Reflexes and Reactions

Age for rooting and reaction

birth to 3-4 months

Procedure for rooting reaction

stroke perioral skin at the corner of the mouth, moving laterally toward the cheek

Rooting reaction response

infant tries to suck stimulating finger

Developmental significance of Rooting Reaction

absent in depressed NS

Turning away from stimulus will occur in satiated babies

Asymmetry can indicate insult to one side of the brain

can be facilitated by placing infant in feeding position

Age for sucking reflex

birth to 3-4 months

Procedure for sucking reflex

place a finger or nipple in infants mouth

Strong persistance of sucking reflex

oral-motor dysfunction

Weak sucking

satiated babies, less intense during few first days, neurologic issues, barbiturates

Moro reflex age

birth to 4-5 months

Moro procedure

support infant’s head and shoulders with hand, allow to drop back

Moro response

abduction followed by adduction

strong persistence of moro

CNS dysfunction

Integration of moro

coincides with development of head control and protective extension forward

Palmar grasp age

birth to 3-4 months

Palmar grasp position

place index finger in hands from ulnar side

Palmar grasp must be inhibited in order to

get voluntary prehension

Plantar grasp age

3 to 7-8 months

Plantar grasp procedure

Firm pressure against volar surface of foot

Persistence of plantar grasp

should disappear before walking with support

Flexor withdrawal age

birth to 4 months

Position for flexor withdrawal

noxious stimuli to sole of one foot

Response for flexor withdrawal

Withdrawal of stimulated leg from stimulus

Failure to obtain flexor withdrawl

may indicate spinal cord lesion

Crossed extension age

birth to 4 months

Procedure for crossed extension

noxious stimulus to sole of one foot

Crossed extension response

extension of contralateral extremity

Spontaneous stepping age

birth to 1-2 months

Spontaneous stepping procedure

support child upright (vertical), incline forward to assist with stepping

Spontaneous stepping response

alternating, rhythmical and coordinated stepping movements

stepping reaction is integrated with

primary standing

premature infants vs full term infants stepping

toe heel vs heel toe

Voluntary walking vs spontaneous stepping

spontaneous stepping is rhythmical and not dependent on gravity, no equilibrium

Asymmetrical Tonic Neck age (ATNR)

1-2 months to 3-4 months

ATNR position

supine, slowly rotate head to one side

ATNR response

jaw side extension, skull side flexion

Full term ATNR vs premature infants

upper extremities stronger in full term, lower stronger in premature

When does ATNR disappear

as neck righting with rotation appears

ATNR response is never totally obligatory

TRUE

obligatory ATNR

inability to engage hands, scoliosis, hip dislocation, inability to grasp and regard, separate movements from upper and lower extremities

Symmetrical Tonic Neck age

5 to 6 months

Symmetrical tonic neck position

examiner passively flexes then extends head or facilitates movement with toy, child prone over knee

Symmetrical tonic neck response

Flexion of head, flexion of UE and extension of LE

Extension of head, extension of UE and flexion of LE

Sometimes opposite is seen

Developmental significance of symmetrical tonic neck

May be used to get into four point position

Persistence of symmetrical tonic neck

prevents child from moving trunk and extremities in rotational patterns when head is moved in sagittal plane

Tonic Labyrinthine reflex present in

pre-term, not always full-term

Tonic Labyrinthine position

Supine:push up to sitting position using back of child’s head, evaluate extensor tone

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Prone:lift head 90 to evaluate flexor tone

Tonic Labyrinthine response

Supine: extensor dominates, hips extend, head pushes back into hand

Prone: Flexor dominates, hips flexed, chin will push down into examiner’s hand

Developmental significance of Tonic Labyrinthine

Child will not be able to lift head to clear airway in prone

Won’t be able to bring hands to mouth in supine

Tonic Labyrinthine persists

dominates posture, motor development will be delayed

Labyrinthine Righting age

Primary righting reaction, birth to 4 months when vision matures

Labyrinthine Righting position and procedure

blindfold child, tilt anteriorly, posteriorly, and laterally from vertical so head drops in all directions

Labyrinthine Righting response

head orients immediately to vertical position and is steady

Absent Labyrinthine Righting

vestibular dysfunction

Slow Labyrinthine Righting response

sensorineural hearing loss

Labyrinthine Righting needed for?

