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Neonatal Reflexes/primary motor patterns and Infant reflexes and reactions
The content of these flashcards were taken from O'Sullivan & Siegelman National Physical Therapy Examination (NPTE) Review and Study Guide version 2009, pages 248-249, and Scott Guiles Scorebuilders pages 110 - 111 version 2009
Babinski Reflex
- 0 - 12 Months
- Stroke lateral aspect of the plantar surface of foot
- RESPONSE: Get extension and fanning of toes
- Stroke lateral aspect of the plantar surface of foot
- RESPONSE: Get extension and fanning of toes
Flexor withdrawal
- 0 - 2 Months
- Sharp, quick pressure stimulus to the sole of the foot or palm of hand
- RESPONSE: Get withdrawal of stimulated extremity
- Sharp, quick pressure stimulus to the sole of the foot or palm of hand
- RESPONSE: Get withdrawal of stimulated extremity
Crossed extension
- 0 - 2 Months
- Sharp, quick pressure stimulus to the sole of the foot
- RESPONSE: Withdrawal of stimulated lower extremity and extension of opposite leg
- Sharp, quick pressure stimulus to the sole of the foot
- RESPONSE: Withdrawal of stimulated lower extremity and extension of opposite leg
Galant or Trunk incurvation reaction
- 0 - 2 Months
- Sharp stroke along paravertebral line from scapula to top of iliac crest
- RESPONSE: Lateral trunk flexion towards the stimulated side
If persists, it will interfere with:
- Development of sitting balance
- Can lead to scoliosis
- Sharp stroke along paravertebral line from scapula to top of iliac crest
- RESPONSE: Lateral trunk flexion towards the stimulated side
If persists, it will interfere with:
- Development of sitting balance
- Can lead to scoliosis
Primary Standing Reaction (Positive support reflex)
- 0 - 2 Months
- Hold infant in supported standing
- RESPONSE: Infant supports some weight and extends LE (Stiffening of legs and trunk into extension)
- If this reflex persits, it will interfere with:
- Walking by causing extension of all joints of the LE and not allowing disassociation of flexion and extension
- Standing
- Balance reactions and weight shifting
- Can lead to contractures of ankles into plantarflexion
- Hold infant in supported standing
- RESPONSE: Infant supports some weight and extends LE (Stiffening of legs and trunk into extension)
- If this reflex persits, it will interfere with:
- Walking by causing extension of all joints of the LE and not allowing disassociation of flexion and extension
- Standing
- Balance reactions and weight shifting
- Can lead to contractures of ankles into plantarflexion
Primary Walking (Stepping) Reflex
- 0 - 2 Months
- Hold infant in supported standing, tilt trunk forward slightly
- RESPONSE: Reciprocal stepping motions in LE ( reciprocal flexion and extension of LE)
- If this reflex persists, it will interfere with:
- standing and walking
- Balance reactions and weight shifting in standing
- Developmental of smooth, coordinated reciprocal movements of LE
- Hold infant in supported standing, tilt trunk forward slightly
- RESPONSE: Reciprocal stepping motions in LE ( reciprocal flexion and extension of LE)
- If this reflex persists, it will interfere with:
- standing and walking
- Balance reactions and weight shifting in standing
- Developmental of smooth, coordinated reciprocal movements of LE
Palmar Grasp Reflex
- 0 - 4 Months
- Pressure stimulus agains the palm
- RESPONSE: Grasping of objects with slow release (flexion of fingers causing a strong grip)
- If this reflex persists, it will interfere with:
- Ability to grasp and release objects voluntarily
- Weight bearing on open hand for propping, crawling, and protective responses
- Pressure stimulus agains the palm
- RESPONSE: Grasping of objects with slow release (flexion of fingers causing a strong grip)
- If this reflex persists, it will interfere with:
- Ability to grasp and release objects voluntarily
- Weight bearing on open hand for propping, crawling, and protective responses
Moro Reflex
- 0 - 4 Months
- Sudden extension of neck (head dropping into extension suddenly for a few inches)
- RESPONSE: Flexion, abduction of shoulders, extension of elbows, and then extension, abduction of shoulders, flexion of elbows. (Arms abduct with fingers open, then cross into adduction), CRY!
- TEST LAST!!
If this reflex persists, it will interfere with:
- Balance reactions in sitting
- Protective reactions in sitting
- Eye-hand coordination, visual tracking
- Sudden extension of neck (head dropping into extension suddenly for a few inches)
- RESPONSE: Flexion, abduction of shoulders, extension of elbows, and then extension, abduction of shoulders, flexion of elbows. (Arms abduct with fingers open, then cross into adduction), CRY!
- TEST LAST!!
If this reflex persists, it will interfere with:
- Balance reactions in sitting
- Protective reactions in sitting
- Eye-hand coordination, visual tracking
Asymmetrical Tonic Neck Reflex ( ATNR)
- 0 - 5 or 6 Months
- Rotation of the head
- RESPONSE: Extension of face side extremities
Flexion of skull side extremities
Spine curved with convexity towards face side
If this reflex persists, it will interfere with:
- grasping and hand to mouth activities (feeding)
- visual tracking
- midline use of hands, and bilteral use of hands
- rolling
- development of crawling
-may result also in: scoliosis, hip subluxation and dislocation
- Rotation of the head
- RESPONSE: Extension of face side extremities
Flexion of skull side extremities
Spine curved with convexity towards face side
If this reflex persists, it will interfere with:
- grasping and hand to mouth activities (feeding)
- visual tracking
- midline use of hands, and bilteral use of hands
- rolling
- development of crawling
-may result also in: scoliosis, hip subluxation and dislocation
Rooting
- 0 - 3 Months
- Touch on the cheek (perioral region)
- RESPONSE: Head turns to that side with mouth opening
-important feeding reflex
If persists, it will interfere with:
- Oral motor development
- Development of midline control of head
- Optical-righting, visual tracking, social interaction
- Touch on the cheek (perioral region)
- RESPONSE: Head turns to that side with mouth opening
-important feeding reflex
If persists, it will interfere with:
- Oral motor development
- Development of midline control of head
- Optical-righting, visual tracking, social interaction
Tonic Labyrinthine Reflex ( TLR)
- 0 - 6 months
- Prone position = Maximal flexor tone ( UE + LE held in flexion)
- Supine position = Maximal Extensor tone ( UE + LE held in extension)
If persists, it will interfere with :
- Ability to initiate rolling
- Ability to prop on elbows with extended hips when prone
- Ability to flex trunk and hips to come to a sitting position from supine
- Often causes full body extension, which interferes with balance in sitting or standing.
