Sensory profile

1. SENSORY PROFILE

2. PURPOSE
• To evaluate possible sensory processing patterns that support
and/or interfere with a child’s daily functional performance.
• Helps to identify which specific sensory system or systems are
contributing to dysfunctional behavior.
• Provides information about the child’s level of responsivity
(hyper responsive or hypo responsive)

3. KEY CHARACTERISTICS
• Age: Birth to 36 months
Assessment approach:
Judgment based-Caregiver Questionnaire
Supports family-centered care philosophy
Caregiver main source of data collection

4. Assesses child’s response to sensory stimuli in a natural environment
(daily routines at home)
This tool can be used in early intervention and private practice
setting.
Judgment based- in form of caregiver questionnaire

5. DOMAINS
• Quadrants: Sensory processing sections:
sensation seeking
sensory sensitivity
sensation avoiding

6. • Sensory processing sections:
General
Auditory
Visual
Tactile
Vestibular
oral ( 7-36 months only)

7. TESTING PROCEDURES: 3 WAYS TO
ADMINISTER:
• Send Caregiver Questionnaire with cover letter for specific
instructions home with parent
• Inform caregiver to fill out front page of Caregiver
Questionnaire including: child’s name, child’s birthdate,
caregiver name, relationship to child, and other questions.

8. INFANT NEUROLOGICAL
INTERNATIONAL BATTERY(INFANIB)

9. INTRODUCTION
• Infant Neurological International Battery (INFANIB) is a
standardised neuromotor examination, used to determine tone
and posture of 0-18 months infant which is less time
consuming and easily fits into the routine of a paediatric
evaluation.

10. • The INFANIB was developed by Ellison (15) and was designed to provide
information on age-specific motor development impairment during the first
18 months of life and to identify which infants could benefit from early
intervention.

11. ADMINISTRATION
The infant is assessed in supine, prone, sitting, standing, or
suspended positions for the following items under each factor:
Factor I-Spasticity: tonic labyrinthine supine, tonic labyrinthine
prone, asymmetric tonic neck reflex, hands open/closed.

12. • Factor II-Vestibular function: backward parachute, forward parachute, sideway
parachute, body rotative
• Factor III-Head and trunk: sitting, pulled to sitting, all fours, body derotative
• Factor IV-French angles: scarf sign, heel to ear, popliteal angle, abductor's angle
• Factor V-Legs: standing, foot grasp, dorsiflexion of foot, positive support reflex.

13. • The examiner must then determine if the infant’s performance falls into the
expected age ranges (birth-2.9 months, 3-5.9 months, 6-8.9 months, or 9-18
months) .
• Infanib uses a three-point scoring scale where each item is scored with 1, 3, or 5
points.
A score of 5 is given for when the picture matches age,
3 is given for one stage delay,
 1 is given for 2 stage delay.

14. • According to the INFANIB score attained, the infant can be classified as
abnormal, transiently abnormal, or normal, using the cut-off points published by
the test developer. The cut-off points are:
• less than 4 months: abnormal ≤ 48, transient = 49-65, normal ≥ 66.
• 4 to 8 months old: abnormal ≤ 54, transient = 55-71, and normal ≥ 72.
• 8 months old or more: abnormal ≤ 68, transient = 69-82, and normal ≥ 83

15.  If classified as abnormal, then, the infant is further categorized into
• spastic tetraparesis/dyskinesia,
• spastic hemiparesis,
• spastic diplegia or hypotonia categories

16. EVIDENCE REGARDING MEASUREMENT PROPERTIES OF
INFANIB
• Ellison et al, conducted a study for the construction of INFANIB,
where 365 assessments were made, 261 infants were assessed
once, 37 twice and 10 thrice. The authors calculated the
internal consistency and reliability of each factor (spasticity .86,
vestibular function .89, head and trunk .86, French angles .89,
legs .72).

