reflexes (pedia)

reflex gods

moro

stimulus: sudden neck extension

startle

stimulus: sudden noise

rooting

stimulus: stroking lips / around mouth

positive supporting

stimulus: light pressure or weight bearing on plantar surface

asymmetric tonic neck

stimulus: head turning to side

symmetric tonic neck

stimulus: neck flex & neck ext

palmar grasp

stimulus: touch or pressure on palm or stretching finger flexors

plantar grasp

stimulus: pressure on sole distal to MT heads

automatic neonatal walking

stimulus: on vertical support plantar contact and passive tilting of body forward

placement or placing

stimulus: tactile contact on dorsum of foot or hand

moro reflex and startle reflex

response: shoulder abd, elbow and finger ext, followed by arm flex add

rooting

response: moving mouth, head toward stimulus in search of nipple

positive supporting

response: legs extend for partial support of body weight

asymmetric tonic neck

response: extremities extend on face side, flex on occiput side

symmetric tonic neck

response: arms flex, legs extend; arms extend, legs flex

palmar grasp

response: flexion of all hingers, hand fisting

plantar grasp

response: flexion of all toes

automatic neonatal walking

response: alternating automatic steps with support

placement or placing

response: extremity flexion to place hand or foot

moro / startle / tonic labyrinthine

age of suppression: 4-6 months

4 months

age of suppression of rooting reflex

3-5 months

age of suppression of positive supporting

6-7 months

age of suppression of ATNR and STNR

12-14 months

age of suppression of plantar grasp

3-4 months

age of suppression of automatic neonatal walking

before end of first year

age of suppression of placement or placing

neck righting or body derotational

stimulus: neck rotation in supine

neck righting or body derotational

response: sequential body rotation from shoulder to pelvis toward direction of face

4 months

age of suppression of neck righting or body derotational; replaced by volitional rolling

tonic labyrinthine

stimulus : supine

supine (tonic labyrinthine)

stimulus: _______ response: predominant extensor tone

prone (tonic labyrinthine)

stimulus:_____ response: predominant flexor tone

head righting

stimulis: visual and vestibular

head righting

response: align face/head vertical, mouth

2 months

age of emergence of head righting (prone)

3-4 months

age of emergence of head righting (supine) :

head and body righting

stimulus: tactile, vestibular, proprioceptive

head and body righting

response: align body parts in anatomic position relative to each other and gravity

4-6 months

age of emergence of head and body righting

protective extension or parachute reactions

stimulus: displacement of center of gravity outside supporting base in sitting, standing

protective extension or parachute reactions

response: extension/abduction of lateral extremity towards displacement to prevent falling

5-7 months

age of emergence of protective extension or parachute reactions (sitting anterior)

6-8 months

age of emergence of LATERAL protection extension or parachute reactions

7-8 months

age of emergence of protective extension or parachute reactions (posterior)

12-15 months

age of emergence of protective extension or parachute reactions (Standing)

equilibrium or tilting reactions

stimulus: displacement of center of gravity

equilibrium or tilting reactions

response: adjustment of tone and posture of trunk to maintain balance

6-8 months

age of emergence of equilibrium or tilting reactions in sitting

12-14 months

age of emergence of equilibrium or tilting reactions & protective extension or parachute reactions (standing)

spinal level (3 stages of reflexes)

age of onset: birth

spinal level (3 stages of reflexes)

age of integration: 2-3 months

2-3 months

age of onset of brainstem level (3 stages of reflexes)

5-6 months

age of integration of brainstem level (3 stages of reflexes)

5-6 months

age of onset of cortical level (3 stages of reflexes)

cortical level (3 stages of reflexes)

age of integration: persists

flexor withdrawal reflex, cross extension response, moro, startle, traction response, grasp reflex

spinal level reflexes (6)

flexor withdrawal reflex

stimulus: noxious stimulus on the sole

flexor withdrawal reflex

response: IPSILATERAL toe extension, ankle DF, total LE flexion

cross extension

stimulus: noxious stimuli on the ball of the foot

cross extension

response: CONTRALATERAL total LE flexion, total LE adduction, total LE extension

moro

stimulus: sudden change in head and neck position

moro

response: UE extension, UE abduction, hand open, cry, UE flexion, UE adduction, arms across

startle

stimulus: sudden loud and harsh noise

startle

response: Ue extension or abduction, cry

traction response

stimuli: passive pull at the forearm

traction response

response: rigid UE flexion, good head control

grasp reflex

stimulus: stationary pressure on palm/sole

grasp reflex

response: grasp

ATNR, STNR, Tonic Labyrinthiine, Tonic Lumbar, Positive supporting, negative supporting

brainstem level reflexes (6)

ATNR

stimulus: neck movement to rotation

ATNR (response: chin)

response: chin: ipsilateral UE and LE extension

ATNR (response: occiput)

response: occiput: ipsilateral UE and LE flexion

STNR

stimulus: neck flexion or extension

STNR (neck flexion)

response: B UE flexion & B LE extension

STNR (neck extension)

response: B UE extension & B LE flexion

tonic labyrinthine

stimulus: total body position in prone or supine

tonic labyrinthine (prone)

response: total flexion

tonic labyrinthine (supine)

response: total extension

tonic lumbar

stimulus: lumbar rotation

tonic lumbar

response: IPSILATERAL UE flexion & LE extension; CONTRALATERAL UE extension & LE flexion

positive & negative supporting

stimulus: contact on the ball of the foot

positive supporting

response: rigid LE extension

negative supporting

response: rigid LE flexion

tilting reactions / equilibrium reactions, protective extension, writhing reaction

cortical reflexes (writhing reaction)(3)

tilting reactions / equilibrium reactions

stimulus: change in COG (gradual)

tilting reactions / equilibrium reactions

response: contralateral trunk lateral flexion

protective extension

stimulus: change in COG (sudden)

protective extension

response: ipsilateral UE extension + LE downward position

neck on body / body on neck reflexes

neck moves, upper body follows; upper body moves, neck follows

body on body reflexes

upper body moves, lower segment follows; lower segment moves, upper body follows

optical on neck / neck on optical reflexes

when the eyes move, neck follows; neck moves, eye follows

trunk incurvation / galant

stimulus: deep moving pressure (paravertebral muscle: neck

→ sacrum)

trunk incurvation / galant

response: ipsilateral trunk lateral flexion (opposite with tilting reaction)

placing reaction

stimulus: deep moving pressure (dorsum of hand/foot)

placing reaction

response: “place” hand or foot above the surface

primary standing

stimulus: supported standing position

primary standing

response: standing position

primary walking

stimulus: supported standing position + forward lean

primary walking

response: automatically walk or step (“stepping reflex”)

rooting reflex

stimulus: stationary pressure (cheek)