Peds Lec 2: Assessment of Developmental Reflexes

_____ are the basic building blocks of movement

reflexes

spinal cord level reflexes

simplest reflexes, involuntary stimulus response, (DTR, Flexor withdraw)

brainstem level reflexes have a ______ duration

longer

midbrain level reflexes consists of what two groups of reactions?

righting reactions and protective extension

cortical level reactions

equilibrium reactions (balance), volitional movement (the will to move)

reflex

stereotypes response following reception and transmission of a sensory stimulus (response is same every time!)

primitive reflex

reflex that appears during gestation and generally becomes integrated by about six months of age.

T/F: primitive reflexes are pathological

F - they are NOT pathological. they should be present in all normal, full-term newborns

reaction

complex, non-stereotypes response which is easily modified by varying associated physiological status and maturity of the nervous system

integration

when a reflex is inhibited by higher centers of control, the reflex is no longer stereotyped (same every time).

T/F: once a reflex is integrated is does not appear again

F

obligatory

persistence of a reflex beyond the time when it should have been integrated. the individual is unable to volitionally overcome it.

T/F: the obligatory reflex itself is not pathological

T: but it may be indicative of a pathological condition or CNS insult

How do we assess reflexes? (in order)

Position, Stimulus, Procedure, Response

should you test the involved or uninvolved side first?

uninvolved

list the non-level specific reflexes

rooting, suck/swallow, palmar grasp, Plantar grasp, galant, proprioceptive placing, primary stepping

primary stepping: Position, Stimulus, Procedure, Response,

Position: vertical suspension, slight forward lean

Stimulus: tactile, proprioception, vestibular

Procedure: Lower child to the surface, pressure of feet on surface, forward tilt of trunk

Response: Infant demonstrates reciprocal, heel toe “walking“

Rooting: Position, Stimulus, Procedure Response,

P: supine, head in midline

S: Tactile

P: Stroke cheek from mouth, up toward ear

R: head rotates toward stimulus, mouth searching

Suck/Swallow: Position, Stimulus, Procedure Response,

P: All

S: Tactile

P: object (nipple, finger) placed in mouth

R: strong latching, rhythmical suck coordinated with rhythmical swallow

Palmar Grasp: Position, Stimulus, Procedure Response,

P: Any non wb on hands, head in midline

S: tactile/proprioceptive

P: insert pinky finger from ULNAR side of palm, pressure over full palm

R: strong finger flexion, may see fingernail blanching

will the baby have a harder time grasping with the wrist in flexion or extension?

flexion

will the palmar grasp or plantar grasp reflex integrate first?

Palmar

Plantar Grasp: Position, Stimulus, Procedure Response,

P: any non wb on foot, head in midline

S: tactile/proprioceptive

P: pressure across metatarsal heads with thumb

R: flexion of toes over thumnb

What might occur of the plantar grasp reflex does not integrate?

pt will not be able to walk on flat feet

Galant: Position, Stimulus, Procedure, Response,

P: Prone or prone suspension

S:Tactile

P: stroke paraspinals vertically (should be on skin)

R: incurvature toward stimulus

what is the purpose of the galant reflex?

to help baby get out of the birth canal

Proprioceptive Placing UE and LE: Position, Stimulus, Procedure Response,

P: vertical suspension

S: Tactile/proprioceptive

P: UE - stroke back of hand against a firm surface, LE- stroke top of foot against firm surface

R: extremity flexes and then extends to be “placed” on the surface

spinal level reflexes

phasic reflex which coordinate movement into total flexion or extension patterns. elicited by tactile or noxious stimulation. positive response normal up to 2 months

what are the spinal level reflexes?

flexor withdraw, extensor thrust, crossed extension

Flexor Withdawl: Position, Stimulus, Procedure Response,

P: supine, head in midline

S: tactile/Noxious

P: with thumb, stroke sole of foot from heel to metatarsal heads quickly, providing a noxious stimulus

R: Hip and knee flexion of stimulated side

what happsn if the flexor withdrawal persists?

pt will have trouble with weight bearing

crossed extension: Position, Stimulus, Procedure Response,

P: supine with head in midline

S: tactile / NOXIOUS

P: hold foot in hand and drag thumb from heel to metatarsals

R: contralateral LE with flex at hip and knee, then extend and adduct

Extensor Thrust: Position, Stimulus, Procedure Response,

P: supine, head in midline, one hip flexed

S:tactile

P: pressure to metatarsal heads of foot on flexed side

R: extension of hip and knee on test side (pushed examiner away)

if extensor thrust persists what will the pt have trouble with?

walking because they can’t weight shift or flex

brain stem level reactions are elicited by the change of . . . “…”. What do these changes cause?

elicited by changes in position of head and body in space (vestibular and/or proprioceptive stimuli). Causes postural reflexes which effect change in distribution of muscle tone throughout the body.

brain stem level: if theres an obligatory response what happens to the pt?

inability to roll, sit, weight bear and ambulate independently

List the brain stem level reflexes?

asymmetrical tonic neck reflex (ATNR), symmetrical tonic neck reflex (STNR),Tonic Labyrinthine Reflex prone and supine, Positive supporting, Moro.

Asymetrical Tonic Neck Reflex: Position, Stimulus, Procedure, Response

Position: supine or quadruped (for older child)

Stimulus: proprioceptive

Procedure: active or passive Head/neck rotation bilaterally

Response: extremities on face side extend,

Extremities on skull side flex

Symmetrical Tonic Neck Reflex: Position, Stimulus, Procedure, Response

Position: prone over examiner’s lap or quadruped

Stimulus: proprioceptive and /vestibular

Procedure: flexion of the head

Response: upper extremities flex, lower extremities extend

If you perform Extension of head, extension of upper extremities and flexion of lower extremities

what is the purpose of the symmetrical tonic neck reflex

to help babies get into quadriped

STNR with nexk flexion appears at about ___ months of age

5

if STNR is not integrated, what issue might you see?

pt will use reflex (head flexion) to bring hand to mouth. difficulty with dissociated movements

what system is being stimulated/tested in the tonic labrynthine reflex?

vestibular system

Tonic Labrynthine Reflex in supine what should we see?

full bias for extension

Tonic Labrynthine Reflex in prone what should we see?

full bias for flexion

if TLR supine is not integrated, the child will have issues with what? What about prone?

issues with flexion, issues with antigravity extension

positive supporting: position, stimulus, procedure, response

P: vertical suspension

S: tactile, proprioceptive

PR: bring infant to surface to allow weight bearing through feet through contact with surface

R: extension of lower extremities and weight bearing

neonate

refers to first 28 days of life

If positive supporting' does not integrate what will the child have issues with?

flexion of lower extremities, weight shifting, reciprocal movement

when should positve supporting of LE’s integrate?

about 2 months

negative supporting (astasia): position, stimulus, procedure, response

P: vertical suspension

S: tactile/proprioceptive

PR: lower to contact with the surface

R: initial extension of LE’s then relaxed into flexion. may bounce up and down flex/extend

once there is integration of neonatal positive supporting you will be able to see ____ _____.

negative supporting

what time frame should a child be able to elicit negative supporting response?

2-3 months

if negative supporting does not integrate, the child will have trouble with what?

weight bearing

Moro Reflex: position, stimulus, procedure, response

P: semi-setting facing you, head supported, hands gently held in midline

S: vestibular/movement

PR: quickly lower head in a posterior direction 2-3 inches, letting go of hands simultaneously

R: UE abd, and flex with elbow, wrist and finger extension, followed by adduction back to midline, baby may cry.

Moro:_____, Startle:______

movement, sound