Developmental Reflexes PDF

University of Santo Tomas College of Rehabilitation Sciences...

University of Santo Tomas College of Rehabilitation Sciences Human Development in Occupational Therapy 1 Developmental Reflexes A. SPINAL CORD REFLEXES Reflexes Onset Integrated Position Stimulus Response Crossed 28 wks GA 1-2 months Supine Noxious stimuli to ball of foot of LE fixed in Opposite LE flexes, adducts and extends Extension extension Flexor 28 wks GA 1-2 months Supine or sitting Noxious stimuli to sole of foot Flexion of hip and knee, dorsiflexion of ankle, Withdrawal extension of toes Extensor thrust 28 wks GA 2 months Supine, one leg extended, Stimulate sole of foot to the flexed leg Uncontrolled extension of stimulated leg opposite leg flexes Galant 32 wks GA 2 months Symmetrical prone Stroke back along paravertebral muscles in Trunk curves with concavity on stimulate side cephalocaudal direction from midthoracic area to low lumbar area Placing 35 weeks 2 months Hold baby with both hands Lift baby so that the dorsal part of foot Baby lifts leg (hip and knee flex) up to step onto reaction of legs under arms and around lightly touches protruding edge of table top table the chest. Support chin and head with your fingers Placing Birth 2 months Same as above Lift baby so that the dorsal part of hand Baby lifts arm up onto the table reaction of lightly touches protruding edge of table top arms Automatic 37 weeks 2 months Same as above Keep baby upright and allow soles of feet to Spontaneous stepping walking touch flat surface Primary 35 weeks 1-2 months Same as above Allow baby to take body weight on LE, Rigid extension of LE standing press own on sole of feet Sucking 28 wks GA 3 months Supine Place index finger 3-4 cm into mouth (pad Rhythmic sucking (upward and backward) toward palate) Rooting 28 wks GA 3 months Supine, head in midline Finger stroke perioral skin corner of mouth Directed head turning toward stimulated side; mouth opens, jaw drops, tongue tries to stick out Traction 28 wks GA 2-5 months Supine Grasp infant’s forearms and pull slowly up Resistance to extension of arms, arms pull into to sit full flexion grasping of fingers Moro 28 wks GA 4-6 months Supine or sitting Sudden change in position of head in Shoulder ABD/ER, elbow extension of flexion, supported at 60deg relation to trunk. Allow head to drop back or finger ext/abd, crying followed by flex/add of keep holding head and bend knees and arms across chest drop down Palmar Grasp Birth 4-6 months Supine Index finger from ulnar side into the hands Flexion of all fingers, involuntary grasp and press Plantar grasp 28 wks GA 9 months Supine Press sole of foot behind toes Grasping response of feet/toes; should be strong and consistent in neonates Avoidance Birth 6-7 years Supine/sitting Light contact to dorsum of hand Flex-ext, abd and add and rotation of extremity to reaction enable hand to escape the stimulus  University of Santo Tomas College of Rehabilitation Sciences Human Development in Occupational Therapy 2 Developmental Reflexes B. BRAINSTEM REFLEXES Medulla Reflexes Onset Integrated Position Stimulus Response ATNR Birth 4-6 months Supine Turn head to one side, passive or active Skull extremities flex and chin extremities extend STNR 4-6 months 8-12 months On lap for infants; Ventroflexion of head 🡪 UE flexion, LE extension quadrupeds when older than 6 months Extension of head 🡪 UE extension, LE flexion Tonic Birth 4 months Prone Stimulated by position of head in relation to Prone – facilitates flexor tone Labyrinthine Supine gravity Supine – facilitates extensor tone Pons Landau 4 months 12-24 mos Child held in ventral Position, tactile pressure to abdomen, and Head, spine, and legs extend; arms extend at suspension with movement through space shoulders one hand under lower abdomen Midbrain Neonatal Neck 34 weeks 4-5 months Supine Rotate head to one side Body rotates as a whole in same direction as righting the head. Look at line from the shoulder to hip Labyrinthine head Birth-2mos Persists Hold infant as for Occlude vision; alter body position by tipping Head orients to vertical with mouth horizontal righting placing body in all directions then back to midline, suspend in prone and supine Neck righting acting 4-6 months 5 years Supine Rotate head to one side, actively or Head turning followed by rotation of body as on the body passively. a whole (log rolls) to align body with head Body righting acting 4-6 months 5 years Supine Passively rotate upper and lower trunk Body segment not rotated follows to align the of the body segment. For older kids, ask them to roll. body segments. Segmentation should be (derotative) evident. If response is absent, child may log roll Body righting acting Birth-2mos 5 years Supine or prone Asymmetrical stimulation of skin receptors on Head orients to vertical position with mouth on the head the supporting surface horizontal. Stimulation of skin receptors causes activity in trunk and limb muscles which raise head into upright position.  