Developmental Concepts: Reflexes Flashcards
What are the 5 components of reflexes?
- Time of appropriate/integration if appropriate
- Testing position
- Stimulus
- Normal response (certain ages norm vs. abn)
- Abnormal response
Flexor withdrawal:
What is the testing position?
Supine
Flexor withdrawal:
How do you test it?
Noxious stimuli to the sole of the foot
Squeeze ball to foot with firm pressure
Flexor withdrawal: What is the response?
Uncontrolled FLEXION of the leg, usually with ER, ABDUCTION
Flexor withdrawal: Withdrawal?
What would be a red flag?
Usually see full reflex the first time you stimulate
Red flag if every time stimulus is given, full reflex occurs (obligatory)
Flexor withdrawal: What is abnormal?
Absence, asymmetry, persistence
Flexor withdrawal: Asymmetry represents some sort of _____ is there
damage
Flexor withdrawal: Reflex should be there at _____ weeks
28
Stepping: What ages do you see this?
37 weeks GA to 2 months post
Stepping: How do you test?
Holding child support in upright position
Place weight on feet and tilt child forward
Stimulus in DF position in standing
Stepping: What is the response?
Will see stepping pattern even though baby cannot walk yet
Rhythmical stepping - NOT GRAVITY DEPENDENT
Stepping: What is abnormal?
Absent
Asymmetrical — should be symmetrical in both legs
Persistence
Positive supporting: what is the time frame that you see this reflex?
32 weeks GA to 1-2 months
Positive supporting: How do you test?
Support child upright
Firm contact of feet on surface
Positive supporting: Is adduction abnormal?
YES
Positive supporting: Is flexion at hip and knees abnormal?
No, extension is abnormal
Positive supporting: What is the response?
Co-contraction in LEs, slight flexion of hips and knees
Positive supporting: Where do you have a limitation?
In full extension
Positive supporting: What would be an excessive response?
Leaning back into extension
Positive supporting: what are abnormal responses?
Absent, asymmetrical, EXCESSIVE response
Palmar/plantar grasp: What is the position?
Supine, head midline
or other reflexes play in [ATNR]
Palmar/plantar grasp: How do you test?
Pressure in palm/ball of foot
Palmar/plantar grasp: What is the response?
Flexion of digits, grasp of hand
Palmar/plantar grasp: What would be an abn response?
Indwelling thumb —> thumb tucks into palm, or sticks out through fingers
Thumb (obligatory) flexion = abnormal
Palmar/plantar grasp: What are abnormal responses?
What can we work on?
Asymmetry, absent, persistence
Work on desensitization
Moro: what is the testing position?
Semi recline, supported sit —> PT hands along back, drop hands
Moro: Procedure?
Drop head into 20-30 deg extension —> stimulation of spine into extension
Moro: What is the response?
Abduction and extension of UEs
Then adduction and flexion of UEs
Then crying
Look at shoulder girdle also
Moro: What are abnormal responses:
Absent
Asymmetry
Persistent
Describe what an upper plexus injury (Erbs Plexus) is
1 arm comes out into abduction/extension, the other arm stays in flexion, but hand opens
Describe what a distal plexus injury is
Arm comes out, but hand is closed
Moro: Without _____ _____, Moro will persist
Head control
ATNR: When is this reflex present?
Emerges birth-2 months
Integrated 4-6 months
(Max at 2 months)
ATNR: What is the testing position?
Supine, head in midline
ATNR: What is the procedure?
Head rotation
ATNR: What is the response?
Extension on face side, flexion on skull side
ATNR: Normal development: ________ ATNR, move into it and able to flex arm to bring object to mouth
Attitudinal
Excessive if through out the whole body
ATNR: What are abn response?
Absent, obligatory, persistent
ATNR: At 2 months, should be _____ on both sides
Symmetrical
ATNR: If rolling kids, don’t turn head because ATNR will impact ability to promote rolling so keep head in _____
Midline
STNR: Crawling with symmetrical movements, child will “_____ ____” through quadruped
Bunny hop
STNR: When does the reflex occur?
Emerges at 4-6 months, integrated at 10-12 months
STNR: Position for testing?
Ventral suspension or QP
STNR: Procedure for testing
Raise and lower head in QP
Arms do what heads does, legs are opposite
STNR: If you have head extension, what happens at the arms and legs?
Extension of arms, flexion of legs
STNR: If you have head flexion, what happens at the arms and legs?
Flexion of the arms, extension at the legs
STNR: What are abnormal responses?
Persistence, obligatory
Tonic Labyrinthine: When does this reflex occur?
Birth to 6 months
Tonic Labyrinthine: What is the testing position?
Supine/prone (head midline)
Tonic Labyrinthine: In supine, you have more ____
Extension
Tonic Labyrinthine: What does pistatonic mean?