17. • Stavrakas et al assessed 243 infants with Infanib at 6 and 12 months of age and
found that the assessment at 6 months could predict cerebral palsy at 12 months
using the spasticity (88.8%) and head and trunk (88.1%) factors

18. POPULATION
• High risk infants with premature deliveries
• Low birth weight
• intrauterine growth retardation
• birth asphyxia
• intraventricular hemorrhage,
• respiratory distress, congenital heart diseases

19. DEVELOPMENTAL REFELEXES AND
ITS CLINICAL SIGNIFICANCE

20. INTRODUCTION
Primary reflexes :
• Usually emerge first in the development under the elements of
spatial, temporal, and physical domains
• Primary movement patterns are complex non-volitional movement
patterns, muscle tone, and sensory input.
• These reflexes affect the body as total body responses or localized
segments or localized responses.

21. CLASSIFICATION OF NEONATAL REFLEXES

22. GLOBAL PRIMITIVE
REFLEXES : ( BRAIN-STEM
REFLEXES

23. 1. TONIC LABYRINTHINE REFLEX (TLR)
• PRONE SUPINE SIDELYING
• Occur at birth and present till 4-6 months of age.
• Typical Response : supine : extensor tone of body touching the surface. ( sh.,
trunk,hip,knee extension ), Prone : Flexor tone of the body touching the
surface , sidelying : extensor on wt bearing side and flexor on non-wt
bearing.

24. • Atypical response : absent in children with hypotonia, spinal cord
lesions(prolonged ) cp , (asymmetrical) hemiplegia,diplegia,,quadriplegia
• Clinical significance : Helps in development of muscle tone, balance, posture ,its
non integration creates increased rigidity in leg muscle and neck muscles

25. ASYMMETRICAL TONIC NECK REFLEX (ATNR”)
• Present at birth and remains until 4-6 months of age
• Can be done in two sides : ATNR to the right ATNR to the left
• Typical Response : ATNR Right : extensor tone will be
predominating onto right side flexor tone predominate on non-
testing side . ATNR Left : extensor tone will be predominating
onto left side. flexor tone predominant on non-testing side.

26. • Atypical responses : (absent ) hypotonia ,sci, ( prolonged ) cp, deformities
• Clinical significance : Helps in development of eye-hand coordination , if persists
problem in rolling occurs.

27. 3. SYMMETRICAL TONIC NECK REFLEX ( STNR )
• Emerges at 4-6 months and disappears around 8-12 months
• Typical Response : STNR head extended : infant demonstrates extension of
the upper extremity (shoulder and elbow) and flexion of the lower extremity
(hip and knee ). STNR head flexed : flexor tone will predominate in the infant
from waist to the head and extensor tone from waist to the feet.

28. • . Atypical response : absent in hypotonia, sci, ( prolonged ) cp, head trauma, w
sitting
• Clinical significance : helps in maintaining crawling position ,improves hand
weight bearing

29. PHASIC REFLEXES :
AUTONOMIC REFLEXES )

30. GALANT REFLEX
• Observed at 32 weeks of GA. Present at birth till 2months
• Typical Response : incurving of the trunk towards the side stimulated is
seen(Lat.flexn.) Atypical response : (absent) dd , (prolonged) cp, scoliosis
• Clinical significance : helps encourage movement to develop ROM in hip for
preparation of walking and crawling

31. MORO REFLEX
• present at birth and disappears around 5-6 months.
• Persists longer in preterm infants
• Typical Response : Phase 1 : flaring of arms into extension and abduction
with hands open, legs extending. phase 2 : groping of arms into flexion and
adduction across chest with hands being fisted.

32. • Atypical response : (absent) cns depression ,hypotonia , (prolonged) sensory
motor dysfunction ,decreased hand grasp and release
• Clinical significance : helps to embrace and protect itself and is a survival instinct
and cling to mother.

33. MIDBRAIN REFLEXES

34. NEONATAL NECK RIGHTING ACTING ON THE BODY
REFLEX (NEO-NOB)
• Present at birth ,disappears between 4-5 months
• Typical Response : should be equal on both sides. body rolls as one unit ,log
rolling to the right. body rolls as one unit ,log rolling to the left .

35. • Atypical response : ( absent ) trunk and rotational skills ,(prolonged ) delays
segmental rotational skills
• Clinical significance : Assists birthing process and in development of non-
volitional primitive trunk rotational movement patterns

36. NEONATAL BODY RIGHTING ACTING ON THE BODY
REFLEXES (NEO-BOB)
• Present at birth ,disappears between 4-5 months
• Typical Response : should be equal on both sides. body as one unit, log
rolls to the right. body as one unit , log rolls to the left.

