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Primitive Reflexes.pdf
- 1. Primitive Reflexes Dr. Vivek H. Ramanandi (PT) MPT (Neuro), Ph.D. Scholar Assistant Professor, SPB Physiotherapy College, Surat.
- 2. What are Reflexes? • A reflex, or reflex action, is an involuntary & nearly instantaneous response to a stimulus. • Examples: – Constriction of pupils when exposed to light – Sneezing or coughing when exposed to irritant – Jerky withdrawal of leg when pricked
- 3. What are Primitive Reflexes? • Reflex actions originating in the CNS and are exhibited by normal infants, but not neurologically intact adults, in response to particular stimuli. • Suppressed by the development of the frontal lobes during process of normal development
- 4. What are Primitive Reflexes? • Represent neurological maturation of the newborn and most develop before birth • Also called infantile, infant or newborn reflexes • Absence of response & abnormal persistence of reflex both may suggest neurological abnormality
- 5. Adaptive Value of Primitive Reflexes • Assisted in the survival of babies during human evolution (e.g., The Moro Reflex) • Reflexes such as sucking and grasping help establish interaction between parents and infants
- 6. Classification of Primitive Reflexes Cortical Level Midbrain Level Brainstem Level Spinal Cord Level
- 7. Spinal Level Reflexes Flexor Withdrawal Extensor Thrust Crossed Extension Rooting Sucking Grasp Traction
- 8. • Noxious stimulus (pinprick) to sole of foot. Tested in supine or sitting position. Stimulus • Toes extend, foot dorsiflexes, entire LE flexes uncontrollably Response • 28 weeks of gestation Onset • 1–2 months Integrated Flexor withdrawal
- 9. • One leg extended and the other flexed; sole of flexed leg is given stroking Stimulus • Immediate extension adduction and internal rotation of flexed leg with plantar flexion of foot Response • Birth Onset • 4 months Integrated Extensor thrust
- 10. • Noxious stimulus to ball of foot of LE fixed in extension; tested in supine position. Stimulus • Opposite LE flexes, then adducts and extends. Response • 28 weeks of gestation Onset • 1–2 months Integrated Crossed Extension
- 11. • Stroking cheek or mouth Stimulus • Turn its head towards stimulus, searching object Response • Birth Onset • 4 months (3-6 months) Integrated Rooting
- 12. • Touch the roof of mouth Stimulus • Sucking Response • Birth Onset • 4 months (3-6 months) Integrated Sucking
- 13. • Maintained pressure to palm of hand (palmar grasp) or to ball of foot under toes (plantar grasp) Stimulus • Maintained flexion of fingers or toes Response • Palmar: Birth • Plantar: 28 weeks of gestation Onset • Palmer: 4–6 month • Plantar: 9 months Integrated Grasp
- 14. • Grasp forearm and pull up from supine into sitting position Stimulus • Grasp and total flexion of the UE Response • 28 weeks of gestation Onset • 2–5 months Integrated Traction
- 15. Brainstem Level Reflexes Asymmetrical Tonic Neck Reflex Symmetrical Tonic Neck Reflex Symmetrical Tonic Labyrinthine Reflex Positive Supporting / Walking / Stepping
- 16. • Rotation of the head to one side Stimulus • Flexion of skull limbs, extension of the jaw limbs, “bow and arrow” or “fencing” posture Response • Birth Onset • 4–6 months Integrated Asymmetrical Tonic Neck Reflex (ATNR)
- 17. • Flexion or extension of the head Stimulus • With head flexion: flexion of UEs, extension of LEs; with head extension: extension of UEs, flexion of LEs Response • 4–6 months Onset • 8–12 months Integrated Symmetrical Tonic Neck Reflex (STNR)
- 18. • Prone or supine position Stimulus • With prone position: increased flexor tone/flexion of all limbs; with supine: increased extensor tone/extension of all limbs Response • Birth Onset • 4–6 months Integrated Symmetrical Tonic Labyrinthine Reflex (STLR/TLR)
- 19. • Contact to the ball of the foot in upright standing position Stimulus • Rigid extension (co-contraction) of the LEs Response • Birth Onset • 6 months Integrated Positive supporting/ Walking/ Stepping
- 20. Midbrain Level Reflexes Neck Righting Reaction Optical Righting Reaction Labyrinthine Righting Reaction
- 21. • Supine blind folded: Rotate head to one side Stimulus • Body rotates to that side as a whole Response • Birth Onset • 3 months Integrated Neck Righting Reflex
- 22. • Hold child from armpit in a suspended position then change position of his head from side to side Stimulus • Eyes will always move to same side as head Response • 1-2 Years Onset • Persists Integrated Optical Righting Reflex
- 23. • Same as Optical righting Stimulus • Same as Optical righting Response • 2-3 months, reaches peak 5-6 months Onset • Persists Integrated Labyrinthine Righting Reflex
- 24. Cortical Level Equilibrium Reflexes • Movement of tilt board or rocking board Stimulus • Extension of upper and lower extremities on the side of tilt Response • Sitting: 10-12 months • Standing: 18 months Onset • Persists Integrated
- 25. Automatic Reactions Moro Reflex Startle reaction Landau Reflex Glabellar Tap Galant Reflex Parachute Reaction
- 26. • Sudden change in position of head in relation to trunk; drop patient backward from sitting position. Stimulus • Extension, abduction of UEs, hand opening, and crying followed by flexion, adduction of arms across chest. Response • 28 weeks of gestation Onset • 5–6 months Integrated Moro Reflex
- 27. • Sudden loud or harsh noise Stimulus • Sudden extension or abduction of UEs, crying Response • Birth Onset • Persists Integrated Startle Reflex
- 28. • Either active or passive flexion of neck in ventral suspension Stimulus • Flexion of both upper and lower limbs Response • 3 months (Reaches at peak at 8 months) Onset • 10 months Integrated Landau Reflex
- 29. • Light tapping over glabellar region Stimulus • Blinking of both eyelids Response • 2-3 months Onset • Persists Integrated Glabellar Tap Reflex
- 30. • Stroke child’s side of back Stimulus • Swing towards side of stroke Response • Birth Onset • 4-6 months Integrated Galant Reflex
- 31. • Child is held upright and the baby's body is rotated quickly to face forward Stimulus • Extension of arms forward as if to break a fall Response • 6-12 months Onset • Persists Integrated Parachute Reaction
- 32. • Resisted voluntary movement in any part of the body Stimulus • Involuntary movement in a resting extremity Response • Birth–3 months Onset • 8–9 years Integrated Associated Reactions
- 33. References Pediatric Physical therapy (4th Ed.) – J. Tecklin Nelson Essentials of Pediatrics (2nd Ed.) Physical Rehabilitation (6th Ed.)- Sullivan Physiotherapy in Neuro-Conditions- Glady S. Raj