist through life with reduced influence on motor performance (kinda go in a closet and go away, but if something goes wrong, they can come back out)

facilitate movement, provide protection

what are developmental reactions?

persist throughout life

-- righting reactions

----- head on body, body on body

-- equilibrium

----- supporting and equilibrium reactions

when would a developmental reflex be considered abnormal?

when is becomes obligatory (you have to do it) versus dominant (holds power, but not mandatory)

what should you remember when testing developmental reflexed and reactions?

test them last (tend to make babies angry)

environment (parents may be present)

allow 30 seconds for a response

note if:

- stimulus elicits a response

- stimulus should elicit a response but does not

- baby attempts to prevent stimulus

- baby is able to move out of the response

what is the onset of spontaneous stepping?

37 weeks gestation age

what is the integration of spontaneous stepping?

2 months

what is the position of spontaneous stepping?

hold the child upright with your hands under the child's arms and around the chest. if the child is young, support the back of the head with your thumbs

what is the procedure of spontaneous stepping?

keep the child upright with the trunk supported and the feet touching the table surface. incline the child forward and gentle move forward to accompany any stepping

what is the response of spontaneous stepping?

alternating stepping movements, rhythmical and coordinated, needing no propulsion

what is the significance of spontaneous stepping?

stepping reactions declines or is integrated in parallel with neonatal positive supporting

absent in paresis of legs

what is the onset of moro?

28 weeks of gestational age

what is the integration of moro?

5-6 months

what is the position of moro?

supine, symmetrical, with arms in front of beside chest. head in midline

what is the procedure of moro?

- support head and shoulder with hands. then allow head to drop back 20-30 degrees with respect to trunk

- gently pull the infant by the hands (up a few inches) toward a sitting position so that the head is off the support. then release hands so head falls back suddenly

what is the response of moro?

abduction of the UEs with extension of the elbows, wrists, and fingers; followed by subsequent adduction of the arms at the shoulders and flexion at the elbows

what is the significance of moro?

- asymmetry indicates insult to one side of the brain or asymmetric injury to peripheral nerve supply

- different from the startle reaction which can be elicited by a loud noise or sudden light (startle reaction consists of flexion movement only)

- involved in breaking up predominate flexion postures at birth

- disappears before sitting and presents of protective and tilting reactions

- should be universally present in normal full-term infants

- asymmetry may be due to Erb's palsy or clavicular fracture

what is the onset of galant?

32 weeks gestational age

what is the integration of galant?

2 months

what is the position of galant?

prone

what is the procedure of galant?

gently stimulate along paravertebral line about 3 cms from midline and from shoulder down to buttocks (between 12th rib and iliac crest) do on both sides, and give stimulus repeatedly

what is the response of galant?

produces brief lateral incurving to the side stimulated with production of folds in the skin (concavity on the stimulated side)

what is the significance of galant?

one of the most common reflexes in normal newborns

absent response below the level of a transverse lesion of the spinal cord

long lasting response persistence can lead to scoliosis

retention may cause considerable delay in the development of symmetrical stabilization of the trunk and independence of the head (necessary for sitting, standing, or walking)

what is the onset of traction?

birth

what is the integration of traction?

2-5 months

what is the position of traction?

supine with head in midline

what is the procedure of traction?

grasp child's wrist and pull up as if to pull into sitting position, thereby passively stretching shoulder adductors and arm flexors

what is the response of traction?

flexion of shoulder, elbows, wrists, and fingers (flexor synergy). response can be strong enough to support the child's entire weight

what is the significance of traction?

easily obtainable in the neonate

asymmetry indicates insult to one side of the brain or birth trauma to nerve roots or brachial plexus

persistence after 4-5 months inhibits voluntary reach and grasp

what is the onset of asymmetrical tonic neck reflex?

0-2 months

what is the integration of asymmetrical tonic neck reflex?