37. • Atypical response : ( absent ) trunk and rotational skills ,(prolonged ) delays
segmental rotational skills
• Clinical significance : Assists infants in assimilating combination of horizontal
alignment along sagittal axis

38. LOCAL PRIMITIVE REFLEXES : (INNATE
REFLEXES)

39. ROOTING REFLEX
• Emerges at 28 weeks GA. Present at birth till 3 months.
• Typical Response : After stimulus is elicited, infant’s bottom lip lowers on
same side, tongue protrudes toward stimulus and as the stimulus finger
slides along right side ,head follows it.

40. • Atypical response : (absent) cns depression, post delivery medications,
sensorimotor dysfunction ,affects feeding (prolonged ) sucking interference,
oral motor and speech developmental disrepency, avoids touch stimulus
• Clinical significance : helps moving of the head towards source of nutrition

41. LEGS :TONIC REFLEX
• Plantar Grasp Reflex
• Emerges around 25 weeks of GA. Present from birth till 9-12
months.
• Typical Response : toes curl around the thumb or index finger
as if to grasp the finger or thumb.

42. • Atypical response : (absent) sci dysfunction , (prolonged) neurological
dysfunction with spasticity ,walking and standing delayed
• Clinical significance : helps in preparation for weight bearing

43. PRIMARY STANDING REFLEX (NEONATAL POSITIVE
SUPPORT REFLEX )
• Emerges at 35 weeks of GA. Present since birth till 2 months of age.
• Typical Response : knees are partially extended with partial weight bearing
of feet on the surface. Knees are semi-extended but hip flexed .( positioned
immaturely )

44. • Atypical response : (absent) sci lesion ,pni, higher cns damage (prolonged)
spastic cp, interferes walking.
• Clinical significance : helps regulating weight bearing

45. STEPPING REFLEX
• Emerges at 37 weeks of gestation. Present at birth until 2
months of age.
• Typical response : Firstly the primary standing reflex is activated
allowing partial weight bearing on the legs. Secondly steeping
reflex is stimulated as it spontaneously takes steps

46. • . Atypical response : (absent) breech infants, reduced nonvolitional leg
movements, balance of flexor and extensor tone of legs are altered (prolonged)
if stepping >standing reflex child with cp,shows fluctuating tone of athetosis, if
vice versa, higher tone, spasticity , Clinical significance : helps in walking and
supported standing

47. PLACING REFLEX OF THE LEGS
• Emerges at 35 weeks of GA. Present at birth until 2 months of
age
• Typical Response : phase one : hip and knee on stimulated leg
flex ,lifting the foot and placing on top of the table. phase two ;
once sole touches table top, it extends with foot in firm and
immature partial weight bearing .

48. • Atypical response : (absent) infantile spinal musculature atrophy disease ,sci,
spina bifida, severe hypotonia,(prolonged) hinderance of crawling ,standing
,walking
• Clinical significance : provides the infant with primitive sensory and motor
movement patterns of the legs

49. FLEXOR WITHDRAWAL REFLEX (SPINAL CORD )
• Emerges at 28 weeks of GA. Present at birth till 1-2 months.
• Typical Response : stimulated foot dorsiflexes ,toes extend ,knee and
hip flex to withdraw from stimulus. Brisk reaction for a short latent
period.

50. • Atypical response : (absent) brain damage, pni, muscle weakness, breech
delivery ,delayed ll movements (prolonged ) difficulty in standing and walking
,extensor tone hamper
• Clinical significance : Helps perform dorsiflexion of foot and flexion of knee for
clinically testing

51. CROSSED EXTENSION REFLEX
• Emerges at 28 weeks of GA Present at birth till 1-2 months.
• Typical Response : phase one : flexion of knee phase two : adduction
of leg towards midline. phase three : leg extends out,maintains
increase in extensor tone of the leg

52. • Atypical response : (absent) alters development of reciprocal leg movement
(prolonged) reduces weight bearing for balance, crawling ,creeping and walking.
• Clinical significance : Protects infant from noxious stimuli by reinforcing weight
bearing in nonstimulated leg.