If head and feet on ground and rest of body is up in supine position (very extended)
Tonic Labyrinthine: In prone, you are more ____
Flexed
Tonic Labyrinthine: In prone position as a fetus, it is abnormal to move into extreme _____
Extension
Tonic Labyrinthine: Position in _____
Space
Tonic Labyrinthine: Extension/flexion (normally only a bias toward the ______
Reponse
Tonic Labyrinthine: What is abnormal ?
Persistence
Excessive response
Tonic Labyrinthine: If strong, what position should you work in?
Sidelying
Tonic Labyrinthine: How do you test in prone? What is your command?
Do an airplane
If sea-saw … abnormal
Tonic Labyrinthine: How do yo test in supine?
Do a sit up
How long can they hold it?
Associated reactions: At what age should the child be able to inhibit the response?
8 years old
Associated reactions: What is the testing position?
Any position
Looking at effortful task for the child
Associated reactions: Effort during activity —> should be able to ______ _____ of it at specific age
Break out
Associated reactions: _____ and _____ contraction of other parts of body
Tonic and sustained
Associated reactions: What is abnormal?
Asymmetric
Absent
Persist/excessive
Neck Righting: What is the testing position?
Supine, arms at side
Neck Righting: How do you test it?
Head rotation to shoulder
Neck Righting: Rolling as one unit (log) - early on, okay… later on should see _______
Separation
Neck Righting: What are abn responses?
Asymmetric, Obligatory, Persistence, Absent
Modification of Primitive Reflexes:
Suppression of primitive reflexes as child gains _______ control
Volitional
Modification of Primitive Reflexes: If ATNR/STNR comes back, need to work in ____
Midline
Modification of Primitive Reflexes: Emergence of ______ responses
Mature
Modification of Primitive Reflexes: In case of neurological damage, we see _______ of primitive reflexes
Reappearance
Labyrinthine/optical righting: When does each occur?
Lab: 32 weeks
Optical: 1-2 months
Labyrinthine/optical righting: _____ ___: tells where body is in space
Inner ear
Labyrinthine/optical righting: Drive from lab system to pick up ____ and look (lab righting) and then reinforce to keep ____ up
Head
Head
Labyrinthine/optical righting: Both persist for _____
Life
Labyrinthine/optical righting: Testing positions
Supine
Prone
Supported upright
Labyrinthine/optical righting: Position of head?
Head vertical, mouth horizontal (oriented to ground)
Labyrinthine/optical righting: Abn response?
Absence
Slow/weak
Placing: Proprioceptive/Tactile and Visual: When do these reflexes show up?
Proprioceptive: 35 weeks GA/birth to 2 months
T and V: 3-4/5 months for life
Placing: Proprioceptive/Tacile and Visual: Reach before _____
Touch
Placing: Proprioceptive/Tacile and Visual: What is the order of how these progress?
P > T > V
Placing: Proprioceptive/Tacile and Visual: What is the testing position?
Supported vertical
Placing: Proprioceptive/Tacile and Visual: How do we test?
Stimulate dorsum or hand/foot
Placing: Proprioceptive/Tacile and Visual: What is the response?
Lifts extremity, places on surface, and weight bears
Placing: Proprioceptive/Tacile and Visual: What are abn responses?
Asymmetric, absent, B/L response (should only occur on stimulated side_)
Protective Extension: Emerging times of:
Forward:
Sideways:
Backward:
Forward: Emerges at 6-7 months
Sideways: Emerges at 7-8 months
Backwards: 9-10 months
Protective Extension: Testing position?
Ventral suspension/sitting/sitting
Protective Extension: Fast movement through space ______ surface
Toward
Protective Extension: ____ and _____ of UEs with Weight bearing
Extension and abduction
Protective Extension: Abn responses?
Asymm
Absent
Staggering: protective extension of ____
LEs
Staggering: When does this reflex emerge?
15-18 months, remains for life
Staggering: Standing, walking at ____ months
12
Staggering: How to test?
Shift weight so center of gravity is displaced off BOS
Staggering: Protective movement of ____ to restore ____
LEs
Balance
Staggering: Use to see ankle ___
DF
Staggering: Abn responses:
Asymm
Absent
Weak
Tilting/Equilibrium Reactions: How do you test?
Tilt thru space (if done quickly, will stimulate protective extension)
Tilting/Equilibrium Reactions: Trunk concavity, extremity _____ on uphill side, protective reaction on _____ side
Abduction
Downhill
Tilting/Equilibrium Reactions: Abn responses
Asymm
Absent
Slow/weak
Tilting/Equilibrium Reactions: If you want to test equilibrium reactions, how do you test?
Slower
Smaller
Tilting/Equilibrium Reactions: If you wanted to test protection, how would you test?
Faster, larger
Emergence of tilting/equil responses: PRONE SUPINE SITTING QP KNEELING STANDING
PRONE: 6 mos SUPINE: 7-8 mos SITTING: 7-8 mos QP: 9-12 mos KNEELING: 15 mos STANDING: 12-21 mos
