Lecture 5: Primitive Reflexes and Balance Reaction

Question 1

Any of various simple, stereotypic, automatic neuromuscular responses characteristic of the mature fetus and newborn but typically inhibited during the first year of life

Answer 1

Primitive Reflex
* Some start in utero and some don’t
* NOTE: there are some reflexes that don’t intergrate, and some change as we get older (baby babinski different than adult babinski - it flips)

Question 2

When does the rooting reflex begin?
* When does it intergrate?
* Procedure?
* Response
* What reflex does it go with?

Answer 2

28-32 weeks gestation

Intergrates at 3 months

Procedure: gentle stroke infant from cheek to lips

Response: Should turn head towards side stroked

goes with sucking reflex because they typically are looking for food to eat and will suck on it
* and they want to eat milk

Makes sense that it goes away at 3 months because thats when they typically want to start eatting

Question 3

Sucking reflex:
* When does it start?
* Integration
* Procedure
* Response

Answer 3

Onset: 28-32 weeks

Integration: 5 months

Procedure: Place nipple or finger into infants mouth

Response: Rhythmical sucking

Question 4

Many people want to feed babies young because it allows them to sleep through the night when they hit a certain weight (so parents want to feed the babies young). However, why can’t a baby be fed before 5 months?

Answer 4

Because the sucking reflex doesnt go away until 5-6 months –> so they’re just suck on it and spit out the food

Question 5

Palmer Grasp Reflex
* Intergration
* Procedure
* Response

Answer 5

Onset: 28 weeks gestation/birth

Integration: 4-7 months

Procedure: Place finger in infants palm

Response: Infants Finger flex

Question 6

Plantar Grasp
* Onset
* Integration
* Procedure
* Response

Answer 6

Onset: 28 weeks gestation

Integration: 9-15 months

Procedure: Apply firm pressure to plantar surface of foot and toes will curl down

Response: Plantarflexion of all toes (curling of toes)

Question 7

Flexor Withdrawal reflex
* Onset
* Integration
* Procedure
* Response

Answer 7

Onset: 28 weeks gestation

Integration: Persists throughout lifetime
* note its more prominant at the start of life (1-2 months) and goes away some but not entirely throughout lifetime

Procedure: apply stimulus to sole of foot

Response: Withdrawal of foot from stimulus with hip and knee flexion (trying to get foot out of the way)

Question 8

Crossed Extension
* Onset
* Integration
* Procedure
* Response

Answer 8

Onset: 28 wekks gestation/birth

Integration: 1-2 months

Procedure: Hold one leg in extension at knee, apply firm pressure to sole of foot of this leg

Response: Opposite leg will flex, adduct, then extend

nobody understands why body does this

Question 9

Galants response
* Onset
* Integration
* Procedure
* Response

Answer 9

Onset: 28-32 weeks gestation

Integration: 2-3 months

Procedure: gently stimulate along paravertebral area from C7 area to buttocks

Response: laterally flex toward stimulated side (touch down just left of vertebra = left ipsilateral flexion)
* flex to side fingers on

NOTE: you cannot MMT a baby / see all their movement patterns if they’re just lying there. This allows you to look at those movement patterns

Question 10

NOTE: baby needs to be calm and not pissed off thrashing around for many of these reflexes to work

Question 11

What is the main thing you’re looking for w/ all of these reflexes?

Answer 11

Symmetry (needs to also be an appropriate response and not over the top or not dampered)

Question 12

When memorizing focus on the big things and when things change

Question 13

Neck righting on body
* Onset
* Integration
* Procedure
* Response

Answer 13

Onset = 34 weeks gestation

Integration: 4-6 months

Procedure: Turn head to one side

Response: Infants entire body will turn in direction of head to align

If this reflex is really strong parents are going to come in with a 3 week that can roll - this is a problem
* This reflex is just super strong and pulling them over
* Babies shouldnt hav any reflexes that are so strong that you cant override it

Question 14

Body righting on Body
* Onset
* Integration
* Procedure
* response

Answer 14

Onset: 34 weeks gestation

Integration: 4-5 months

Procedure: Flex on limb over chest and rotate limb across body

Response: Infant’s upper body will follow pelvix in a log roll

Basically if you move their leg over than their body will start to follow
* We use this one when teaching babies how to roll
* we just flex their leg and leave it there and their body will follow

Question 15

Positive Support/Primary Standing
* Onset
* Integration
* Procedure
* response

Answer 15

Onset: 35 weeks/birth

Integration: 2 months

Procedure: Lift infant so dorsum of foot contacts support surface

Response: Stimultaneous contraction of flexor and extensor muscles of lower extremities supporting only minimal weight with hips and knees remaining in partial flexion

At about 35 weeks you can put a baby in standing and they will contract their legs and stand. they essentially lock their legs out.
* Cant actually stnad when you let go over them because their weight is to much
* essentually just that dorsum of their foot contacting the ground will cause them to push through their feet (knee extension)
* They’re just pushing through the ground

Question 16

Moro Reflex
* Onset
* Integration
* Procedure
* Response
* difference between this and startle reflex

Answer 16

Onset: 28 weeks gestation emerging-strong by 36 weeks/birth

Integration: 3-5 months (we start sitting by 6 months, so we want this integrated by then)

Procedure: Support head and shoulders with one hand. Allow neck to drop back to allow anterior neck muscle to stretch
* kind of have them halfway between sitting and supine
* Then you let their head drop back so the stress their anterior neck muscle (then arms go out and legs go flex and then they come back up)

Response: Shoulders abduct, elbows, wrists and finers extend. Then shoulder adduct, and elbows and fingers flex
* aka startle reflex

Moro = when head goes back this happens

startle = loud noise happens and they do this (flex back in)

NOTE: I’m still worried AB the symmetry of the motion

NOTE: do this one last because the baby will cry - and let parents know what you’re doing

Question 17

KNOW: Everyone knows how much resting tone you need to hold yourself up. Note, some people have more resting tone than others. If you have low tone your body isnt telling your muscles how much to contract at rest –> these are our kids that are floppy (think down syndrome). Think. gymnists/dancers are more likely to be lower tone = more flexibile. Note, you can make low tone stronger by strength training (putting muscle on low tone). You can also have high tone –> think pts that have had a stroke. It can be in just one area or the entire body.

