05-01b: Developmental Reflexes and Righting Reflexes Flashcards
Purpose of Tests and Measures
- Provide objective data to determine degree of function and/or dysfunction
- Focuses the POC on task-specific (pt goal-oriented) interventions and goals
- Provides objective data that justifies need for PT
Integration
No longer automatic - primitive reflexes are integrated during development
Persistence
Lasting longer than the normally expected time of integration; can cause developmental delay, abnormal movements, and.or structural deformities
Reimergence
Had been integrated, now showing up again; Primitive reflexes can reimgerge after injury to brain
ATNR
- Asymmetrical Tonic Neck Reflex
- Stimulus: Head position turned to one side
- Response: UE/LE on face side extended; UE/LE on scalp/skull side flexed; Spine curved with convexity to face side
- Integration: Birth to 6 months
ATNR Persistence
- Feeding
- Visual tracking
- Midline use of hands
- Bilateral hand use
- Rolling development of crawling
- Can lead to skeletal deformities (scoliosis, hip subluxaton, hip dislocation)
STNR
- Symmetrical Tonic Neck Reflex
- Stimulus: Head positon, flexion or extension, baby is prone
- Response: Head flexed —> UE flexed, LE extended; Head extended —> UE extended, LE flexed
Integration: 6-8 months (onset 4-6 months)
STNR Persistence
- Ability to prop on arms in prone
- Attaining and maintaining hands/knees position
- Crawing reciprocally
- Sitting balance when looking around
- Use of hands when looking at object in hands in sitting
TLR
- Tonic Labyrinthine Reflex
- Stimulus: position of labyrinth in inner ear is reflected in head position
- Response: Supine - Body, extremities held in extension; Prone - Body, extremities held in flexion
Integration: Birth to 6 months
TLR Persistence
- Ability to initiate rolling
- Ability to prop on elbows with extended hips when prone
- Ability to flex trunk and hips to come from sitting to supine
- Often causes full body extension, which interferes with balance in sitting or standing
Galant Reflex
- Stimulus: touch skin along spine from shoulder to hip (almost tickle response)
- Response: Lateral flexion of trunk on sode of stimulus
- Integration: 30 weeks of gestation to 2 months
Galant Persistence
- Development of sitting balance
- Can lead to scoliosis
Palmar Grasp Reflex
- Stimulus: pressure in palm on ulnar side of hand
- Response: flexion of fingers causing strong grip
- Integration: 28 weeks of gestation to 4 months
Palmar Grasp Persistence
- Ability to grasp and release objects voluntarily
- WB on open hand for propping, crawling, protective responses
Plantar Grasp Reflex
- Stimulus: Pressure to base of toes
- Response: Toe flexion
- Integration: 28 weeks gestation to 9 months
Plantar Grasp Persistence
- Ability to stand with feet flat on surface
- Balance reactions and WS in standing
Flexor Withdrawal Reflex
- Stimulus: Noxious (pin-prick) to the sole of the foot. Test in supine
- Response: Toes extend, ankle dorsiflex, LE flexes
- Integration: 28 weeks gestation to 2 months
Rooting Reflex
- Stimulus: Touch on cheek
- Response: Turning of head to same side with mouth open
- Integration: 28 weeks gestation to 3 months
Rooting Reflex Persistence
- Oral-motor development
- Development of midline control head
- Optical righting, visual tracking and social interaction
Moro Reflex
- Stimulus: Head dropping into extension suddenly for a a few inches (about 30˚) and then re-support
- Response: Arms abduct with fingers open, then cross trunk into adduction; Cry
- Integration: 28 weeks of gestation to 5 months
Moro Reflex Persistence
- Balance reactions in sitting
- Protective responses in sitting
- Eye-hand coordination, visual tracking
Startle Reflex
- Stimulus: Loud, sudden noise
- Response: Similar to Moro response, but elbows remain flexed and hands closed
- Integration: 28 weeks of gestation to 5 months
Startle Reflex Persistence
- Sitting balance
- Protective responses in sitting
- Eye-hand coordination, visual tracking
- Social interaction, attention
Positive Support Reflex
- Stimulus: Weight placed on balls of feet when upright
- Response: stiffening of legs and trunk in LE extension
- Integration: 35 weeks of gestation to 2 months
Positive Support Reflex Persistence
- Standing and walking
- Balance reactions and WS in standing
- PF contractures of ankles
Stepping Reflex
- Stimulus: Supported upright position with soles of feet on firm surface
- Response: Reciprocal flexion/extension of legs