4-6 months

what is the position of asymmetrical tonic neck reflex?

infants and children under 5 years - supine with head in midline

children - 3 months and older - observe child in supine functional activities

children 5 years and older who do not show the ATNR overtly or in functional activities but who may demonstrate remnants of the response check the following:

- supine with head in midline

- quadruped

- sitting

- standing with eyes closed and arms outstretched to shoulder level

- walking forward

- walking backward

- walking tandem forward

- walking tandem backward

- stand on one foot

- walk on heels

- check for tonal changes in functional positions

what is the procedure of asymmetrical tonic neck reflex?

for #1 and #3 do first voluntarily with child following an object, then manually turn the head slowly to one side, and hold in this extreme position with jaw over the shoulder

for #2 and #3, observe the child's head and extremity movements during the activities asymmetrical postures

what is the response of asymmetrical tonic neck reflex?

jaw arm and leg extend. "skull arm flexes at elbow. skull leg may flex. upper extremities participate more strongly than lower extremities

if changes are subtle in the group of tests, it must be counted 5 times or more in order for the reflex to be counted as present

what is the significance of asymmetrical tonic neck reflex?

disappears as neck righting reflex appears

disappears for the child to be able to roll over segmentally

disappears before adequate prehension and feeding take place

disappears before child has unsupported sitting balance when placed in sitting

asymmetry indicates insult to one side of the brain or nerve supply

reflex assists initial eye hand regard

what is the onset of protective extension forward?

6-7 months

what is the integration of protective extension forward?

persists

what is the position of protective extension forward?

support the child horizontally in the air in prone position with your hands around the body

what is the procedure of protective extension forward?

plunge the child downward toward a table top or other flat surface

what is the response of protective extension forward?

arms extend and slightly adduct, and fingers spread as if to break the fall

what is the significance of protective extension forward?

needed for 4 point position

asymmetry may indicate insult to one side of the brain

needed for sitting with arm support

what is the onset of protective extension of arm sideways (lateral)?

7 months

what is the integration of protective extension of arm sideways (lateral)?

persists

what is the position of protective extension of arm sideways (lateral)?

symmetrical sitting with legs out in front (tailor sit)

what is the procedure of protective extension of arm sideways (lateral)?

push the child on one shoulder with enough force to cause loss of balance

what is the response of protective extension of arm sideways (lateral)?

abduction of the opposite arm; extension of the elbow, wrist, and fingers in the direction of the fall before contact is made with the table

what is the significance of protective extension of arm sideways (lateral)?

1. asymmetry may indicate insult to one side of the brain

2. failure to obtain or late to persist indicates general depression of the CNS or sensorimotor depression

3. needed for sitting without hand support

what is the onset of protective extension of arm backwards?

9-10 months

what is the integration of protective extension of arm backwards?

persists

what is the position of protective extension of arm backwards?

symmetrical sitting with legs out in front (tailor sit)

what is the procedure of protective extension of arm backwards?

push the child backward with enough force so as to set them off balance

what is the responses of protective extension of arm backwards?

full reaction if the child presents with backward extension of both arms. frequently an element of trunk rotation is present, and the reaction is seen in one arm only

what is the significance of protective extension of arm backwards?

asymmetry may indicate insult to one side of the brain

needed for good sitting balance and trunk rotation

what is the onset of parachute?

6-7 months

what is the integration of parachute?

persists

what is the position of parachute?

support the child horizontally in the air in prone position with your hands around the body

what is the procedure of parachute?

plunge the child downward toward a table top or other flat surface

what is the response of parachute?

arms extend and slightly abduct, and fingers spread as if to break the fall

what is the significance of parachute?

needed for 4 point position

asymmetry may indicate insult to one side of the brain

needed for sitting with arm support

what is the onset of symmetrical tonic neck reflex?

4-6 months

what is the integration of symmetrical tonic neck reflex?

8-12 months

what is the position of symmetrical tonic neck reflex?

child in ventral position supported by trunk over the examiner's legs or in all 4's position

what is the procedure of symmetrical tonic neck reflex?

flex the head

extend the head

what is the response of symmetrical tonic neck reflex?

with head flexion, upper extremities flex and lower extremities extend, with extension, upper extremities extend and lower extremities flex.

if response is not apparent by position, check muscle tone for change

what is the significance of symmetrical tonic neck reflex?

in quadruped, the integration of the STNR is seen when the child can lift the buttocks from the heels without flexing the head and upper limbs (breaks up extensor patterns)

if strong prevents the child from reciprocal creeping (abdomen off the floor). will creep like a rabbit or hitch if present

what is the onset of landau?

