The document outlines various primitive reflexes essential for protection and survival in infants, detailing their onset, integration, testing positions, and functional significance. It emphasizes the importance of reflex testing for therapists to diagnose developmental delays or conditions and tailor interventions. Each reflex, such as the rooting and sucking reflexes, has specific developmental milestones and implications for physical and neural health.

1. PRIMITIVE REFLEXES

2. DEVELOPMENTAL REFLEXES
Primitive reflexes are important for
– Protection
– Nutrition
• Sucking reflex
• Rooting reflex
– Survival
• Labyrinthine reflex

3. WHY THERAPIST NEED TO TEST……
• Therapist should be aware of and test for when presented
with an infant or child with possible developmental delay
or tonal problems.
• Reflex testing can assist the therapist in determining the
cause of the delay such as CNS impairment, peripheral
nerve injury, and muscle weakness.
• Reflex review will also assist in developing an individual
treatment intervention designed to help the child integrate
reflexes that appear to be delayed or missing

4. SPINAL LEVEL

5. PALMAR GRASP
• Onset - 10 weeks gestation
• Integration - 4-6 months
• Testing position - supine,
head midline, arms and hands free
• Procedure - place a finger in infant’s hand from the ulnar
to the palmar surface
• Response observed - infant’s fingers will flex around the
finger
• Functional significance -following the development of
grasp, the infant begins to reach for objects and utilizes a
crude palmer grasp to hold them

6. FLEXOR WITHDRAWAL
• Onset - begins at 28 weeks gestation
• Integration - 2 months for normal child;
may persist in developmentally
delayed and/or CP child
• Testing position - child supine, head midline, lower extremities
extended
• Procedure - apply a noxious stimulus to the sole of the foot
• Response observed - withdrawal of the foot from the stimulus
employing hip and knee flexion
• Developmental significance - failure to attain and integrate this
reflex may indicate sensorimotor delay and/or CNS depression

7. CROSSED EXTENTION
• Onset - begins at 28 weeks gestation
• Integration - 1-2 month
• Testing position - child in supine, head in midline, lower
extremities extended
• Procedure - Holding one leg in extension at the knee,
apply firm pressure to the sole of this leg
• Response observed - child’s opposite leg will flex,
adduct, and then extend
• Functional significance - this reflex can interfere with
reciprocal kicking and later functional activities

8. THE TRACTION RESPONSE
Onset - begins at 28 weeks gestation
Integration - 2-5 months
• Testing position - child in supine with the arms and head in midline
• Procedure - grasp the child’s wrists and pull up to sitting placing a
stretch on the shoulder adductors and arm flexors
• Response observed - the child will flex and elevate shoulders, arms
and wrists
• Functional significance- traction is a primitive reflex which enables
the child to hold onto the mother when being pulled. Traction helps
stabilize the head before the child has voluntary head control

9. MORO REFLEX
• Onset - begins at 28 weeks gestation
• Integration - 5-6 months
Testing position - child in supine with head
in midline, support the child's head while pulling the child to a position
halfway between supine and upright sitting
• Procedure - support the infant’s head and shoulders with one hand.
Allow the neck to drop back to allow the anterior neck muscles to
stretch
• Response observed - the shoulders abduct, the elbows, wrists and
fingers extend. Subsequently, the shoulders adduct, and the elbows and
fingers flex
• Functional significance - asymmetry during this reaction may indicate a
brain lesion or injury or peripheral nerve problems to the upper
extremity

10. BRAIN STEM LEVEL

11. ASYMETRICAL TONIC NECK REFLEX (ATNR)
• Onset - 0-2 months
• Integration - 4-6 months
• Testing position – supine, Fencer position
• Procedure - Gently turn the infant’s head to one side
• Response observed – Bow & Arrow (Fencer posture)
position.Extention of UL&LL extremities in Head turned
side and Flexion of extremities in opposite side.
• Functional significance - persistence of this reflex may
indicate CNS damage

12. SYMMETRICAL TONIC NECK REFLEX (STNR) OR CRAWLING REFLEX
• Onset : 4-6 months
• Integration : 8 - 12 months
• Testing position :
Child in quadruped position on the floor
• Procedure: Passively flex the head forward and then extend
it backwards
• Response observed - forward head flexion will produce
flexion of the upper extremities and extension of the lower
extremities; extension of the head will produce extension of
the upper extremities and flexion of the lower extremities
• Functional significance - necessary to achieve quadruped
crawling

