3What are Infant Reflexes? Involuntary stereotyped movement responses to a particular stimuli.Dominant movement form during the last 4 months of prenatal life and first 4 months after birth.Occur subcortically (below the level of the higher brain centers)
5Infant vs. Lifespan Reflexes Most “infant” reflexes do not last beyond the first year.Infant reflexes may not completely disappear.May be inhibited by maturing CNS.May be integrated into new movements.Reflexes that endure are called “lifespan” reflexes.Examples?
6Infant reflexes are very important in the process of development.
7Why is the study of infant reflexes important? Dominant form of movement for last 4 months prenatally and first 4 months postnatally.Primitive reflexes critical for human survival.Postural reflexes believed to be foundation for later voluntary movements.Appearance and disappearance helpful in diagnosing neurological disorders.
9Role of the Reflexes in Survival Human infants essentially helpless.Highly dependent on their caretakers and reflexes for protection and survival.Primitive reflexes occur during gestation or at birth and most are repressed by 6 months of age.Primitive reflexes are important for protection, nutrition, and survival.Examples?
10Role of Reflexes in Developing Future Movement Postural reflexes are related to the development of later voluntary movement.Reflexes integrated, modified, and incorporated into more complex patterns to form voluntary movements.Automatic movement is “practice” for future voluntary movements.Some believe reflexes may not be related to future motor development.Examples?
11Role of Reflexes in Developing Future Movement Infant ReflexFuture Voluntary MovementCrawlingLabyrinthineUpright posturePalmar graspGraspingSteppingWalking
12Reflexes as Diagnostic Tools Reflexes can determine level of neurological maturation.Reflexes are age-specific in normal, healthy infantsSevere deviations from normal time frame may indicate neurological immaturity or dysfunction.Reflexes should be tested carefully and only by trained professionals.Need state of quiet.If baby restless, crying, sleepy, or distracted, may not respond to applied stimulus.
13Reflexes as Diagnostic Tools ConcernMoro reflexMay signify cerebral birth injury if lacking or asymmetric.Asymmetric tonic reflexMay indicate cerebral palsy or other neurological problem if persists past normal time.
14Reflexes as Diagnostic Tools Milani Comparetti Neuromotor Development ExaminationMeasures several infant reflexes from birth to 24 months.Develops profile of child’s movement in relation to what is expected at a specific age.Especially valuable with children suspected of motor delay.
15Reflexes as Diagnostic Tools Primitive Reflex ProfileQuantification of the level of presence or strength of primitive reflexes3 reflexes: moro, asymmetric tonic neck, symmetric tonic neck5 point classification system (0 for absent, 4 for so strong it dominates individual).
16Pinpointing the Number of Infant Reflexes Different terminologies used for same reflex by expertsRooting reflex = search reflex; cardinal points reflexReflexes are often poorly defined and more complex than once thoughtPalmar grasp vs. traction response
20Primitive Reflexes ~ Sucking Stimulus / ResponseS: touch of lips R: sucking actionDurationIn utero - 3 months postpartumConcernsNo reflex problematic for nutritionOtherOften in conjunction with searching reflex
21Primitive Reflexes ~ Search Stimulus / ResponseS: touch cheek R: head moves toward stimuliDurationWeeks prenatal - 3 months postpartumConcernsNo reflex problematic for nutritionNo reflex or lack of persistence may be sign of CNS or sensorimotor dysfunction.OtherOften in conjunction with sucking reflex. Contributes to head/body-righting reflexes.
