Reflexes 0-12 Months Flashcards
Principle
REFLEX BEFORE CORTICAL CONTROL
earliest response
matured response
earliest response:
- ATNR
- MORO
matured response:
1. moves limbs, independent of head
Principle
TOTAL BODY MOVEMENT BEFORE ISOLATED MOVEMENT (DISSOCIATION)
earliest response
matured response
earliest: random
UE swiping
prone kicking both legs (random)
matured response: isolated
grasp
prone flexing/extending knee
Principle
PROXIMAL CONTROL BEFORE DISTAL CONTROL
earliest response
matured response
earliest:
- shoulder and hip stability
matured:
- elbow-wrist-hand-knee-ankle
Principle
CEPHALIC BEFORE CAUDAL CONTROL
earliest response
matured response
earliest response:
-shoulders control and stability
matured:
- hip control and stability
Cephalocaudal Direction First Quarter
head control in all positions
Cephalocaudal Direction Second Quarter
arms and upper trunk control (shoulder girdle)
Cephalocaudal Direction Third Quarter
lower trunk and pelvic control (hips)
Cephalocaudal Direction Fourth Quarter
mobility and control of the lower legs and upright postural control (standing)
Cephalocaudal Direction After Fourth Quarter
antigravity control
Principle
MEDIAL CONTROL BEFORE LATERAL CONTROL
earliest response
matured response
earliest:
3 ULNAR fingers dominate first grasp
matured:
thumb and index finger dominate grasp
Principle
EXTENSOR ANTIGRAVITY CONTROL BEFORE FLEXOR ANTIGRAVITY CONTROL
earliest response
matured response
earliest:
lift head in prone at 4 months , antigravity extensor
matured:
lift head in supine at 5 months, antigravity flexor
Principle
WEIGHT BEARING ON FLEXED EXTREMITIES BEFORE EXTENDED EXTREMITIES
earliest response
matured response
earliest:
prone on elbow
matured:
prone on extended arms
Principle
GROSS MOTOR DEVELOPMENT BEFORE FINE MOTOR DEVELOPMENT
earliest response
matured response
earliest:
jump
matured:
handwrite
Grasp Patterns
RAKING
emerges at 6 MONTHS
thumbs against curled index finger
Grasp Patterns
PINCER GRASP
emerges 8-12 MONTHS
pad of thumb and pad of index finger
note: WHICH IS IT??
pad to pad is more refined than tip to tip
pad to pad is nails together?
tip to tip is the palmar aspect of fingers together?
Developing hand preference before 12 months:
developing hand before 12 months indicates motor impairment in the opposite extremity
When does hand preference start?
NOT begin to develop until age 2 years
establish somewhere between 3 and 4
should see swatting, reaching, grabbing with both hands in infants
What reflexes are present at birth?
- Moro
- Suck
- Root
- Palmar
- Plantar
- ATNR
- Babinski
What reflexes are not present at birth but emerge during infancy?
- STNR
- Landau
- Parachute
When does Moro start?
Startle reflex
Start: week 28-32 gestation
well established by week 37
infant is born with this normal reflex
Integrates: 4-5 months diminishes with head control
poor neck stability may retain startle response longer
What does a baby do in Moro reflex?
- Startled look
- wide abduction and extension of UEs, Palms Up, Baby will freeze for a moment in that position:
followed by adduction and flexion of UEs and relocation of limbs
-usually cries
What stimulates Moro reflex?
6
this is done in the hopes of grabbing onto something to prevent a fall
Reflex activated when STARTLED
- loud noise
- change in light
- change in body position
- feeling like falling backwards
- their own cry will startle them
- head suddenly tips backwards. neck hyperextension
startling can wake up a sleeping infant
ELICIT: LOWER HEAD RAPIDLY BELOW THE LEVEL OF THE SPINE
What is the purpose of the Moro reflex?
grab onto something to prevent a fall
When does Moro reflex integrate?
Startle reflex
START: week 28-32 gestation
well established by week 37
infant is born with this normal reflex
INTEGRATES: 4-5 MONTHS, DIMINISHES WITH HEAD CONTROL
Poor neck stability may retain startle longer if persists:
- throws infant off balance in upright positions sitting, standing, walking
- excess extensor tone development
- associated with CP
Why may a moro reflex persist? what happens? (3)
Poor neck stability may retain startle longer if persists:
- Throws infant off balance in upright positions sitting, standing, walking
- EXCESS EXTENSOR TONE DEVELOPMENT
- associated with CP
What does it mean if Moro absent on ONE SIDE? (3)
- fractured clavicle or humerus
- brachial plexus injury
- hemiplegia
What does COMPLETE BILATERAL ABSENCE of Moro mean?
damage to the BRAIN or SPINAL CORD
Elicit Moro relfex
elicit by lowering head rapidly below the level of the spine
Rooting Reflex
what is it?
what is its purpose?
what if it persists?
what if it is absent?
tactile stimulation to cheek head rotates and mouth opens
food finding: prepares baby to suck, helps baby find bottle or breast
persistence can interfere with volitional sucking
absence seen in neuro impaired infants
Purpose of rooting reflex
food finding: prepares baby to suck, helps baby find bottle or breast
When is Rooting absent?
