Reflexes Flashcards
(27 cards)
Rooting Reflex
Onset: 28 weeks gestation
Integration: 3 months
Test Position: infant in supine position with head in midline
Stimulus: stroke finger outward at corner of mouth or on lips or on cheek
Response: infant turns head towards stimulus and opens mouth
Purpose: obtain nourishment – allows infant to search for breast or bottle in direction of stimulus
If reflex persists: interferes with normal sucking
If reflex is absent: sensorimotor dysfunction in inability to find object for sucking
Level: Level One – Spinal Cord
Sucking Reflex
Onset: 28 week gestation
Integration: 2-5 months
Test Position: infant in supine with head in midline
Stimulus: stimulate lips or place finger or nipple in infant’s mouth
Response: close mouth, sucking movements followed by swallowing
Purpose: obtain nourishment; develop tongue movement and later produce sound
If reflex persists: inhibits development of volitional sucking and normal tongue movements and later patterns of producing sound
If reflex is absent: sensorimotor dysfunction results in decreased nourishment
Level: Level One – Spinal Cord
Plantar or Proprioceptive Placing of Legs
Onset: 35 weeks gestation
Integration: 2 months
Test Position: infant is held in upright positions and is supported under arms and around chest; also support head of young infant
Stimulus: press dorsum (back) of foot against edge of table
Response: hip and knee flexion, ankle dorsiflexion followed by extension of hip and knee and placing of foot squarely on table
Purpose: primitive form of walking which allows stepping over of objects
If reflex persists: delayed development of skills that precede standing and walking
If reflex is absent: sensorimotor dysfunction
Level: Level One – Spinal Cord
Additional
Spontaneous Stepping Reflex/Primary Walking/Reflex Stepping
Onset: 37 weeks gestation
Integration: 2-3 months
Test Position: infant is held in vertical upright position with support under arms and around chest
Stimulus: allowing infant’s feet to touch table, lean infant forward slightly and gently move infant forward
Response: alternate stepping movements with both legs with a rhythmic heel-toe pattern
Purpose: prerequisite for walking
If reflex persists: athetosis may be indicated if there is a stronger stepping reflex than positive supporting reflex
If reflex is absent: spasticity may be indicated if there is a stronger positive supporting reflex than stepping reflex
Level: Level One - Spinal Cord
Palmar Grasp Reflex
Onset: Birth
Integration: 3-6 months
Test Position: sitting
Stimulus: pressure in palm of hand with your finger or toy or dowel
Response: flexing of fingers or grasping of object
Purpose: precursor to coordinated voluntary grasp
If reflex persists: may be interference with hand reflex or hand development
If reflex is absent: watch for muscle weakness or nerve injury
Level: Level One – Spinal Cord
Plantar Grasp Reflex
Onset: 28 weeks gestation
Integration: 9 months
Test Position: supine with head in midline or infant is held upright at trunk
Stimulus: if supine: press thumb into ball of infant’s foot
if upright: apply pressure to foot from table or floor
Response: flexion of toes of foot stimulated- grasps with toes
Purpose: probably precedes balance in standing position
If reflex persists: difficulty with standing and walking alone because of unstable base of support; may evoke toe walking
If reflex is absent: sensorimotor dysfunction
Level: Level One- Spinal Cord
Moro Reflex/ Startle Reflex
Onset: 28 weeks gestation
Integration: 5-6 months
Test Position: infant in supine with head in midline and arms on chest or infant in semi-reclining position
Stimulus: dropping head backward from a semi-reclined position- cradle child in a semi-reclined position, support child’s head with your hand, keeping hand and forearm under the child’s head and trunk drop child’s body downward and backward
Response: extension and abduction of arms and opening of hands, crying, followed by flexion and adduction of upper extremities across chest
Purpose: to break flexion patterns present at birth
If reflex persists: affects development of head control, sitting and extension patterns
If reflex is absent: sensorimotor dysfunction resulting in inability to break flexor patterns
Level: Level One- Spinal Cord/Brain Stem Level Two
Galant Reflex
Onset: 32 weeks gestation
Integration: 2 months
Test Position: infant in prone
Stimulus: run fingernail along a line parallel to spine and about 3 cm lateral to spine from 12th rib to iliac crest
Response: curving of trunk toward stimulated side with production of skin folds, incurvature of spine to same side