22Primitive Reflexes ~ Moro (startle) Stimulus / ResponseS: Suddenly but gently lower baby’s head S: head suddenly shifts positionstartled by a sudden noise R: Arms and legs extendDurationPrenatal – 4-6 months postpartumConcernsMay signify CNS dysfunction if lackingMay signify sensory motor problem if persistsMay delay sitting & head control if persistsMay indicate injury to one side of brain if asymmeticalOtherReaction time increases with age Preceeds startle refle
24Bilateral absence of the reflex may mean damage to the infant's central nervous system while a unilateral absence could mean an injury due to birth trauma . Erb’s palsy or some other form of paralysis is also sometimes present in such cases
25Primitive Reflexes ~ Startle Stimulus / ResponseS: Same as Moro R: Arms and legs flexDuration2-3 months after Moro disappears – 1 yearOtherLess severe startle reflexes elicited through lifespan
26Primitive Reflexes ~ Asymmetric Tonic Neck Stimulus / ResponseS: Prone/supine position, turn head to one side R: Limbs flex on one side, extend on other sideDurationAfter birth – 3 monthsConcernsFacilitates bilateral body awarenessFacilitates hand-eye coordinationOtherAlso called ‘bow and arrow’ or ‘fencer’s’ position
27Asymmetric Tonic NeckWhen the child's head is turned to the side, the arm on that side will straighten and the opposite arm will bend . If reflex continues (six months of age) : a disorder of the upper motor neurons. the tonic neck reflex is a precursor to the hand/eye coordination of the infant.
28Primitive Reflexes ~ Symmetric Tonic Neck Stimulus / ResponseS: Baby sitting up and tip forward R: Neck and arms flex, legs extend S: Baby sitting up and tip backward R: Neck and arms extend, legs flexDurationAfter birth – 3 monthsConcernsPersistence may impede many motor skills and cause spinal flexion deformities
29Primitive Reflexes ~ Plantar Grasp Stimulus / ResponseS: Touching the ball of foot R: Toes graspDurationBirth – 1 yearOtherMust disappear before the baby can stand or walk.Issue of shoes versus no shoes?
30Primitive Reflexes ~ Babinski Stimulus / ResponseS: Stroke bottom or lateral portion of foot R: Great toe turns downwardDurationBirth – 4 monthsConcernTest of the pyramidal tract (i.e. ability to perform conscious / voluntary movement)
31Primitive Reflexes ~ Palmar Mandibular Stimulus / ResponseS: Pressure to both palms or hair to hand R: Eyes close, mouth opens, and/or neck flexes (which tilts the head forward)DurationBirth – 3 monthsOtherAlso called the Babkin reflex
32Primitive Reflexes ~ Palmar Mental Stimulus / ResponseS: Scratch base of palm R: Lower jaw opens and closesDurationBirth – 3 months
34Postural Reflexes Stepping Crawling Swimming Head and Body Righting ParachutingLabyrinthinePull Up
35Postural Reflexes ~ Stepping Stimulus / ResponseS: Infant upright with feet touching surface R: Legs lift and descendDurationAfter birth – 5-6 monthsConcernsEssential forerunner to walkingOtherSometimes called walking reflexDevelopmental changes in reflex over time
36Postural Reflexes ~ Crawling Stimulus / ResponseS: Prone position on surface, stroke alternate feet R: Legs and arms move in crawling actionDurationBirth – 3-4 monthsConcernsPrecursor to later voluntary creeping
37Postural Reflexes ~ Swimming Stimulus / ResponseS: Infant held horizontally R: Arms and legs move in coordinated swimming type actionDuration2 weeks after birth – 5 monthsOtherRecognition of reflex led to popularity of infant swim programs
38Postural Reflexes ~ Head and Body Righting Stimulus / ResponseS: Supine, turn body in either direction R: Head “rights” itself with the body S: Supine, turn head in either direction R: Body “rights” itself with the headDurationHead:1-6 months; Body: 5 months-1 yearConcernsRelated to voluntary rolling movements.
39Postural Reflexes ~ Parachuting Stimulus / ResponseS: Off balance in upright position R: Protective movement in direction of fallDuration4 months – 1 yearConcernsAssessed in preterm babies as markers of neurological development Related to upright postureOtherAlso called propping reflexOccurs downward, sideways, & backward
40Postural Reflexes ~ Labyrinthine Stimulus / ResponseS: Baby held upright, tilted in one direction R: Baby tilts head in opposite directionDuration2-3 months – 1 yearConcernsRelated to upright postureOtherAlso considered primitive reflex
41Postural Reflexes ~ Pull Up Stimulus / ResponseS: Sitting/standing, hold hands, tip in one direction R: Arms flex or extend in to maintain upright positionDuration3 months – 1 yearConcernsRelated to upright posture