University of Santo Tomas College of Rehabilitation Sciences Human Development in Occupational Therapy 3 Developmental Reflexes C. CEREBRAL REFLEXES Reflexes Onset Integrated Position Stimulus Response Optical Righting Birth-2months Persists Any position Alter body position by tipping body in all Head orients to vertical position with mouth directions horizontal. Equilibrium 6 months Persists Prone Displace center of gravity. Slowly tilt board Body is flexed against the tilt, lateral curving of Reaction – Prone laterally to right and left the head. Upper arm and leg extended and abducted, protective extension of extremities on opposite side Equilibrium 7-8 months Persists Supine Displace center of gravity. Slowly tilt board Same as above Reaction – Supine laterally to right and left Equilibrium 7-8 months Persists Sitting on tilt board Slowly tilt laterally and antero-posteriorly Lateral – body remains upright and is flexed Reaction - Sitting or vestibular ball against the tilt. Concavity of spine upward, neck flexed lat and head slowly rotate with face toward upper side. Arm and leg on upper side abd and ext, those on lower side in protective ext position. Ant- limbs are retracted and trunk and head ext. Post- limbs are advance and trunk and head flexed Equilibrium 9-12 months Persists Quadruped on tilt 1. Tilt back and forth (laterally) 1. Lateral curving of head and thorax, concave Reaction – All 4s board 2. Tilt ant-post side up; abd-ext of arm and leg on raised side and ext on lowered side 2. Post – head and back flexed; Ant – head and back ext Equilibrium 12-21 months Persists Standing and 1. Tilt back and forth (laterally) 1. Lateral curving of head and thorax, concave Reaction – kneeling 2. Tilt ant-post side up; upper leg bent at hip and knee and Standing and other leg stiffly ext. Kneeling 2. Post – head and back flexed; Ant – head and back ext Positive Supporting Elbows – Persists WB position See if infant will bear weight on elbows and WB on elbows or hands – WB on UE 3months hands Hands – 4-6 months  University of Santo Tomas College of Rehabilitation Sciences Human Development in Occupational Therapy 4 Developmental Reflexes Positive Supporting 6-9 months Persists Support infant in Allow feet to make a firm contact with flat Simultaneous contraction of LE flexors and - vertical position surface extensors with WB on LE, hips and knees WB on LE with hands under extended arms around chest Protective 6-7 months Persists Support child Displacement of COG outside the base of Arms ext and slightly abd, and fingers ext and Extension of Arms horizontally in air support. Plunge child downward toward a flat spread as if to protect body before touching – Forward prone with your surface surface. Contact made on palmar surface, (Parachute) hands around the strong enough to support body weight. Note body. (In older, response of each UE, may be asymmetrical. children and adults can test in sitting, kneeling, standing) Protective 7 months Persists Symmetrical sitting Push child on one shoulder with enough force Abd of opposite arm, with ext of elbow, wrist extension of arms – with legs out in to cause loss of balance and fingers before contact is made with table. sideways front Weight is taken on open palm and fingers Protective 9-10 months Persists Symmetrical sitting Push child backward, with enough force to Full reaction is backwards, ext or both arms. extension – with legs out in offset balance Frequently an element of trunk rotation comes Backward front in and is seen in one arm only Protective 6-9 months Persists Displace COG outside the base of support Legs ext and abd to support and to protect extension of legs body against falling. See-saw reaction 12 months Persists Standing Examiner passively lifts one leg, while pushing Strong extension and abd of the same leg BW of child to side in the direction of the lifted lifted leg Staggering 5-18 months Persists Standing 1. Move to R or L side push or hold upper arm 1. Hopping or stepping sideways to maintain (protective) 2. Move forward equilibrium reactions 3. Move backward 2. Hopping or stepping forward to maintain equilibrium 3. Hopping or stepping backward to maintain equilibrium or DF of feet going on to heels /jacotr/l,otrp /pgmotrp 06