- Integration: 38 weeks gestation to 2 months
Stepping Reflex Persistence
- Standing and walking
- Balance reactions and WS in standing
- Development of smooth, coordinated reciprocal movements of LE’s
Equilibrium/balance reactions of postural reflexes
- Highest level of responses that allow humans to function on 2 LEs and use hands to manipulate while standing and moving
- Helps establish normal postural tone which allows for movement against gravity
- Allows muscles to be in a state of “readiness”
Neck Righting (General)
- Stimulus: Child turns head
- Response: Body will realign itself with head
- Functional Implication (FI): Neck is first independent body part to rotate
- Develops trunk control
Neck Righting (Neonatal)
S: Head is turned
R: Body rotates as a whole toward side that is turned; differentiation of body segments developed only between head and trunk (non-segmental except head and trunk - shoulder and pelvis move with trunk)
FI: Prevents suffocation when infants in prone
Onset: 0-10 days
Integration: 4-6 months
Neck Righting (4-6 months)
S: Head is turned
R: Body follows with rotation seen between pelvis and shoulders
FI: Segmented rolling
Onset: 4-6 months
Head Righting (3-5 months)
Head always attempts to align itself to a vertical position to the floor, with mouth horizontal and face vertical - develops sequentially.
- Prone (3 mo), Supine (3 mo), Lateral (5 mo)
Onset: 3-5 months FI: Neck muscles stimulated/developed from neck righting - Prone: Neck extensors stimulated - Supine: Neck flexors stimulated - Lateral: Lateral flexion is developed
Head Righting - Labyrinthine righting
Head rights itself in relation to gravity
FI: Important for development of head control
Head Righting - Optical/Visual righting
Head rights in relation to visual horizontal
- Closing eyes can affect balance
FI: Important for development of head control
Body Righting
When one body part is displaced in relation to the other body parts, child will initiate a series of rotational movements that will realign the body
FI: Rotational movement of body parts facilitates segmented rolling and leads to rotational components needed for moving in and out of position
Onset: 5-6 months
Body-on-Head Righting
- When supporting surface is moved, infant rights head toward the vertical
- If trunk is rotated, head will have a tendency to follow
Body-on-Body Righting
- If pelvis is rotated, shoulders will tend to follow the pelvis
- If shoulders (or upper trunk) are rotated, the pelvis follows
Landau reaction
S: Child suspended in prone, supported under the lower chest (Superman position)
R: Child will right head (facilitated by labyrinthine and optical righting reactions); Symmetrical extension of the spine and hips will follow
FI: Activates total extension (facilitates toward standing); development of spinal and trunk extensors; Ability to sit without support
Onset: 6 months
Integration: 12-24 months
UE Protective Reaction (Forward Protective)
- When child is sitting and body falls forward, child’s shoulders will flex, arms extend and abduct (move away from body) and hands open
- When hands contact surface, UE supports body on hands
- Onset: 6-7 months
UE Protective Reaction (Sideways Support)
- When child is sitting and body falls to side, arm on that side abducts (moves away from body) and extends
- When hands contact surface, UE supports on hands
- Onset: 7-8 months
UE Protective Reaction (Backwards Support)
- When child is sitting and body falls backward, shoulder and arms extend and hands open
- When hands contact surface, UE are supported on hands
- Onset: 9-10 months
UE Protective Reaction (Extension downward)
- When body is suspended head-first toward surface, arms extend and abduct (move away from body) and hands open to contact surface
- FI: protectiion of head
- Onset: 7 months
LE Protective Reaction
- Positive support reactions
- Taking a step if upright
Reflex Scoring (0-4+)
0 = Absent 1+ = Tone change: slight, transient with NO movement of extremities 2+ = Visible movement of extremity 3+ = Exaggerated, full movement of extremities 4+ = Obligatory and sustained movement lasting for more than 30 seconds
Primitive Reflexes: 0 = normal
Age-appropriate: 2+ = normal
- If a developmental reflex is present beyond its normal integration period, it is considered abnormal
- Reflex score of 0 is normal for any reflex not present after its integration period
Balance Reaction
When balance is lost, BR is automatic response to use arms to stabilize body.