absence seen in neuro impaired infants
What does persistence of rooting cause?
persistence can interfere with volitional sucking
Sucking Reflex
- when does it start
- purpose
- when may it be absent
- how to elicit
- how to test strong suck
- what does sucking action promote
- when does it integrate
- what if it persists
does not begin until 32nd week of gestation
not fully developed until 36 WEEKS
PURPOSE: develop oral musculature
PREMATURE BABIES MAY HAVE A WEAK/ IMMATURE SUCK
ELICIT: stimulate the roof of the mouth
TEST: determine strong suck: if you can remove the bottle easily
PROMOTES: sucking action promotes FLEXION
INTEGRATES: 2-5 months
PERSISTENCE: may inhibit voluntary sucking
Purpose of sucking reflex
develop oral musculature
Persistence of sucking reflex
may inhibit voluntary sucking
When does sucking reflex integrate
2-5 months
How do you determine if an infant has a strong suck?
if you can remove the bottle easily
What action does sucking promote?
FLEXION
PALMAR Grasp Reflex:
when elicited
what is it
what if response is diminished, asymmetric, no response?
when integrated?
ELICITED 28 WEEKS
—response diminished with prematurity
**stimulate palm and fingers flex strongly
CANNOT VOLITIONALLY RELEASE
DIMINISHED: premature
ASYMMETRIC: brachial plexus injury, humeral fracture
NO RESPONSE: severe neurological deficit
INTEGRATED: when voluntary grasp develops (6 months able to grasp voluntarily toy and release it)
PLANTAR Grasp Reflex:
when does it begin
what is it
when does it integrate
BEGINS at 28 weeks gestation
apply firm pressure to the base of the toes and toes flex/curl, toe curling may be seen when standing
INTEGRATES: around the time child walks
(distal fixing: use a distal point and contract to assist proximally, such as an open mouth: put out tongue for new motor skill, walking with hands tightly grasped to support proximally)
BABINSKI
when is it normal/abnormal,
how to stimulate
response
NORMAL: until age 2 yrs
- *disappear as child ages and as the nervous system becomes more myelinated
- -may disappear as early as 12 MONTHS
**sign of UMN LESION after age 2 YEARS ie CP)
STIMULATE: stimulate from heel along lateral edge across ball of foot
RESPONSE: thumb toe DF, toes fan out
Step or walk reflex:
onset
what is it/response
when is integration
ONSET: 37 weeks of gestation
Elicit: support infant upright with feet touching a hard surface. Incline the infant forward and gently move the infant forward to accompany any stepping.
Response: alternating, rhythmical, and coordinated steps. May see walking on toes or scissors.
INTEGRATION: 2 months
ATNR
when is it seen
what is it
what may be indication of atypical development
persistent neck reflexes 12-24 months…
Present 2 weeks until 4 months
Turn head and see posturing: Skull side flexion, face side extension
considerable resistance to moving the infant out of ATNR may be indication of atypical development
–persistent neck reflexes 12-24 months: suggests limited motor control, association with a decreased possibility of independent walking
persistent neck reflexes 12-24 months
ie ATNR
-what it means
-why this is a problem
suggests limited motor control
association with a decreased possibility of independent walking
Neck Righting on the Body
onset
testing position/procedure
response:
integeration
ONSET: 34 weeks of gestation
Testing position: Infant supine, head midline
Procedure: turn infants head to one side
Response: infants entire body turn in the direction of the head
–>Accidental rolling
INTEGRATION: 4-6 months
Body Righting on the Body
Rotate the infants hips and log rolling occurs to realign the body
LANDAU REFLEX
onset
testing position
procedure
response
integration
ONSET: 3-4 months
Testing position: infant prone supported in air by therapist places hands under chest and stomach
Procedure: wait for a reaction
Absent Response: head and hips remain below horizontal absent response
? Response: Extends head above horizontal and extends trunk. Butt and head below the horizontal.
Complete response: Extends head above horizontal then extends trunk and symmetrical raises hips and legs into full extension-complete response
SUPERMAN
INTEGRATION: 12-24 months
**need extension, wont see in low tone baby
STNR
4th -7th month
Flex neck–> arms flex and legs extend
Extend neck–> arms extend and legs flex
online:
ONSET - 4-6 months
INTEGRATION - 8 - 12 months
TESTING POSITION - child in quadruped position on the floor
PROCEDURE - passively flex the head forward and then extend it backwards
RESPONSE forward head flexion will produce flexion of the upper extremities and extension of the lower extremities; extension of the head will produce extension of the upper extremities and flexion of the lower extremities
FUNCTIONAL SIGNIFICANCE - necessary to achieve quadruped crawling
**hemiparesis, head down when walk, need to flex LE to walk, stiff and get hip hiking/circumduction
Parachute
LAST POSTURAL REFLEX TO DEVELOP
Appears ~6/9 months
baby turned face down to mat: arms extend as if baby is trying to catch himself
REMAINS THROUGHOUT LIFE!!!
(before developing this reflex the baby will bring his arms back to plane of body away from mat)
