Reflexes

Question 1

Moro Reflex (Newborn Reflexes)

Answer 1

• *Onset:** 28 weeks gestation
• *Int. Period:** 5-6 months
• *Position:** Place child supine with head in the midline, arms on chest.
• *Procedure:** Support infant’s head and shoulders with hand, allow head to drop back 20 – 30o with respect to trunk, stretching neck muscles
• *Response:** Abduction of the upper extremities with extension of the elbows, wrists, and fingers, followed by subsequent adduction of the arms at the shoulders and flexion at the elbows, and cry.
• *Lack of Integration:** Interferes with head control, sitting equilibrium, and protective reactions
• *If not:** Can interfere with ADLs such as eating, bathing. Play such as sitting and playing with a toy or using playground equipment. Education such as sitting at a desk and completing work

Question 2

Landau Reflex (Newborn Reflexes)

Answer 2

(superman)

• *Onset:** 3-4 months
• *Int. Period:** 12-24 months
• *Position:** Examiner supports infant horizontally in the air in prone position with one hand under the lower part of the thorax.
• *Procedure:** Position in space.
• *Response:** Head extends, back arched with slight concavity upward, and hips partially extend in sequence.
• *Lack of Integration:** Slows development of prone extension, sitting, and standing
• *If not:** Impacts ADLs such as dressing, grooming, hygiene, functional mobility. Play, education.

Question 3

Plantar Grasp (Newborn Reflexes)

Answer 3

• *Onset:** 28 weeks gestation
• *Int. Period:** 9 months
• *Position:** Place infant supine with head in midline and legs relaxed or infant in a standing position
• *Procedure:** Firm pressure against ball of infant’s foot, directly below toes.
• *Response:** Plantar flexion of all toes.
• *Lack of Integration:** Could result in toe clawing, gait, standing, could have walking problems like walking on toes
• *If not:** Can interfere with functional mobility. Interferes ADLs while standing, Education transitioning from classroom to classroom, Play such as in the playground, Social Participation

Question 4

Palmar Reflex (Newborn Reflexes)

Answer 4

• *Onset:** 37 weeks gestation
• *Int. Period:** 4-6 months
• *Position:** Sitting/Laying supine
• *Procedure:** Place fingers in babys palm
• *Response:** Finger flexion
• *Lack of Integration:** Keep their hands in extension
• *If not:** Different with grasp development (or delays)

Question 5

Spontaneous Stepping (Newborn Reflexes)

Answer 5

(Walking)

• *Onset:** 37 weeks gestation
• *Int. Period:** 2 months
• *Position:** Support infant in the vertical position with examiner’s hand under the arms and around the chest.
• *Procedure:** Support infant upright, feet touching the table surface. Incline the infant forward and gently move the infant forward to accomplish any stepping
• *Response:** Infant will make alternating, rhythmical and coordinated stepping movement.
• *Lack of Integration:** Could result in gait, standing, and walking problems
• *If not:** Can interfere with functional mobility. Interferes ADLs while standing, Education transitioning from classroom to classroom, Play such as in the playground, Social Participation

Question 6

Traction (Newborn Reflexes)

Answer 6

(pull to sit)

• *Onset:** 28 weeks gestation
• *Int. Period:** 2-5 months
• *Position:** Supine
• *Procedure:** Grasp infants forearms and pull to sit
• *Response:** Complete flexion of the upper extremity
• *Lack of Integration:** Head remains tilted back
• *If not:** Inability to dissociate activation of individual joints/movement of UE (or delays)

Question 7

Suck/Swallowing Reflex

Answer 7

• *Onset:** 28 weeks gestation
• *Int. Period:** 2-5 months
• *Position:** Sitting up
• *Procedure:** Finger in mouth
• *Response:** Strong, rhythmical sucking
• *Lack of Integration:**
• *If not:** Difficulty with feeding/eating

Question 8

Rooting

Answer 8

• *Onset:** 28 weeks gestation
• *Int. Period:** 3 months
• *Position:** Varied Positions
• *Procedure:** Stroke corner of mouth
• *Response:** Movement of tongue, mouth, and head toward sim
• *Lack of Integration:**
• *If not:** Inability to habituate or ignore stimulations, involuntary movement with any stimulation