13. TONIC LABYRINTHINE REFLEX
(TLR)
• Onset - birth
• Integration - 6 months
• Testing position - prone or supine
• Procedure - prone - lift the infant up to evaluate for the presence
of flexor tone; supine, lift the child to sitting to observe for
extensor tone
• Response observed - prone - flexor tone will dominate; supine -
extensor tone
• Functional significance - persistence of TLR will impede activities
which require graded coactivation of flexor and extensor muscles

14. ASSOCIATED REACTIONS
• Onset - birth to 3 months
• Integration - never, less common after 8-9 years
• Testing position - sitting
• Procedure - hand grasp in younger children, rapid
arm movements in older children
• Response observed - overflow of movement to the
contralateral side should decrease with age
• Functional significance - excessive build-up of
movement, or tonal increases in the opposite
extremity indicate brain damage

15. CORTICAL LEVEL

16. RIGHTING REACTIONS
(LABYRINTHINE HEAD RIGHTING)
• Onset - birth to 2 months
• Integration - persists throughout life
• Testing position - vertical position
• Procedure - tilt the child anterior, posterior, and
lateral from the vertical
• Response observed - the head orients to the
vertical position and is maintained steady
• Functional significance - in order to move around in
space, this reflex is necessary to allow the body to
turn freely around the head

17. EQUILIBRIUM REACTIONS
• Onset: 8 months
• Integrated: Persists throughout the life
• Testing position: standing
• Procedure: Alter the body centre of mass
(COM) and / or base of support (BOS)
• Keep COM with in BOS
• Response: Observe the automatic postural
adjusment that serve to maintain balance
• PROTECTIVE REACTIONS: Outside the BOS

18. BODY RIGHTING REACTION
(BOB)
• Onset - begins at 34 weeks
gestation
• Integration - 4-5 months
• Testing position - infant supine, head midline
• Procedure - flex one limb over the chest and rotate the limb
across the body
• Response observed - infant’s upper body will follow the pelvis in
a log roll
• Functional significance - this reflex assists the child in rolling
between supine and prone

19. SPONTANEOUS STEPPING
Onset - begins at 37 weeks gestation
• Integration - 2 months
• Testing position : supported in the vertical position
• Procedure - support the infant upright with the feet touching a
hard surface. Incline the infant forward and gently move the
infant forward to accompany any stepping
• Response observed - alternating, rhythmical, and coordinated
steps
• Functional significance - premature infants will tend to walk in
a roe-heel fashion while more mature infants will walk in a
heel-toe pattern

20. POSTURAL FIXATION IN STANDING
• Onset - 12 - 21 months
• Integration - persists through life
• Testing position - standing and one-legged standing
• Procedure - exert minimal force to the pelvis in all four
directions
• Response observed - observe for force fields of the
lower extremities to prevent falling or tipping
• Functional significance - allows for the preservation of
the center of gravity and balance in standing and
walking

21. THANKS

22. • LABYRINTHINE HEAD RIGHTING
• Onset - birth to 2 months
• Integration - persists throughout life
• Testing position - vertical position
• Procedure - tilt the child anterior, posterior, and lateral from
the vertical
• Response observed - the head orients to the vertical position
and is maintained steady
• Functional significance - in order to move around in space, this
reflex is necessary to allow the body to turn freely around the
head

23. • THE ROOTING REACTION
• Onset - 28 weeks gestation
• Integration - 3 months
• Testing position - with the infant supine, the head in midline
and hands on chest
• Procedure - gently stroke the infant from the lips to the cheek
• Normal response - the infant should turn his head toward the
stimulated side with the mouth opening and a trial of sucking
the finger. May not be present if the infant is not hungry.
• Functional significance - persistence can interfere with sucking.
Absence of this is seen in neurologically impaired infants

24. PARACHUTE REFLEX

25. • NECK RIGHTING ON THE BODY (NOB)
• Onset - begins at 34 weeks gestation
• Integration - 4-6 months
• Testing position - infant in supine, head midline
• Procedure - turn the infant’s head to one side
• Response observed - infant’s entire body will turn in the
direction of the head
• Functional significance - early in development the infant
uses NOB in order to transition between supine,
sidelying, and eventually prone

26. CORTEX LEVEL

27. • NECK RIGHTING ON THE BODY (NOB)
• Onset - begins at 34 weeks gestation
• Integration - 4-6 months
• Testing position - infant in supine, head midline
• Procedure - turn the infant’s head to one side
• Response observed - infant’s entire body will turn in the
direction of the head
• Functional significance - early in development the infant
uses NOB in order to transition between supine,
sidelying, and eventually prone