Question 18

Automatic Stepping
* Onset
* Integration
* Procedure
* response

Answer 18

Onset: 37-38 weeks - because it needs mylein

Integration: 3-4 months - never (its never because when put in the pool = no weight bearing this came back, however, w/ gravity it leaves)

Procedure: Tilt forward and gently move forward with any stepping

Response; Alternating, rhythmical, and coordinated steps

You essentially just support them by holding them unedr their arms, and lean them forward and they start walking (however, they still can’t support their own body weight)
* it is human nature to walk –> if they arent doing this were concerned
* However, babies can still override this if they want to

Question 19

Asymmetrical Tonic Neck reaction-ATNR
* Oneset
* Integration
* Procedure
* response

Answer 19

Onset: 0-3 months (as early as 20 weeks gestatioin)

Integration: 4-5 months - we want this gone before they start rolling

Procedure: gently turn head to one side

Response: Arm and leg on face side extends, arm and leg on skull side flexes

NOTE: This is much like shooting a bow
* Same arm and leg flex

This reflex should never be obligitaory - they should always be able to override it
* if they have a retained reflex (one that does integrate) it starts to mess up function
* Think it will stop you from rolloing / eating (because they can’t reach the foot
* Think riding bike/playing sports and have this retained

NOTE: Once their older and want to see if this reflex has been retained we put them in quadruped and see if their arm bends w/ head movement (just like we did in class)
* NOTE: this is not a problem unless it messes up function

Question 20

Labyrinthine Righting
* Onset
* Integrating
* Procedure
* Response

Answer 20

Onset: Birth - 2 months

Integration: Persists throughout life (never integrates)

Procedure: Tilt anterior, posterior, and latearl from vertical
* Grab baby under arms and tilt side to side and head will come up to vertical (try it)

Response: Head orients to vertical position and is maintained steady

Question 21

Optical Righting
* Onset
* Integration
* Procedure
* Response

Answer 21

Onset: Birth-2 months

Integration: Never integrates

Procedure: Tilt anterior, posterior and latearl from vertical

Response: Head orients to vertical position and is maintained vertically oriented in environment

same as labyrinthine righting except with this one they want their eyes to midline and w/ laby they are using their vesitublar system to do this
* I cant take away vestibular system but i can take away optical system (blind fold). If they can still right without optical system we know that their vestibular system is okay. However, our bodies use both simultaneously.

Question 22

Landau
* Onset
* Integration
* Procedure
* response

Answer 22

Onset: 3 months

Integration: 12 months

Procedure: Assume testing position and wait for response

Response: Head then back and hips will extend with concavity upwards

prone supported in air and head, hips and bottom will come up

Question 23

Symmetrical tonic Neck reaction-STNR
* Oneset
* Integration
* Procedure
* response

Answer 23

Onset: 4-6 months

Integration: 8-12 months

Procedure: Passively flex head forward and then extend it backwards

Response:

Flexion of head/neck:
* Flexion-UE
* Extension-LE

Extension of head/neck
* Extension-UE’s
* Flexion-LE’s

So they’re in quadruped - when you flex their head their arms bend and LE extends
* Think about it like a dog eats food, then bend their arms down to eat their food

So they’re in quadruped - when you extend their head, their UE extend and their LE flex

Question 24

Protective Extension-Forward
* Onset
* Integration
* Procedure
* response

Answer 24

Onset: 6 months

Integration: Persists throughout life

Testing position: Sitting

Procedure: Tilt forward outside base of support (she pushed us)

Response: UE’s should extend and prevent fall

Question 25

Protective Extension Sideways
* Onset
* Integration
* Procedure
* Response

Answer 25

Onset: 8 months

Integration: Persists throughout lifetime

Procedure: Tilt ouside base of support to the side (she pushed us)

Response: UE extends and abducts with open fingers to catch/prevent a fall

Question 26

TEST

6-8-10

You get protective extension for-forward at 6 months

You get protective extension sideways at 8 months

You get protective exntesion backwards at 10 months

Question 27

Protective Extension Backwards
* Onset
* Integration
* Procedure
* Response

Answer 27

Onset: 10 months

Integration: Persists throughout lifespan

Procedure: Tilt backwards otuside BOS (she pushed us)

Response: Extension of UE’s and open hand

Question 28

KNOW: Babies can typically sit on their own around 6 months

Question 29

Babinski
* Onset
* Integration
* Procedure
* response
* how does it change in adults vs kids?

Answer 29

Onset: Birth

Integration: 6 months-2years

Procedure: Blunt instrument rubbed from bottom of foot towards toes on lateral sole of foot

Response: Great toe extension and toe abduction/fanning

In adults vs kids its flipped. In kids (under 2) the toes fan out, when its done in adults the toces come down
* However, if person is super ticklish they can overide this
* On ticklish people they can have a flexor withdrawl reflex (same one if you stepped on a thumb tack)