Purpose: precursor to symmetrical sitting; promotes sitting
If reflex persists: delay in the development of symmetrical trunk stabilization and head movements necessary for sitting and standing independently, may lead to scoliosis
If reflex is absent: CNS inadequacy, sensorimotor dysfunction related to sitting skills
Level: Level One- Spinal Cord
Flexor Withdrawal
Onset: 28 weeks gestation
Integration: 1-2 months
Test Position: supine with head in midline; legs extended
Stimulus: touch sole of foot with irritating stimulus
Response: stimulated leg flexes/withdraws from stimulus-flexion at knee, hip, dorsiflexion of ankle, extension of toes
Purpose: protect against noxious stimulus to sole of the foot
If reflex persists: prevents standing and weightbearing
If reflex is absent: inadequacy of CNS or injury to peripheral nerves or muscle weakness
Level: Level 1-Spinal Cord
Crossed Extension Reflex
Onset: 28 weeks gestation
Integration: 1-2 months
Test Position: supine with head in midline; one leg extended, the other flexed
Stimulus: passively flex extended leg
Response: extension of opposite leg with internal rotation and adduction
Purpose: protective response to noxious stimulus to foot; prepares for reciprocal use of lower extremities-later in life helps maintain balance on 1 leg with use of positive supporting reaction
If reflex persists: possible interference with walking
If reflex is absent: sensorimotor dysfunction
Level: Level 1-spinal cord
Assymetric Tonic Neck Reflex (ATNR)
Onset: Birth-2 months
Integration: 4-6 months
Test Position: supine with head in midline and arms and legs extended
Stimulus: child turns head actively or gently turn child’s head to one side; (noise)
Response: “bow and arrow” or “fencing” position of upper extremities; extension of UEs and LEs on face side; flexion of limbs on skull side
Purpose: enhances eye-hand awareness and the development of coordinated body rolling movement
If reflex persists: asymmetrical posture; impairment of development of bilateral coordination
If reflex is absent: sensorimotor dysfunction
Level: Brainstem/Level 2
Symmetric Tonic Neck Reflex
Onset: 4-6 months
Integration: 10-12 months
Test Position: place child on all fours in a crawling position or hold child over lap
(the puppy dog)
Stimulus: hand will be placed on forehead and gently lift
Response: she/he should sit
Purpose: promotes kneeling position
If reflex persists: difficulty with sitting, standing
If reflex is absent: nerve injury or muscle weakness
Level: Level 2—Brainstem
Tonic Labyrinthine Reflex
Onset: Birth
Integration: 6 months
Test Position: prone (stomach) position with head in midline
Stimulus: 1. Place infant in prone position with head in midline – test position is the stimulus 2. Place infant in supine (back) position with head in midline – test position is the stimulus
Response: 1. Greater flexor tone of neck, UEs and LEs 2. Greater extensor of neck, UEs and LEs
Purpose: ability to gain head control and rolling skills
If reflex persists: inability to right head and inability to attain rolling skills
If reflex is absent: nerve injury or muscle weakness
Level: Level 2/Brainstem
Neonatal Positive Support (Primary Standing)
Onset: 35 weeks gestation
Integration: 2 months
Test Position: child is held upright with support under arms
Stimulus: soles of feet are firmly placed on the table top or floor
Response: hips and knees flex and assume partial weight bearing
Purpose: allows partial weight bearing
If reflex persists: delay in development of spontaneous stepping reflex
If reflex is absent: sensorimotor dysfunction
Level: Level 2/Brainstem
Additional—Astasia: 2-7 months of age; period of no weight bearing
Positive Supporting Reaction
Onset: 7 months
Integration: 6 years
Test Position: child is held upright with trunk supported under arms
Stimulus: soles of feet are firmly placed on table top or floor
Response: child will bear full body weight with knees, hips and trunk extended
Purpose: necessary for standing and walking
If reflex persists: delay in development of standing and walking
If reflex is absent: sensorimotor dysfunction
Level: Level 2/Brainstem
Associated Reactions
Onset: Birth-3months
Integration: 8-9 years
Test Position: child under 4: squeeze toy for 15 seconds; older child: have child touch thumb to finger tips or pronate/supinate arm rapidly
Stimulus:
Response: observe overflow of movements to opposite extremity
Purpose: inducement of muscle contraction in opposite extremity
If reflex persists: poor coordination; increased muscle activity of opposite extremity may indicate brain damage
If reflex is absent: muscle weakness; nerve injury
Level: Level 2/Brainstem
Neck Righting
Onset: Birth
