Lecture 5: Primitive Reflexes and Balance Reaction Flashcards
Any of various simple, stereotypic, automatic neuromuscular responses characteristic of the mature fetus and newborn but typically inhibited during the first year of life
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)
When does the rooting reflex begin?
* When does it intergrate?
* Procedure?
* Response
* What reflex does it go with?
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
Sucking reflex:
* When does it start?
* Integration
* Procedure
* Response
Onset: 28-32 weeks
Integration: 5 months
Procedure: Place nipple or finger into infants mouth
Response: Rhythmical sucking
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?
Because the sucking reflex doesnt go away until 5-6 months –> so they’re just suck on it and spit out the food
Palmer Grasp Reflex
* Intergration
* Procedure
* Response
Onset: 28 weeks gestation/birth
Integration: 4-7 months
Procedure: Place finger in infants palm
Response: Infants Finger flex
Plantar Grasp
* Onset
* Integration
* Procedure
* Response
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)
Flexor Withdrawal reflex
* Onset
* Integration
* Procedure
* Response
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)
Crossed Extension
* Onset
* Integration
* Procedure
* Response
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
Galants response
* Onset
* Integration
* Procedure
* Response
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
NOTE: baby needs to be calm and not pissed off thrashing around for many of these reflexes to work
What is the main thing you’re looking for w/ all of these reflexes?
Symmetry (needs to also be an appropriate response and not over the top or not dampered)
When memorizing focus on the big things and when things change
Neck righting on body
* Onset
* Integration
* Procedure
* Response
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
Body righting on Body
* Onset
* Integration
* Procedure
* response
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
Positive Support/Primary Standing
* Onset
* Integration
* Procedure
* response
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
Moro Reflex
* Onset
* Integration
* Procedure
* Response
* difference between this and startle reflex
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
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.
Automatic Stepping
* Onset
* Integration
* Procedure
* response
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
Asymmetrical Tonic Neck reaction-ATNR
* Oneset
* Integration
* Procedure
* response
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
Labyrinthine Righting
* Onset
* Integrating
* Procedure
* Response
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
Optical Righting
* Onset
* Integration
* Procedure
* Response
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.
Landau
* Onset
* Integration
* Procedure
* response
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
Symmetrical tonic Neck reaction-STNR
* Oneset
* Integration
* Procedure
* response
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
Protective Extension-Forward
* Onset
* Integration
* Procedure
* response
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
Protective Extension Sideways
* Onset
* Integration
* Procedure
* Response
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
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
Protective Extension Backwards
* Onset
* Integration
* Procedure
* Response
Onset: 10 months
Integration: Persists throughout lifespan
Procedure: Tilt backwards otuside BOS (she pushed us)
Response: Extension of UE’s and open hand
KNOW: Babies can typically sit on their own around 6 months
Babinski
* Onset
* Integration
* Procedure
* response
* how does it change in adults vs kids?
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)
