Primitive Reflexes

Question 1

Give all 6 primitive reflexes that start at 28 weeks of gestation.

Answer 1

Rooting, Sucking, Moro, Plantar Grasp, Flexor Withdrawal, and Crossed extension

Question 2

Which reflexes begin at birth?

Answer 2

Palmar Grasp, ATNR, Tonic Labyrinthine, and some Associated movements

Question 3

Give the integration time, stimulus, and response for the rooting reaction.

Answer 3

Integration: 2-5 months; 7 months while sleeping
Stimulus: Corner of mouth stroked outwards
Response: Lower lip drops at corner; Tongue moves towards stimulus; head turns toward side of mouth that was stimulated

Question 4

What would be a normal response to the rooting reaction? What is abnormal?

Answer 4

Normal: Assists in finding nipple
Abnormal: prolonged may adversely effect control of oral motor musculature, feeding, & speech

Question 5

What is the integration, stimulus, and response for the sucking reflex?

Answer 5

Integration: 2-5 months
Stimulus: Finger or nipple placed in infants mouth
Response: Rhythmical sucking

Question 6

When looking at the sucking reflex give the normal and abnormal responses.

Answer 6

Normal: Important for feeding and self calming
Abnormal: Absence-> problems with feeding and calming; Persistence-> contributes to oral motor coordination problems with feeding and speech

Question 7

What is the difference in nutritive sucking and non-nutritive sucking?

Answer 7

Nutritive: Draws out milk by creating negative suction in oral cavity
Non: Can perform minutes after birth, complex sequential pattern with definable components, beneficial with self calming.

Question 8

The Moro Reflex is integrated around what time? What stimulates that and what is the response?

Answer 8

Integration: 3-5 months
Stimulus: Child is semi-reclined with head in midline. Support the infants head and shoulders and allow the head to drop back 20-30 degrees. Neck muscles are stretched.
Response: ABD/Ext of arms then ADD/Flex or arms

Question 9

What is the normal response of the Moro reflex trying to accomplish? What would be considered abnormal and why?

Answer 9

Normal is trying to hold on to mommy
Abnormal: Asymmetry may indicate brain injury, peripheral nerve injury, or muscle injury. If this persists it will interfere with normal movement.

Question 10

When does the Palmar Grasp reflex become integrated? What is the stimulus and response?

Answer 10

Integration: 4-9 months
Stimulus: Pressure against plan of hand from ulnar side to middle of palm.
Response: Fingers flex around finger or object

Question 11

Normal response in the palmar grasp is significant why? Why is it bad if the response is abnormal?

Answer 11

Normal: Early experience of active closing of hand
Abnormal: If persists precludes normal hand function

Question 12

After onset at 28 weeks gestation, the plantar grasp is integrated at ____ months. The stimulus for this reflex is ______ and the response is ________.

Answer 12

9-12 months
Pressure against sole of foot behind toes
Flexion of all toes

Question 13

The ATNR is integrated at how many weeks? When is it the strongest?

Answer 13

Integration: 4-6 months

Strongest at 2 months old

Question 14

What stimulus is given to get a response from ATNR?

Answer 14

Stimulus: Rotation of infants head to one side (actively or passively)
Response: Archers pose

Question 15

Why is it important that a baby have a normal ATNR response? Why is it bad if they have an abnormal response?

Answer 15

Normal allows for hand eye coordination and visual regard, disappears when neck righting reaction with rotation appears.

Abnormal: Must be integrated for rolling, hands to mouth or midline, and creeping

Question 16

When does Symmetrical Tonic Neck Reflex (STNR) begin and integrate? What is the stimulus and response? Why is this significant?

Answer 16

Onset: 4-6 months
Integration: 10 ish months
Stimulus: Neck flexion or extension while infant prone or quad
Response: Neck Flexion-UE flex and LE ext
Neck Ext- UE Ext and LE Flex
Significance: Must be integrated to achieve adequate 4 point position for creeping

Question 17

When will the Tonic Labyrinthine Reflex be integrated? What is the stimulus/response?

Answer 17

Integrated: 6 months
Stimulus/Response: Flexor and extensor tone dependent on position changes— Prone= increased flexor tone; Supine= increased extensor tone

Question 18

What is the issue with TLR if it persists?

Answer 18

May cause motor delays- unable to lift head in prone, unable to bring heads to mouth in supine and unable to move against gravity

Question 19

Give the onset, integration, stimulus, and response for Positive Support Reaction.

Answer 19

Onset: 35 weeks gestation
Integration: 1-2 months
Stimulus: Lower child in vertical suspension so feet make flat contact with hard surface (cutaneous and proprioceptive input to ball of foot)
Response: Contraction of flexors and extensors in LE in order to support weight. Should come down on heels not toes!

Question 20

If a child’s positive support reflex looks normal what will you see? What is hindered with the persistence of this reflex?

Answer 20

Normal: Indicator of muscle tone

If persistent then GMS are decreased

Question 21

What is the name of the condition when positive support goes away at 2 months? Is bouncing considered part of the reflex?

Answer 21

Astasia

No bouncing is not part of the reflex!

Question 22

What is the onset, integration, stimulus, and response for automatic stepping?

Answer 22

Onset: 27 weeks
Integration: 2 months
Stimulus: Child supported in vertical suspension with feet touching surface and inclined forward.
Response: Alternating rhythmical reciprocal “walking” with heel strike

Question 23

What is considered normal and abnormal for automatic stepping?

Answer 23

Normal: Represents early use of neural circuits used for locomotion
Abnormal: Prevents functional locomotion with balance and equilibrium reactions

Question 24

Explain what you know about Flexor Withdrawal

Answer 24

Onset: 28 weeks gestation
Integration: 1-2 months
Stimulus: Legs extended with noxious stimulus to sole of foot
Response: Withdrawal of stimulated leg from stim
This is normal for protection, it is abnormal if it decreases norma gait

Question 25

Give all the information we should know for crossed extension.

Answer 25

Onset: 28 weeks gestation
Integration: 1-2 months
Stimulus: One leg held into ext; sole of foot stimulated
Response: Flexion followed by ext and ADD of contralateral leg with toe ABD.
Normal reaction is to push examiner away for protection; abnormal will decrease GMS

Question 26

What information is important for the galant response?

Answer 26

Onset: 32 weeks gestation
Integration: 2 months and may persist
Stimulus: Moving stimulus on skin along paravertebral (shoulders to buttocks)
Response: Incurvatum with hip swing towards stimulus
Most common reflex in babies and is abnormal if scoliosis results due to trouble stabilizing at midline

Question 27

Explain UE Placing reactions.

Answer 27

Onset: Birth
Integration: 2 months
Stimulus: Vertical position, press dorsum of hand against table edge
Response: UE flexes to clear table edge and then extends to WB on hand

Question 28

Explain LE placing reactions

Answer 28

Onset: 35 weeks gestation
Integration: 2 months
Stimulus: Same as UE but push dorsum of foot into table edge
Response: Same as UE but WB on plantar surface of toot

Question 29

Why are both placing reactions important?

Answer 29

Normal: Protective mechanism

Abnormal will decrease GMS

Question 30

What information is important for associated movements?

Answer 30

Onset: Birth- 3 months
Integration: 8-9 years
Stimulus: Instruct child to squeeze rubber squeaky toy for 15 seconds
Response: Observe overflow with other arm

Question 31

Why is it important that associated movements not be abnormal?

Answer 31

Abnormal: tonic increase in muscle activity of opposite extremity could indicate brain damage. Lack of coordination or late persistence could indicate depression of CNS or sensorimotor depression.