Integration: 6 months
Test Position: infant in supine with arms and legs extended
Stimulus: passively rotate the child’s head fully to one side
Response: body rotates as a whole in the direction to which the head was turned
Purpose: allows rolling from supine to prone position
If reflex persists: would be hard to learn other gross motor skills
If reflex is absent: inability to execute rotational patterns of rolling, sitting, or standing
Level: Level III, Midbrain
Body Righting
Onset: 4-6 months
Integration: 5 years
Test Position: supine or prone with arms and legs extended
Stimulus: while in supine, flex one knee toward the chest and across the body; while in prone, place a hand under the hips and gently pull backward
Response: segmental roll of hips followed by the shoulders
Purpose: to promote rolling
If reflex persists: would be constantly rolling and have problems sitting and walking
If reflex is absent: inability to control head and to learn to roll, sit and walk
Level: Level III, Midbrain
Labrynthine Righting (head righting) - Automatic movement reflex
Onset: 2 months
Integration: all through life
Test Position: prone, supine or vertical position in space, with eye occluded (can be blindfolded)
Stimulus: tilt body laterally
Response: head will seek a vertical position in space
Purpose: needed for head control
If reflex persists: it lasts throughout life…it should persist
If reflex is absent: central nervous system damage
Level: Level III, Midbrain
Landau Reflex
Onset: 3-4 months
Integration: 12-24 months
Test Position: prone, with child supported under the trunk between thorax and stomach
Stimulus: suspend the child horizontally
Response: extension of the neck, spine, hips, shoulders: retraction of the scapula
Purpose: assist extension of neck when prone and breaks the flexor posture that is present at birth; promotes ability to support upper body on forearms and hands to prepare for standing
If reflex persists: exaggerated reaction may indicate spasticity or increased muscle tone.
If reflex is absent: motor reflex or CNS damage
Level: Level III, Midbrain
Protective Extensor Thrust (parachute reactions) – Automatic Movement Reflex
Onset: 6 months
Integration: throughout life
Test Position:
1. Downward parachute-child held upright with trunk supported under arms
2. Sideways parachute- child sitting, held firmly at the waist
3. Forwards parachute- sitting or upright kneeling
4. Backward parachute- sitting with legs extended to front or in a tailor position
Stimulus:
1. Lower to flat surface quickly so he/she feels they are falling
2. Quickly but firmly tip the child to the side
3. Lower head first while supported at trunk
4. Displace center of gravity backward with a sharp push
Response:
1. Extension and abduction of hips, extension of knees, abduction of hips
2. Child extends arm to catch his balance
3. Child extends both hands to catch himself
4. Hyperextension of both shoulders and extension of elbows
Purpose: Protect against falling vertically, sideways, backward or forward.
If reflex persists: It should unless absent
If reflex is absent: Inability to protect against falling; CNS damage
Level: Level III, Midbrain
Optic Righting
Onset: Birth-2 months
Integration: throughout life
Test Position: child is held upright with trunk supported under arms, eyes open
Stimulus: tilt body laterally 45 degrees or more so that the head drops
Response: head orients to a vertical position and is steady
Purpose: keeping head upright in relation to space
If reflex persists: Should persist
If reflex is absent: unable to maintain head upright in space
Level: Level 4, Cortex Level
Prone-lying (prone tilting reactions)
Onset: 6 months
Integration: throughout life
Test Position: place child on stomach on a large ball, pillow, or tilt board
Stimulus: slowly tilt surface from side to side
Response: child tries to compensate by curving his spine so that the concave side of curve is toward the upwardly tilted surface
Purpose: maintain balance when base of support is unstable
If reflex persists: Should persist
If reflex is absent: poor balance on uneven surfaces; difficulty performing voluntary gross body movements
Level: Level 4, Cortex Level
Supine-lying (supine tilting reaction)
Onset: 7-8 months
Integration: throughout life
Test Position: child is places on his/her back on a large ball, pillow, or tilt board
Stimulus: slowly tilt surface from side to side
Response: lateral curvature of the spine so that concave side of curve is toward the upward tilted surface
Purpose: maintain balance on uneven surfaces
If reflex persists: Should persist
If reflex is absent: poor balance on uneven surface
Level: Level 4, Cortex