3-4 months

what is the integration of landau?

12-14 months (full response about 9 months)

what is the position of landau?

support the child horizontally in the air in prone position with one hand under the lower part of the thorax

what is the procedure of landau?

the position is the whole test

what is the response of landau?

head extended, back arched with slight concavity upward, and legs are partially extended at the hips (relaxation can be brought about by passive flexion of the head causing flexion of the legs

what is the significance of landau?

helps break up predominate flexor pattern seen at birth and in the way promotes extension

absence may lead to motor weakness

only observed in children with a strong labyrinthine righting reflex on the head

what is the onset of staggering?

15-18 months

what is the integration of staggering?

persists

what is the position of staggering?

child standing on mobile surface

what is the procedure of staggering?

push child in all directions (forwards, backwards, and to both sides)

what is the response of staggering?

correction of movements of flexion and extension, adduction and abduction of limbs to restore center of gravity

forward = child takes one ore more steps forwards to correct

backward = child takes one or more steps backwards to correct

sideways = child will either side step or cross one foot in front of the other dependent on how hard the push is

what is the significance of staggering?

protects the upright posture when the body is displaced by a horizontal force

asymmetry may indicate insult to one side of the brain

what is the onset of neck righting (body righting on body)?

4-6 months

what is the integration of neck righting (body righting on body)?

inhibited by 5 years

what is the position of neck righting (body righting on body)?

supine, with head in midline

what is the procedure of neck righting (body righting on body)?

flex head an turn slowly to one side. hold in extreme position with the jaw over the shoulder. repeat to the opposite side

what is the response of neck righting (body righting on body)?

stimulus causes head turning followed by rotation of the should, trunk, and then pelvis to the side (same direction as the head was turned)

what is the significance of neck righting (body righting on body)?

needed for child to roll supine to prone and prone to supine

obligatory neck righting wherever the baby rolls over is never normal

persistence in some children until able to rise straight from supine rather than rolling

response stronger on one side than the other is abnormal

asymmetry indicates insult to one side of the brain

what is the onset of neck righting (body righting on head)?

4-6 months

what is the integration of neck righting (body righting on head)?

inhibited by 4-5 years

what is the position of neck righting (body righting on head)?

supine with head in midline

what is the procedure of neck righting (body righting on head)?

flex one leg and rotate it across the pelvis to the opposite side (in children who are able to stand independently ask them to get up)

what is the response of neck righting (body righting on head)?

pectoral girdle and head follow the rotation of the pelvis, and the child turns to prone

normal supine to standing progression:

- 15 months - child must roll over to prone to stand up

- 3 years - child rolls only to side to stand up

- 5 years - child stans up in an adult fashion

what is the significance of neck righting (body righting on head)?

asymmetry indicates insult to one side of the brain

directly modifies the neck righting reflex

important in acquisition of sitting, quadruped, and standing

what is the onset of tilting reaction?

6 months

what is the integration of tilting reaction?

persists

what is the position of tilting reaction?

prone on tilting board

what is the procedure of tilting reaction?

slowly tilt the board laterally (left and right)

what is the response of tilting reaction?

body is flexed against the tilt (concavity of the spine is upward). the arm and leg on the upward side may abduct

what is the significance of tilting reaction?

modified righting reflex

asymmetry may indicate insult to one side of the brain

present once the child has learned to sit unsupported and is able to bear weight on the hands with extended elbows

what is the onset of flexor withdrawl?

29-34 weeks gestational age

what is the integration of flexor withdrawl?

1-2 months

what is the position of flexor withdrawl?

supine with head in midline, legs relaxed and semi-flexed

what is the procedure of flexor withdrawl?

noxious stimulus such as a pin prick to the sole of one foot

what is the response of flexor withdrawl?

withdrawl of stimulated leg away from stimulus

what is the significance of flexor withdrawl?

asymmetry indicates insult to one side of the brain or asymmetric injury to peripheral nerve supply

absent in paresis of legs