Primitive Reflexes Flashcards by BIJAY KENT HIRATA

Influenced by the immature central nervous
system

A. Suppression
B. Motor Behavior
C. Maturation
D. Volitional control

B. Motor behavior

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This means maturation

Suppression

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Volitional control is acquired
usually by the
A. 4-5 months
B. 3-4 months
C. 6-8 months
D. 7-10 months

C. 6-8 months

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Earliest markers of
abnormal neurologic maturatio

Obligatory or persistent primitive reflexes

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More sophisticated postural responses emerge between____
months of age that are used and incorporated into volitional motor
behavior

A. 9-10 mos
B. 2-14 mos
C. 3-12 mos
D. 4-7 mos

B. 2-14 mos

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Sophisticated postural responses are incorporated at birth (T/F)

F, not incorporated

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Adaptive responses that develop during the neonatal period and
integrate over time as the brain matures

Primitive Reflexes

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Reflexes are automatic movements that are controlled by the
______

Brainstem

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Primitive reflexes require no conscious thought (cortical involvement) T/F

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Primitive reflexes are present for survival & development in the early months of life T/F

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Automatic reflexes are measured in terms of:

Timing
Strength
Symmetry

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Indicate how the signals are sent from the brain to the spinal cord
and outward to individual muscles of the:

Face
Neck
Torso
Extremities

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Primitive reflexes are NOT involved in postural control and movement T/F

F, involved

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One of the most common tools used by physicians and therapists to assess the integrity of the ______ in infants and children

CNS

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Causes of retained reflexes:

Caesarean section
Trauma
Exposure to toxins
Anesthetics
Medications

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Other possible causes:

Decreased tummy time in infancy,
short period or lack of crawling,
walking early,
chronic ear infections,
head injuries

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Reflexes should be integrated as the child’s motor development mature T/F

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During normal development, these reflexes are slowly inhibited by
the _____ of the brain as the age progresses

frontal lobe

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The motor responses arising from CNS are inhibited by _____
months of age as the brain matures and replaces them with
voluntary motor activities but certain neurological diseases can
relapse

A. 4-6 mos
B. 6-8 mos
C. 8-10 mos
D. 10-12 mos

A. 4-6 mos

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The persistence of these reflexes beyond the usual ages of integration is suggestive of ___

ischemic brain injury

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Cortical Reflex

Equilibrium reactions

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Midbrain Reflex

Kinetic Labyrinthine
Body righting acting on head
Body righting acting on body
Protective extension
Parachute reflex

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Brainstem Reflex

Tonic Neck Reflex - ATNR/STNR

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Spinal Reflex

Flexor withdrawal
Extensor thrust
Palmar grasp
Plantar grasp
Sucking reflex
Rooting reflex
Walking/Stepping reflex

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Classification depending upon purpose

Protective/Flexor reflexes Antigravity/Extensor reflexes

Classification depending upon clinical basis (Superficial Reflex)

Mucus membrane Cutaneous

Classification depending upon clinical basis (Deep Reflex)

Visceral reflexes Pathologic reflexes

Moro/Startle Reflex (Stimulus)

Sudden neck extension

Moro/Startle Reflex (Response)

Arm extension abduction followed by flexion adduction

Moro/Startle Reflex (Age of Suppression) A. 2-5 months B. 3-8 months C. 4-6 months D. 5-7 months

C. 4-6 months

Moro/Startle Reflex (Significance)

Gives an indication of muscle tone

Moro/Startle Reflex (If retained)

Sensitive/overreactive to sensory stimuli Poor impulse control Sensory overload Anxiety and emotions Social immaturity

Moro/Startle Reflex (signs of a retained moro reflex)

Motion sickness Poor balance Poor coordination Easily distracted Unable to adapt well to change Mood swings

Rooting Reflex (Stimulus)

Stroking the corner of the mouth upper or lower lip

Rooting Reflex (Response)

Moving tongue, mouth and head towards stimulus

Rooting Reflex (Age of suppression) A. 1 mo B. 2 mos C. 3 mos D. 4 mos

D. 4 mos

Rooting Reflex (Signs of Retention)

Anterior Tongue Tie Thumb sucking or oral hypersensitivity Poor eating Speech and articulation problem