53. PALMAR GRASP REFLEX
• Emerges between 23-24 weeks of GA Present since birth till 2-4 months
• Typical Response : birth to 2 weeks : limited response 1 month : catching
and holding phase completes 3-4 months : palmar grasp 4-5 months :
grasp response fractionates and orienting response emerges.

54. • Atypical response : (absent) sci,pni , sensory awareness and grasp of hand is
impaired (prolonged) indicates damage of cerebral cortex ,spastic cp, grasp,
fine movements of hand impaired
• Clinical significance : helps elicit mature fine grasp movements and good
hand grip

55. GLOBAL TRANSITIONAL REACTIONS

56. OPTICAL RIGHTING REACTION – MIDBRAIN LEVEL
REFLEXES
• Occurs from birth - 2 months and persists lifelong.
• Typical response : child’s head will right to vertical from all the
positions (eyes and mouth horizontal, nose vertical from all
positions )

57. • Atypical motor response :Absent: underdeveloped head, trunk, pelvis synergy,
absence of sight Prolonged primitive response: Spastic CP, full development and
dynamic interaction of the righting reaction Asymmetrical: PNS, CNS, MSK
dysfunction
• Clinical significance : maintenance of head in midline and eye body coordination

58. .LANDAU’S REFLEX
• Normal Age span: 2-4 months – 1-2.5 years
• Typical response : child’s head rights ,nose vertical, spine extends,
scapula adducted, forearms pronated and hip slightly extended.

59. • Atypical motor response : Absent: kyphotic posture, volitional pivot prone, erect
sitting, standing Delayed time response: Cerebral insult, sedatives Prolonged
primitive response: Opisthotonos, reaching, weight bearing on arms
Asymmetrical: PNS, CNS, MSK dysfunction
• Clinical significance : prepares the infant on all four limbs for crawling and
prevents smothering while facing downward

60. EQUILIBRIUM REACTIONS : GLOBAL
MATURE MOVEMENT REACTION

61. • EQUILIBRIUM IN SUPINE , PRONE, SITTING AND STANDING: Emergence of
equilibrium responses occurs between 5 months and 21 months of age
• Equilibrium reactions reach full maturity by approximately 4 years of age
and persist for life.

62. Typical Responses : Lateral tilt to the right: spine goes to concavity head rights
to vertical ,limbs on upward side straighten ,abduct
I. Lateral tilt to left: concavity towards right or upward side head rights to
vertical ,limbs upward side straighten ,abduct.
II. Anterior(forward) tilt : concavity of spine posteriorly head rights to vertical
and all four limbs extend and abduct.
III. Posterior (backward) tilt : concavity of spine anteriorly head rights to vertical
and all four limbs extend and abduct.

63. • Atypical responses : (absent) stability impaired ,movement transitions
impaired ,may use protective and supportive responses that interfere with
play ,adl’s. (Impaired responses) inability to complete righting response
(asymmetrical response) indicative of CNS/PNS insult, MSK impairment ,
paresis, hemiplegia

64. REFERENCES
• Soleimani, F. (2006). Infant neurological international battery (infanib): Validity and reliability in
Iran. Neuropediatrics, 37(S 1). https://doi.org/10.1055/s-2006-943607
• harpak, N., de la Hoz, A. M., Villegas, J., & Gil, F. (2016). Discriminant ability of the Infant
Neurological International Battery (INFANIB) as a screening tool for the neurological follow-up of
high-risk infants in Colombia. Acta Paediatrica (Oslo, Norway: 1992), 105(5), e195-9.
https://doi.org/10.1111/apa.13377
• Dunn, W., & Daniels, D. B. (2002). Initial development of the Infant/Toddler Sensory
Profile. Journal of Early Intervention, 25(1), 27–41.
https://doi.org/10.1177/105381510202500104
• Gieysztor EZ, Choińska AM, Paprocka-Borowicz M. Persistence of primitive reflexes and associated motor
problems in healthy preschool children. Arch Med Sci 2018;1:167–73