Week 3 - Reflexes

Primitive & Equilibrium Reflexes

• ___ motor response​

• Originate in the ___​

• Present in utero until ____

• Necessary for newborn survival​

• Involuntary motor response​

• Originate in the brainstem​

• Present in utero until earlychildhood​

• Necessary for newborn survival

Studies show

• __ or more abnormal reflexes are significantly morelikely to have Cerebral Palsy or Developmental Delay​

• Retained primitive reflexes are closely related to __​

• Correlated to __ difficulties​

• Persistent ______R - learning difficulties​

and decreased motor skills​

• 5 or more abnormal reflexes are significantly morelikely to have Cerebral Palsy or Developmental Delay​

• Retained primitive reflexes are closely related to ASD​

• Correlated to clock reading difficulties​

• Persistent ATNR, STNR, and TLR  learning difficulties​ and decreased motor skills​

Reflexes - ____ - ____

Reflexes - Motor Control and Development - Cognitive Learning​

Primitive Walking/Stepping

• Appears:

• Integrates:

• Stimulus:

• Result:

• If this didn’t integrate, what would it​ interfere with?​​

Primitive Walking/Stepping

37 weeks gestation

2 months

Hold infant upright, tilt forward, feet touching surface

Automatic stepping movements

High stepping Trouble w/ walking, balance, leg coordination

Primitive Walking/Stepping

Primitive Walking/Stepping

37 weeks gestation

2 months

Hold infant upright, tilt forward, feet touching surface

Automatic stepping movements

High stepping Trouble w/ walking, balance, leg coordination

Galant

• Appears:

• Integrates:

• Stimulus:

• Result:

• If this didn’t integrate, what would it​ interfere with?​​

Galant

30 weeks gestation

2 months

Stroke skin along spine: shoulder→ hip

Lateral trunk flexion toward stimulus

Issues SB w/ crawling Fidgeting, can't sit still Poor posture

Palmar grasp

• Appears:

• Integrates:

• Stimulus:

• Result:

• If this didn’t integrate, what would it​ interfere with?​

Palmar Grasp

28 weeks gestation

4 months

Pressure to ulnar side of hand

Finger flexion/grasp

Grip - won't let go Poor handwriting, weak pencil grip Difficulty w/ fine motor skills

Plantar grasp

• Appears:

• Integrates:

• Stimulus:

• Result:

• If this didn’t integrate, what would it​ interfere with?​

Plantar Grasp

28 weeks gestation

9 months

Pressure to sole just proximal to metatarsal heads

Toe flexion/grasp

Balance problems Toe walking

Moro/Startle grasp

• Appears:

• Integrates:

• Stimulus:

• Result:

• If this didn’t integrate, what would it​ interfere with?​

Moro/Startle

28 weeks gestation

5 months

Sudden noise or dropping sensation

Arm abduction/extension followed by adduction; crying

Emotional dysregulation - anxiety, easily overwhelmed, difficulty concentration

Rooting grasp

• Appears:

• Integrates:

• Stimulus:

• Result:

• If this didn’t integrate, what would it​ interfere with?​

Rooting

28 weeks gestation

3-8 months

Stroke cheek/side of mouth

Head & mouth turns toward stimulus

Feeding problems Drooling Speech difficulties

Sucking/Swallow grasp

• Appears:

• Integrates:

• Stimulus:

• Result:

• If this didn’t integrate, what would it​ interfere with?​

Sucking/Swallow

28 weeks gestation

5 months

Touch lips or inside mouth

Rhythmic jaw excursion Tongue movement up/down→ swallow

Feeding problems Drooling Speech difficulties

Asymmetrical Tonic Neck Reflex (ATNR) grasp

• Appears:

• Integrates:

• Stimulus:

• Result:

• If this didn’t integrate, what would it​ interfere with?​

ATNR (Asymmetrical Tonic Neck Reflex)

20 weeks gestation

6 months

Turn head to one side

Face side: arm/leg extend Skull side: arm/leg flex

Difficulty crossing midline Handwriting issues Poor coordination

Symmetric Tonic Neck Reflex (STNR)

• Appears:

• Integrates:

• Stimulus:

• Result:

• If this didn’t integrate, what would it​ interfere with?​

STNR (Symmetrical Tonic Neck Reflex)

1 month

4-6 months

Neck flexion or extension

Flexion: arms flex, hips extend Extension: arms extend, hips flex

Poor posture Difficulty sitting still Poor hand-eye coordination

Tonic Labyrinthian Reflex (TLR)