Rooting Reflex (signs of retained reflex)

Difficulty c solid foods Poor articulation Thumb sucking

Positive supporting reflex (stimuli)

Tactile contact and weight bearing on the sole

Positive supporting reflex (response)

Legs extend for partial support of Body weight

Positive supporting reflex (suppression) A. 4-9 months and replaced by volitional standing B. 3-7 months and replaced by volitional standing C. 10-12 months and replaced by volitional standing D. 2-5 months and replaced by volitional standing

B. 3-7 months and replaced by volitional standing

Positive supporting reflex (significance) - 1

Difficulty placing the heel on the ground for standing Putting the heel down first in walking Normal body weight transference in walking

Positive supporting reflex (significance) - 2

Difficulty getting up from or sitting down in a chair and walking down steps because it is not possible to move the joints in weight-bearing (leg-remains stiff in extension)

Positive supporting reflex (significance) - 3

Rigid leg will be able to carry the patient's body weight (unable to contribute any balance

Asymmetric Tonic Neck Reflex (Stimulus)

Head turning or tilting to the side

Asymmetric Tonic Neck Reflex (Response)

Extremity extend on the chin/face side and flex on the occiput side

Asymmetric Tonic Neck Reflex (Suppression) A. 6-7 mos B. 7-8 mos C. 9-10 mos D. 10-11 mos

A. 6-7 mos

Asymmetric Tonic Neck Reflex (significance)

Assists with early eye hand regard Vestibular stimulation

Asymmetric Tonic Neck Reflex (Persistence)

Impair ability to roll Use hands smoothly together at midline Poor visual regard for object held Poor balance and/or fall when rotates his head

Symmetric Tonic Neck Reflex (Stimulus)

Neck flexion or neck extension

Symmetric Tonic Neck Reflex (Response)

Arms flex Legs extend Arms extend Legs flex

Symmetric Tonic Neck Reflex (Suppression) A. 5-8 months B. 3-5 months C. 6-7 months D. 4-9 months

C. 6-7 months

Symmetric Tonic Neck Reflex (Significance)

Development of (B) patterns of body movement Move up against gravity Assume quadruped Integrates as child begin to crawl

Symmetric Tonic Neck Reflex (if retained)

Interfere c advanced reciprocal creeping Impair dissociation between 2 lower extremities Transition between quadruped to sitting Bunny hop vs true creeping in floor

Palmar grasp (stimulus)

Pressure or touch on the palm; stretch of finger flexors

Palmar grasp (response)

Flexion of fingers/toes

Palmar grasp (suppression) A. 2-3 months B. 3-4 months C. 4-5 months D. 5-6 months

D. 5-6 months

Palmar grasp (significance)

Create basic motor patten that lays foundation for voluntary ability

Palmar grasp (if retained)

Stick tongue out while writing Messy handwriting

Plantar grasp (stimulus)

Pressure on the sole just distal to the metatarsal head

Plantar grasp (response)

flexion of toes

Plantar grasp (suppression) A. plantar 12-18 mos B. plantar 18-24 mos C. plantar 24-36 mos D. plantar 36-48 mos

A. plantar 12-18 mos

Plantar grasp (significance)

Integrates at the same time that independent gait

Plantar grasp (significance) A negative or diminished reflex during early infancy is often a sensitive indicator of RIGIDITY (T/F)

F, SPASTICITY

Automatic walking (stimulus)

Contact of sole in vertical titling the body forward and from side to side

Automatic walking (response)

Alternating automatic steps with support

Automatic walking (suppression) A. 1-2 months B. 3-4 months C. 5-6 months D. 7-8 moths

B. 3-4 months

Automatic walking (Significance)

With daily practice of reflex, infants may walk alone at 10 months

Automatic walking (Significance) Premature infants walk in ______ Mature infants walk in

Toe-heel pattern Heel-toe pattern

Neck RIGHTING or body detortational (stimulus)

Neck rotation in supine

Neck RIGHTING or body detortational (Response)

Sequential body rotation from shoulder to pelvis toward direction of face

Neck RIGHTING or body detortational (emerge at)

4 mos and replaced by volitional rolling

Neck RIGHTING or body detortational (Significance)