head control as child moves in space, body can turn freely around head

Optical righting

no blindfold, infants orients and rights self to environment using vision versus vestibular sense

Landau age

emerging at 4 months, present until 7 months

Landau position and procedure

support child horizontally and prone in the air

Landau response

head extends, back and hips extend in sequence “superman”

Landau produced by

Labyrinthine Righting, optical righting, body on head and body and body

Landau poor quality

congenital myopathies or hypotonia

Landau breaks up

flexor pattern seen at birth promotes extension

Neonatal Neck Righting age

birth to 4 months, replaced by body righting

Neonatal Neck Righting position and procedure

supine, turn child’s head to one side

Neonatal Neck Righting response

child’s trunk may initially swing in opposite direction and then will follow direction of head turn, body turns as whole (log roll)

Developmental significance of Neonatal Neck Righting

needed for child to roll from back to side

asymmetry response indicates CNS dysfunction

Body righting on Body position and procedure

supine, flex one leg and rotate it across pelvis to opposite side

BROB response

Child will turn to prone segmentally, first trunk then girdle then head

Persistence of BROB

Persistence of complete rotation from supine to prone to get to sitting beyond 4 years indicates sensorimotor delay, minimal brain dysfunction after 5

Protective Extension forward age

Forward emerges at 5 months, present at 6 months and remains with child

Protective extension forward procedure

vertical, plunge child down toward table or flat surface

Protective extension forward response

Extend head, extend and abduct arms and fingers as if to break a fall, weight is taken on extended arms

Protective extension sideways age

emerging at 7 months, present at 8 months, remains with child

protective extension sideways procedure

Sitting position, pushes child on one shoulder to displace center of gravity

protective extension sideways response

abduction of arm opposite to force with extension of elbow, wrist, and fingers before weight is taken on palms and fingers

protective extension backwards age

emerging at 9 months, present at 10 months and remains with child

protective extension backwards procedure

Symmetrical sitting, pushes child back to displace gravity

protective extension backwards response

extends arm backwards

Need for protective extension backwards

good sitting balance and trunk rotation, standing up without full rotation

Equilibrium reaction supine age

present at 7 months

Equilibrium reaction supine position

supine on tilt board, slowly tilt board laterally

Equilibrium reaction supine response

trunk is curved upward against tilt and head is rotated with the face toward upper side. Slight abduction of upper arm and leg

Equilibrium reaction supine developmental significance

reactions in supine and sitting are needed for sitting without support

Indicates righting reactions have been modified

Equilibrium reaction prone age

present at 6 months

Equilibrium reaction prone response

child will curve upward against displacement of center of gravity, upper arm and leg may abduct

Developmental significance of Equilibrium reaction prone

foundation is righting reflexes

necessary part of balance mechanism

Labyrinths must be intact for tilting to be present

Equilibrium reaction sitting age

present at 8 months

Equilibrium reaction sitting position

sit up, criss cross

Equilibrium reaction sitting response lateral tilt

neck is flexed laterally and head slightly rotated with face toward upper side

Lower side adducted and upper side abducted

Equilibrium reaction sitting response anterior tilt

spine extends and limbs are retracted

Equilibrium reaction sitting response posterior tilt

spine flexed, arms flexed at shoulders, elbows extended, flexion of trunk (most important)

Equilibrium Quadraped age

present 9 months

Equilibrium quadraped response lateral tilt

body flexed against tilt with concavity of spine upward and head is slightly rotated toward upper side

Equilibrium quadraped response anterior tilt

arms extended and legs flex, head is extended and trunk moves backwards

Equilibrium quadraped response posterior tilt

shoulders and hip extend, elbows and head tend to flex and trunk moves forward, curving of trunk is important

Equilibrium standing reaction age

present 10 months to 1 year

Equilibrium standing response lateral tilt

Body is flexed against tilt with concavity of spine upward, upper leg and arm abducted, lower leg and knee extended

Equilibrium standing response anterior tilt

spine extends, displaces body backwards, legs extend, arms may extend. Extension of trunk most important.

Equilibrium standing response posterior tilt

shoulders and hips flex, elbows and head tend to flex and trunk moves forward. Curving of trunk is most important.

Full equilibrium

in all four positions and beginning tilt in standing needed for walking

in standing acquired before child can run

Bring COG over base