- Prone position = Maximal flexor tone ( UE + LE held in flexion)
- Supine position = Maximal Extensor tone ( UE + LE held in extension)
If persists, it will interfere with :
- Ability to initiate rolling
- Ability to prop on elbows with extended hips when prone
- Ability to flex trunk and hips to come to a sitting position from supine
- Often causes full body extension, which interferes with balance in sitting or standing.
Neonatal Neck righting (NOB = Neck righting on Body)
- 0 - 6 Months
- Turn head when infant is in supine
- RESPONSE: Body log rolls towards the same side
- Turn head when infant is in supine
- RESPONSE: Body log rolls towards the same side
Startle Reflex
- 0 - 6 Months
- Loud, sudden noise, sudden light or cold stimulus
- RESPONSE: causes a sudden jerking of whole body or extension and abduction of UE, followed by adduction of the shoulders
If persists, it will interfere with:
- Sitting balance
- Protective responses in sitting
- Eye-hand coordination, visual tracking
- Social interaction, attention
- Loud, sudden noise, sudden light or cold stimulus
- RESPONSE: causes a sudden jerking of whole body or extension and abduction of UE, followed by adduction of the shoulders
If persists, it will interfere with:
- Sitting balance
- Protective responses in sitting
- Eye-hand coordination, visual tracking
- Social interaction, attention
Placing reactions
- 0 - 6 Months
- Drag dorsum of foot or back of hand against edge of table
- REPSONSE: Get placing of foot or hand unto table top
- Drag dorsum of foot or back of hand against edge of table
- REPSONSE: Get placing of foot or hand unto table top
Plantar Grasp Reflex
- 0 - 9 Months
- Pressure stimulus to sole or Lowering of feet to floor
- RESPONSE: curling or toes (Toe flexion)
If persists, it will interfere with:
- Ability to stand with feet flat on surface
- Balance reaction and weight shifting in standing
- MUST BE integrated BEFORE walking occurs
- Pressure stimulus to sole or Lowering of feet to floor
- RESPONSE: curling or toes (Toe flexion)
If persists, it will interfere with:
- Ability to stand with feet flat on surface
- Balance reaction and weight shifting in standing
- MUST BE integrated BEFORE walking occurs
Symmetrical Tonic Neck Reflex (STNR)
- 6 - 8 Months
- Extension of cervical joints (Head in Extension) = UE extension and LE flexion
- Flexion of cervical joints (Head in flexion) = UE flexion and LE Extension
If reflex persists, it will interfere with:
- Ability to prop on arms in prone position
- Attaining and maintaning hands-and-knees position
- Crawling reciprocally
- Sitting balance when looking around
- Use of hands when looking at the object in hands in sitting position
- Development of stable quadruped position and creeping
- Extension of cervical joints (Head in Extension) = UE extension and LE flexion
- Flexion of cervical joints (Head in flexion) = UE flexion and LE Extension
If reflex persists, it will interfere with:
- Ability to prop on arms in prone position
- Attaining and maintaning hands-and-knees position
- Crawling reciprocally
- Sitting balance when looking around
- Use of hands when looking at the object in hands in sitting position
- Development of stable quadruped position and creeping
Landau's Reaction
- 4 - 18 Months
- If infant is held in ventral suspension (prone suspension)
- RESPONSE: Extension of neck, trunk, and hips
- If infant is held in ventral suspension (prone suspension)
- RESPONSE: Extension of neck, trunk, and hips
Protective Extension
- Quick displacement of trunk in a downward direction while held or while sitting in a forward, sideward or backward direction. (persists through life)
- RESPONSE: Extension of legs in downward and extension of arm in the sitting position to catch weight
- Downward begins at 4 months
- Sideward begins at 6 months
- Forward begins at 7 months
- Backward sitting at 9 months
- RESPONSE: Extension of legs in downward and extension of arm in the sitting position to catch weight
- Downward begins at 4 months
- Sideward begins at 6 months
- Forward begins at 7 months
- Backward sitting at 9 months
Tilting Reactions
- Slow shifting of BOS or slow displacement of body in space - RESPONSE: Lateral flexion of spine toward elevated side of support, Abduction of extremities on elevated side, and sometimes trunk rotation. (persist throughtout life)
- Prone tilting reaction begins at 5 months
- Supine tilting reaction begins at 7 months
- Sitting tilting reaction begins at 8 months
- Quadruped tilting reaction begins at 12 months
- Prone tilting reaction begins at 5 months
- Supine tilting reaction begins at 7 months
- Sitting tilting reaction begins at 8 months
- Quadruped tilting reaction begins at 12 months
Traction or Pull to sit
- pull infant to sit from supine
- RESPONSE: UE will flex and there will be a head lag until about 4 - 5 months
- RESPONSE: UE will flex and there will be a head lag until about 4 - 5 months