Enables child to roll from prone to supine Supine to prone Build muscle tone against gravity

Neck RIGHTING or body detortational (Significance) In neurologic cases e.g. cerebral palsy, righting reflexes are PRESENT T/F

F, absent

Head position in space strongest at 45 degrees from horizontal

Tonic Labyrinthine Reflex

Tonic Labyrinthine Reflex (Stimulus) Supine:______ Prone:____

Predominant extensor tone Predominant flexor tone

Tonic Labyrinthine Reflex (Suppression) A. 4-6 mos B. 6-8 mos C. 8-10 mos D. 11-12 mos

A. 4-6 mos

Tonic Labyrinthine Reflex (Significance)

Learn to do neck and head control Together c STNR, Landu etc help infant develop coordination Proper head alignment and posture

Placing reflex (stimulus)

Tactile contact on dorsum of foot or hand

Placing reflex (Response)

Extremity flexion to put foot or arm over an obstacle

Placing reflex (Suppression) A. Before end of 1st month B. After end of 1st month C. After end of 1st yr D. Before end of 1st yr

D. Before end of 1st yr

Placing reflex (Significance)

Demonstrable in new born Persistent failure to elicit at this stage -> neurologic abnormality

Babinski's reflex (stimulus)

Firm painful stroke along the lateral sole from heel to toe

Babinski's reflex (Response)

Flexion/Extension of big toe and sometimes fanning of other toes

Babinski's reflex (Suppression) - Present at birth suppressed by: A. 8-9 months B. 9-10 months C. 10-11 months D. 11-12 months

B. 9-10 months

Babinski's reflex ( Significance)

Presence of reflex later may indicate diseases

This reflexes are needed for development of some activities

Physiologic Postural Reflex Response

PPRR are present at birth and suppressed as the child developes T/F

F; absent at birth, emerge to be integrated during child development

Types of PPRR

Head righting Body, Head righting Parachute reaction or protective extension Equilibrium/Tilting reaction

Head righting (stimulus)

Visual & vestibular Align face/head vertical mouth horizontal

Head righting (emergence) Prone:______ Supine:_____

2 mos 3-4 mos

Head righting delays or absent in CNS would mean immaturity/damage T/F

Body, head righting (stimulus)

Tactile proprioception vestibular

Body, head righting (Reaction)

Align body parts in anatomic position relative to each other an gravity

Body, head righting (emergence) A. 1-2 mos B. 2-3 mos C. 3-4 mos D. 4-6 mos

D. 4-6 mos

Parachute rxn/protective extension (stimulus)

Displacement if center of gravity outside of supporting surface

Parachute rxn/protective extension (response)

Extension-abduction of the extremity toward side of displacement to prevent falling

Parachute rxn/protective extension (emergence) A. 4-10 mos B. 5-12 mos C. 6-14 mos D. 7-16 mos

B. 5-12 mos

Parachute rxn/protective extension (Significance)

Absent/abnormal in CP pts Asymmetric spastic hemiplegia

Equilibrium or tilting rxn (stimulus)

Displacement of COG

Equilibrium or tilting rxn (response)

Adjustment of tone Posture of trunk to maintain balance

Equilibrium or tilting rxn (emergence) Sitting:____ Standing:_____ 5-7 mos 6-8 mos 10-12 mos 12-14 mos

6-8 mos 12-14 mos

Defines as babies born alive BEFORE 37 weeks of pregnancy are completed

Preterm (premature infant)

Sub-categories of preterm birth (based on gestational age) <28 wks

Extremely preterm

Sub-categories of preterm birth (based on gestational age) 28-32 wks

very preterm

Sub-categories of preterm birth (based on gestational age) 32-37 wks

moderate to late preterm

Risk factors of Premature infant

-Twins/triplets/other multiples -<6 mos between pregnancies -Assisted reproduction (in vitro fertilization) - >1miscarriage/abortion - previous premature birth - preeclampsia (especially this) - prelabor rupture of membrane - medicines - smoking - alcohol - low nutrition

Ideal waiting time between pregnancies A. 16-20 B. 17-22 C. 18-24 D. 19-25 mos

C. 18-24

Determine if PRETERM/TERM (Posture) Relaxed attitude, limbs more extended, body size is small, head appear larger in proportion than body