Question 9

Assymetrical Tonic Neck Reflex (ATNR)

Answer 9

• *Onset:** 37 weeks gestation
• *Int. Period:** 4-6 months
• *Position:** Place infant supine with head in midline.
• *Procedure:** Passively turn the head slowly to one side and hold in the extreme position with jaw over the shoulder. Infant may turn head actively. OR have infant follow an object from one side to the other side.
• *Response:** Arm and leg on jaw side, extend. Arm and leg on skull side flex.
• *Lack of Integration:** Interferes with reaching and grasping. Bilateral hand use, and rolling
• *If not:** Can interfere with ADLs such as eating, bed mobility, dressing. Play such toys that require bilateral coordination, playing on the playground. Education such as completing work, transitioning into other settings such as the PE and the cafeteria.

Question 10

Symmetrical Tonic Neck Reflex (STNR)

Answer 10

• *Onset:** 4-6 months
• *Int. Period:** 8-12 months
• *Position:** Suspend child in ventral position or over the examiner’s knee.
• *Procedure:** Examiner passively first extends then flexes the child’s head.
• *Response:** Flexion of the head produces flexion of the upper extremities, extension of the lower extremities. Extension of the head produces extension of the upper extremities and flexion of the lower extremities.
• *Lack of Integration:** Interferes with reciprocal crawling (child “bunny hops”). Moves arms and then legs, and walking
• *If not:** Can interfere with ADLs such as eating, bed mobility, dressing. Play such toys that require bilateral coordination, playing on the playground. Education such as completing work, transitioning into other settings such as the PE and the cafeteria.

Question 11

Tonic Labyrinthine Reflex (TLR)

Answer 11

• *Onset:** >37 weeks
• *Int. Period:** 6 months
• *Position:** Supine – place infant in supine, head in midline.
• *Procedure:** a. Note overall muscle tone when infant is at rest. b. Push up to sitting position with examiner’s hand on back of infant’s head, evaluate presence of extensor tone by amount of resistance c. Increased extensor tone may be noted in neck and trunk when infant is pulled to a sitting position if the head remains in extension
• *Response:** Supine – extensor tone dominates, infant will not flex to sit. Examiner will feel infant push head back into examiners hand. Hips will extend.
• *Lack of Integration:** Interferes with turning on side, rolling over, going from lying to sitting position, crawling. In older children it interferes with holding a supine flexion position or assume a pivot prone position
• *If not:** Can interfere with ADLs such as eating, bed mobility, dressing. Play such toys that require bilateral coordination, playing on the playground. Education such as completing work, transitioning into other settings such as the PE and the cafeteria.

Question 12

Neonatal Body Righting

Answer 12

• *Onset:** 34 weeks
• *Int. Period:** 4 months
• *Position:**
• *Procedure:** Flex one leg up toward chest
• *Response:** Thorax/Chest/Head will follow as a whole
• *Lack of Integration:** Log roll
• *If not:** Helps us maintain alignment when transitioning from supine to side lying

Question 13

Neonatal Neck Righting

Answer 13

• *Onset:** 34 weeks
• *Int. Period:** 4 months (approx)
• *Position:** Place infant in supine
• *Procedure:** Fully turn head to one side
• *Response**: Log rolling of entire body to maintain alignment with he head
• *Lack of Integration:**
• *If not:** Diff with segmental rolling OR movements that require trunk rotation

Question 14

Body Righting (mature)

Answer 14

• *Onset:** 4-6 months
• *Int. Period:** 5 years
• *Position:** Place infant in supine with head in midline
• *Procedure:** Flex one leg up toward the chest and rotate the leg across the body to force the infant to roll over.
• *Response:** The thorax, chest and head will follow pelvis as a whole. Infant rolls onto side.
• *Lack of Integration:** Function: Log rolling – supine to side lying a. Prevents development of segmental rolling b. Prevention of segmental rolling leads to further motor delays because infant will be unable to use rotational components of movement
• *If not:** Can interfere with ADLs & functional mobility such as eating, bed mobility, dressing. If can’t differentiate body segments (head from trunk from legs) and all move as a whole any activity that requires movement on a transverse plane or top and bottom of body rotating will be difficult to do. Play playing on the playground, reaching behind or around to get times etc.