• Appears:

• Integrates:

• Stimulus:

• Result:

• If this didn’t integrate, what would it​ interfere with?​​

TLR (Tonic Labyrinthine Reflex)

Birth

4-6 months

Head position in prone or supine

Prone: increased flexor tone Supine: increased extensor tone

Poor balance, posture, coordination, body awareness

Landau

• Appears:

• Integrates:

• Stimulus:

• Result:

• If this didn’t integrate, what would it​ interfere with?​

Landau

4-6 months

2-3 years

Held horizontally in prone

Extension of head, trunk, and legs

Weak posture Poor trunk strength Delayed postural control

Amphibian

• Appears:

• Integrates:

• Stimulus:

• Result:

• If this didn’t integrate, what would it​ interfere with?​

Amphibian

6 months (after ATNR integration)

Not listed

In prone, lift pelvis on one side

Same-side hip, knee, and arm flexion

Trouble rolling & rotating Poor coordination of head & body movements

Neck Righting on Body

• Appears:

• Integrates:

• Stimulus:

• Result:

• If this didn’t integrate, what would it​ interfere with?​

Neck Righting on Body

4-6 months

5 years

Turn head in supine

Log rolls to that side

Difficulty crawling, rotation, coordination body movements

Protective Extension

• Appears:

• Integrates:

• Stimulus:

• Result:

• If this didn’t integrate, what would it​ interfere with?​

Protective Extension

Downward: 4 mo Forward/Lateral: 6-9 mo Backward: 9 mo

Life

Pushed in a direction Or head held down

Arm extension to prevent fall

Increased fall risk Decreased confidence w/ movement

Five Most Common Retained Reflexes​

1. Moro Reflex/Startle Reflex​

2. ATNR (Asymmetrical Tonic Neck Reflex)​

3. STNR (Symmetrical Tonic Neck Reflex)​

4. Palmar Grasp Reflex​

5. TLR (Tonic Labyrinthine Reflex)​

Retained Moro Reflex​

• What should happen

• Arms extend to catch self​

What is a retained Moro generally associated​ with?​

• Exaggerated startle response​​

• Coordination and balance - Poor eye tracking​​

• Sensory sensitivities​

• Emotional Dysregulation - difficulty focusing, poor impulse control, anxiety ​

Activities to help a retained Moro

What is popcorn on floor

 

Retained ATNR - what should happen

Able to rotate head without arm movement​

What is a retained ATNR generally associated with?​

• Difficulty crossing midline​

• Bilateral tasks​

• Visual Tracking​ - Hand-eye coordination​ - Handwriting​

• Sensory Processing​ 

Activities to Help​ - Retained ATNR

• Seated Switch up​

• Lizard​

• Cross Crawl​

  • Standing​

  • Sitting​

  • Hands and knees​

• Wall pushes with head turns​

Retained STNR - what should happen?

Should be able to flex head and extend arms​

What is a retained STNR generally associated with?​

• Poor sitting posture - slouching ​

• “W” Sitting​

• Difficulty crawling​

• Poor upper and lower body coordination​

• Clumsiness and poor ball skills​

• Visual Tracking​ - Reading and Writing challenges​

• Decreased attention and focus​ & fine motor

Activities to Help - Retained STNR ​

• Cat Cow​

• Rocking Horse/Child Pose​

• Head – Ball push course​

• Superman​

• Bird Dog​

Retained Palmar Grasp​ - What should happen?

Independent finger movements, easily release objects​

What is a retained Palmar Grasp generally associated with?​

• Decreased fine motor skills (writing, drawing, using fork/spoon​

• Mouth movements, tongue sticking out during activity​

• Speech issues​

• Early fatigue with fine motor tasks​

Activities to Help​ - Retained palmar grasp

• Songs with finger pinching​

  • One hand then two, looking at hands then looking away​

• Playdough or putty​

• Paper crumpling​

• Beading/blocks/legos​

• Sensory stimulation to hands​

• Animal walks​

  • Hands in different postures​

Retained TLR​ - What should happen

• Arms and legs should move independently of head position​

• Should be able to hold “superman”​

What is a retained TLR generally associated with?​

• Poor Posture​

• Low Muscle Tone (Floppy)​

• Balance/Coordination​

• Toe Walking​

• Spatial Perception Issues​

• Sequencing Issues​

Activities to Help​ - Retained TLR

• Yeah-Woah’s!​

• Superman/Superwoman​