PRETERM

Determine if PRETERM/TERM (Posture) More subcutaneous fat, rests in a more flexed attitude

TERM

Determine if PRETERM/TERM (SCROTUM/TESTES) Well developed, pendulous, rugated Testes down scrotal sac

TERM

Determine if PRETERM/TERM (SCROTUM/TESTES) Undeveloped, not pendulous, minimal rugae Testes may be in the inguinal canal or in abdominal cavity

PRETERM

Determine if PRETERM/TERM (CLITORIS/LABIA MAJORA) Prominent, labia majora poorly developed and gaping

PRETERM

Determine if PRETERM/TERM (CLITORIS/LABIA MAJORA Fully developed labia majora, clitoris not prominent

TERM

Determine if PRETERM/TERM (SCARF SIGN) Elbow may be brough across chest with little or no resistance

PRETERM

Determine if PRETERM/TERM (SCARF SIGN) Resisting attempt to bring elbow past midline

TERM

Determine if PRETERM/TERM (EARS) Cartilages poorly developed, easily fold

PRETERM

Determine if PRETERM/TERM (EARS) Ear cartilages well formed

TERM

Determine if PRETERM/TERM (HAIR) Firm hair, separate glands

TERM

Determine if PRETERM/TERM (HAIR) Lanugo over back and face

PRETERM

Determine if PRETERM/TERM (RESPIRATORY) Fully developed lungs

TERM

Determine if PRETERM/TERM (RESPIRATORY) Presence of distress, breathing complications

PRETERM

Determine if PRETERM/TERM (BRAIN) By 35th weeks baby’s brain still needs to grow 50%

PRETERM

Determine if PRETERM/TERM (BRAIN) higher brain functioning

TERM

Determine if PRETERM/TERM (BODY FAT) Unable to regulate temperature through body fat until 34th week

PRETERM

Determine if PRETERM/TERM (BODY FAT) Has enough fat and energy to regulate body function

TERM

Determine if PRETERM/TERM (FEEDING) Weak suck/swallowing; not fully developed till 34th weeks

PRETERM

Determine if PRETERM/TERM (FEEDING) Able to suck, swallow leading to rapid weight gain

TERM

COMPLICATIONS OF PREMATURITY (Cardiac) Patent Ductus Arteriosus - if infant is ______wks, 98% it will close by the time of discharge

>30wks

COMPLICATIONS OF PREMATURITY (CNS)

Poor suck Apneic episode - abnormal breathing IV hemorrhage - prone to bleeding Cognitive delays Seizures

COMPLICATIONS OF PREMATURITY (EYES) _______interfere with the normal vascularization process due to abnormal vessel development and sometimes defects in vision such as _____. Myopia and/or ______

Retinopathy of prematurity Blindness Strabismus

COMPLICATIONS OF PREMATURITY (GI tract)

Feeding intolerance increasing risk of aspiration Swallowing/sucking

COMPLICATIONS OF PREMATURITY (Infection)

Sepsis Meningitis 4x likelihood occuring 25% in very low birthweight infants (needs antibiotic)

COMPLICATIONS OF PREMATURITY (Lungs)

Respiratory distress syndrome Chronic lung disease Surfactant production is inadequate to prevent alveolar collapse and atelectasis causing respiratory distress syndrome (RDS) *hindi makabuka so baby will develop repirtory disease syndrome

COMPLICATIONS OF PREMATURITY (Metabolic Problems)

Hypoglycemia, hyperbilirubinemia Kernicterus

COMPLICATIONS OF PREMATURITY (Metabolic Problems) Brain damage cause by hyperbilirubinemia

Kernicterus

COMPLICATIONS OF PREMATURITY (Metabolic Problems) Elevation in bilirubine in the blood d/t immature liver

Hyperbilirubinemia *bilirubin is neurotoxic, if child develops jaundice, they can develop brain damage

COMPLICATIONS OF PREMATURITY (Metabolic Problems) Hyperbilirubinemia causes what type of CP

Athetoid

COMPLICATIONS OF PREMATURITY (Metabolic Problems) Hyperbilirubinemia and kernicterus occurs with serum bilirbin as low as _____

10mg/dL

Primitive Reflexes Flashcards

(139 cards)