Question 15

Neck Righting Reflex (mature)

Answer 15

Onset: 4-6 months

• *Int. Period:** 5. years
• *Position:** Place infant supine, head in midline.
• *Procedure:** Turn infant’s head to one side. Test both directions.
• *Response:** The infant’s trunk may initially swing in opposite direction then will follow the direction of the head turn, body turns as a whole. Infant rolls onto his/her side.
• *Lack of Integration:** Function: Log rolling – supine to side lying
  a. Needed for infant to roll from back to side. b. Asymmetrical response indication of CNS dysfunction – considered abnormal. c. May be important in the birth process. d. Persistence prevents segmental rolling
• *If not:** Can interfere with ADLs & functional mobility such as eating, bed mobility, dressing. If can’t differentiate body segments (head from trunk from legs) and all move as a whole any activity that requires movement on a transverse plane or top and bottom of body rotating will be difficult to do. Play playing on the playground, reaching behind or around to get times etc.

Question 16

Protective Extension (backwards)

Answer 16

• *Onset:** 9-10 months
• *Int. Period:** Persists throughout life
• *Position:** Symmetrical sitting posture with legs out in front or in tailor position.
• *Procedure:** Examiner pushes child backward with enough force to displace center of gravity off base of support.
• *Response:** Child extends arms backward. Full reaction is backward extension of both arms. Frequently an element of trunk rotation comes in and reaction is seen in one arm only. Child takes weight on extended arms.
• *Lack of Integration:** Interferes with head protection when center of gravity is displaced
• *If not:** Interferes with ADLs, such as eating, dressing, bathing, grooming. Play while in sitting or standing. Difficulty with playground equipment. Education such as transitioning from one classroom to the next, engaging in PE. Social participation

Question 17

Protective Extension (forward)

Answer 17

• *Onset:** 6-8 months
• *Int. Period:** Persists throughout life
• *Position:** Examiner supports infant in horizontal prone position in space with examiner’s hands around the infant’s body.
• *Procedure:** Plunge child head first (down) toward a table or other flat surface. Child MUST feel like s/he is falling
• *Response:** The child will extend head, extend and slightly abduct arms and fingers as if to break a fall. Weight is taken on extended arms.
• *Lack of Integration:** Interferes with head protection when center of gravity is displaced
• *If not:** Interferes with ADLs, such as eating, dressing, bathing, grooming. Play while in sitting or standing. Difficulty with playground equipment. Education such as transitioning from one classroom to the next, engaging in PE. Social participation

Question 18

Protective Extension (sideways)

Answer 18

Onset: 7-8 months
Int. Period: Persists throughout life
Position: Place child in symmetrical sitting position with legs out in front or in tailor fashion.
Procedure: Examiner pushes child on one shoulder with enough force to displace center of gravity over base of support and cause child to lose balance.
Response: Examiner pushes child on one shoulder with enough force to displace center of gravity over base of support and cause child to lose balance.
Lack of Integration: Interferes with head protection when center of gravity is displaced
If not: Interferes with ADLs, such as eating, dressing, bathing, grooming. Play while in sitting or standing. Difficulty with playground equipment. Education such as transitioning from one classroom to the next, engaging in PE. Social participation

Question 19

Flexor Withdrawal

Answer 19

• *Onset:** 28 weeks
• *Int. Period:** 1-2 months
• *Position:** Place infant supine with head in the midline, legs relaxed and semi flexed.
• *Procedure:** Noxious stimulus, such as pin prick or pinch to sole of one foot
• *Response:** Withdrawal of stimulated leg from the stimulus. Will see extension of toes, flexion at knee and hip in infant, dorsiflexion of foot; in other children, plantar flexion
• *Lack of Integration:** Can interfere with gait and standing
• *If not:** Can interfere with functional mobility. Interferes ADLs while standing, Education transitioning from classroom to classroom, Play such as in the playground, Social Participation