3 Primitive Reflexes and Reactions (worksheet)

Moro

• Appearance: 28 wks

• Integration: 4-6 months

• Stimulus: Sudden drop of the head in ext

• Response: UE abd then flex toward the body, then cry

• Risk: Dec balance, dec sensory or oversensitive, stress + anxiety in school

Asymmetrical Tonic Neck Reflex (ATNR)

• First appears: Birth

• Becomes integrated: 4-6 months

• Stimulus: Head turning to the side

• Response: Arm + leg ext to side the face is turn with elbow and hip flex to the occipital (other) side

• Risk: Walking difficulty (imbalance), accidentally hitting someone

Body righting acting on body

• First appears: 34 weeks gestation (birth)

• Becomes integrated: 4-6 months (immature), 5 years (mature)

• Stimulus: Push on the body??

• Response: Restore upright position??

• Risk: Involuntary rolling

Flexor withdrawal

• First appears: 28 wks gestation (birth)

• Becomes integrated: 1-2 months

• Stimulus: Noxious stimulus (pin prick or poke) to bottom of the feet

• Response: Same side leg withdrawal or retraction (hip flex, knee flex), relaxation of extensors

• Risk: Burns or cuts??

Startle

• First appears: Birth

• Becomes integrated: Persists

• Stimulus: Loud noise

• Response: Limb flexion, trunk arch, blinking

• Risk: Overreaction to loud noises (unnecessary yelling)

Landau - against gravity

• First appears: 3-4 months

• Becomes integrated: 12-24 months

• Stimulus: The core/trunk

• Response: If head extends, arms and legs also extend against gravity; if head flexes, arms and legs flex

• Risk: No dissociation of UE/LE; difficult to jump, skip hop due to excessive ext; in school: clumsy and dec concentration

Positive supporting

• First appears: 35 wks gestation (birth)

• Becomes integrated: 1-2 months

• Stimulus: Wt bearing on infants legs while supported

• Response: Infants begins to bear wt

• Risk: Difficulty with gait if LE and alternating between flex and ext

Symmetrical Tonic Neck Righting (STNR)

• First appears: 4-6 months

• Becomes integrated: 8-12 months

• Stimulus: Neck positioning

• Response: In quadruped, when neck extends, the arms ext and legs flex; if neck flexes, then the opposite

• Risk: Impaired dissociation with transitional movt; interferes with reciprocal creeping

Optical righting

• Appearance: Birth

• Integration: 6 months

• Stimulus: Tilting of the body laterally

• Response: Head and eyes stay horizontal

• Risk: Cannot orient visually; dec balance

Tonic Labyrinthine Reflex (TLR) - with gravity

• Appearance: Birth

• Integration: 6 months

• Stimulus: Supine or prone

• Response: In supine, head goes back and arms and legs extend

• Risk: Interferes with flex and ext transitions, poor posture, low mm tone, poor ocular control and body awareness

Crossed Extension

• Appearance: 28 wks gestation (birth)

• Integration: 1-2 months

• Stimulus: Stimulus to bottom of the foot

• Response: Other leg responses with hip and knee flex and DF

• Risk: Interferes with functional activities

Palmar grasp

• Appearance: Birth

• Integration: 9 mo

• Stimulus: Place something in palm or apply pressure to palm

• Response: Fingers wrap around object

• Risk: Difficulty grabbing object and holding self in place???

Labyrinthine head righting

• Appearance: Birth

• Integration: Persists

• Stimulus: Cover eyes and tilt body

• Response: Head and eyes assume horizontal position (like with optical)

• Risk: Body cannot turn easily around head

Traction

• Appearance: Birth

• Integration: 2-5 months

• Stimulus: Grasp and pull hands or fingers

• Response: Baby pulls head and trunk toward it

• Risk: Dec head control

Plantar grasp

• Appearance: Birth

• Integration: 9 months

• Stimulus: Pressure to MT heads (bottom of foot)

• Response: Toes curl (flex) and grab on

• Risk: Safety issues with balance while walking or standing

Neck righting on body

• Appearance: 28 wks gestation (birth)

• Integration: 4-6 months (immature), 5 years (mature)

• Stimulus: Turning the head

• Response: The body will follow the direction of the head

• Risk: Involuntary rolling

Rooting

• Appearance: 34 weeks gestation (birth)

• Integration: 3 months

• Stimulus: Stoke the cheek

• Response: Turn head and open mouth (or with mouth open arleady)

• Risk: ??? Difficulties feeding

Parachute

• Appearance: 34 weeks gestation (birth)

• Integration: Persists

• Stimulus: Sudden downward movement while suspended

• Response: Hand and arms go out and in front to protect the head (think if someone falls)

• Risk: If absent or abnormal, could be due to CP or CHI

Spinal Galant

• Appearance: 32 weeks gestation (birth)

• Integration: 9 months

• Stimulus: Touching the mid to lower paraspinals on one side from top-bottom or bottom-top

• Response: The side that is stimulated will lat flex and the hip will flex outward

• Risk: Restlessness, hyperactivity, bedwetting, dec balance; at school: ADHD, difficulty with gross motor tasks, sensory seeking behaviors

Babinski

• Appearance: 11-12 wks gestation

• Integration: 2 years

• Stimulus: Stoke along plantar surface of the foot lat to med following the MT heads

• Response: Great toe ext and abd while other toes extend and fan out ; also DF, hip and knee flex, and hip ER

• Risk: If under developed, flat or pronated foot; if over developed, supinated foot and difficulty walking on uneven ground; at school: poor coordination, balance issues, wide tailor sitting,

Babkin-Palmomental

• Appearance: 9 weeks gestation

• Integration: 3 months

• Stimulus: Firm pressure on center of the palm

• Response: Mouth opens, neck flexion (chin tuck)

• Risk: Poor upper body mm tone and in oral/facia areas, poor hand-to-mouth coordination; at school: fine motor delay, poor dexterity, speech issues

What is the order of protective extension?

Forward, sideways, backwards