Postural Reflexes, Landau Reflex,  Babinski Reflex, Hands Grasping / Pulling Reflexes. Part 1 Do not use or distribute without written permission.

Postural Reflexes Mediated from the midbrain Increased maturity in CNS Postnatal motor development Cephalo-caudal (Head to toe) Proximo-distal (center outward) First in prone, before supine 6 weeks – raise head in prone in line with his body – several minutes 12 weeks – legs no longer flexed, pelvis flat on surface in prone 16 weeks – press down on forearms to lift head and upper torso, stretch limbs and “swim”. Do not use or distribute without written permission.

Righting/Equilibrium Reactions - Video https://www.youtube.com/watch?v=XL4gWG1qlIo Do not use or distribute without written permission.

Equilibrium reflexes https://www.youtube.com/watch?v=XL4gWG1qlIo

Labyrinthene Head Righting Reflex Maintain midline position Perpendicular to the ground when upright Dependent upon vestibular information Synchronizes with the oculo-head righting reflex Synchrony develops balance, controlled eye movements and visual perception 44 pairs of muscles in the neck responsible for good posture By 5 months should gain control over head lag when pulled up in supine Elicited: Tilt the body over a ball to stimulate otolithic organs – will cause compensatory contraction of the neck muscles to keep the head level Do not use or distribute without written permission.

Assessment Seated on the floor Legs straight in front Arms resting on thighs Fixate eyes on object at eye level Close eyes Imagine looking at the object during the entire testing procedure Tester behind client slowly tilts the client to the left on 3 stages, pausing 2 to 3 secs at each stage. (15, 30, 45 degrees) Return to upright seated position in same 3 stages Repeat procedure to the right, return to midline Repeat backwards and forwards, always maintaining eyes on object at eye level Do not use or distribute without written permission.

Scoring 1 = Head drops in the direction of the tilt – no righting apparent 2 = Head slips below the line of the body 3 = Head follows direction of the tilt in line with the body 4 = Head corrects to the vertical midline position throughout the testing Do not use or distribute without written permission.

Oculo-Head Righting Reflex Initiated by visual cues Dependent on functioning of the cerebral cortex Maintains head in stable position Eyes fixate on targets despite other movements in the body Necessary for fixation and sustained visual attention Typically – visual abilities fixate and follow once stability of head posture is achieved Elicited: Combination of visual and vestibular information, stretching of the neck muscles and / or movement of visual images on the retina Do not use or distribute without written permission.

Assessment Seated on the floor Legs straight in front Arms resting on thighs Client fixes eyes on object at eye level Tester behind client slowly tilts the client to the left on 3 stages, pausing 2 to 3 secs at each stage. (15, 30, 45 degrees) Return to upright seated position in same 3 stages Repeat procedure to the right, return to midline Repeat backwards and forwards, always maintaining eyes on object at eye level Do not use or distribute without written permission.

Scoring 1 = Head drops in direction of the tilt 2 = Head leans below the line of the body 3 = Head follows direction of the tilt in line with the body 4 = Head corrects to vertical midline position throughout test Do not use or distribute without written permission.

Intervention Ideas Vestibular training Slow rotation (eyes closed) Rolling and tilting Progressing to eyes open as balance and head righting improves Scooter board Wobble board First lying, then seated, on to standing trampoline Do not use or distribute without written permission.

Forearm Balance In prone push up to forearms and look around – hold for 10 secs Turn head and look at feet in both directions Eyes leading the neck rotation Grade by providing resistance through pressure Do not use or distribute without written permission.

Landau Reflex Infant in prone, they lift their head, upper part of trunk and their arms Later, the infant is also able to lift their legs Upper and lower landau, upper develops first Upper Landau emerges between 2 and 4th month Lower Landau appears between 5 and 6th month of life Lasting up to two years of life Final integration can be as late as 3 years Elicits extensor tone throughout the body in prone – baby suspended in air with support under the stomach Do not use or distribute without written permission.

Influences Symmetry of movement Together with STNR – inhibits TLR forwards, increase head righting and trunk muscle tone Body posture link with emotional response to joy Activation of binocular vision and binaural hearing, also focused and peripheral attention, 3-dimensional vision as well as close and distant vision. Postural, such as muscle tone Locked knees, difficulty bending the body forward Difficulty with new and novel information Bring the head too far backward, could be indicative of other serious illness such encephalopathy, CP Do not use or distribute without written permission.

When integrated Keeping legs on floor in prone and lifts head Increase muscle tone in the back and neck in prone Freeing upper body for reaching, grasping and bringing things to mouth Inter-relationship between TLR and Landau and Spinal Galant Supports focus and attention Do not use or distribute without written permission.

Landau Reflex  https://youtu.be/cSXlXGFXAaQ

Assessment Prone with arms at right angles to the shoulders Or prone with arms stretched backward and lift head and chest at the same time (RMT) Client is instructed to lift upper trunk, arms and hands off the floor Keeping feet on the floor Maintain elevated position for up to 5 secs This may be repeated twice. Do not use or distribute without written permission.

If Reflex is Active The feet raise up off the floor Tension up the back of the legs Neck and head shakes Buttocks may clench Pain in lower back Tension between shoulder blades. Do not use or distribute without written permission.

Scoring 0 = No response 1 = Elevation of both feet several inches above the floor and extensor tone throughput the body. 2 = Elevation of both feet away from the floor 3 = Definite lifting of one or both feet 4 = Integrated Do not use or distribute without written permission.

Primitive Reflex Landau Reflex Superman -Video https://www.youtube.com/watch?v=Gm8u2BDeMmA Do not use or distribute without written permission.

Intervention Ideas Prone work Lifting torso off the ground while keeping feet on the ground RMT: in prone – put light pressure on forehead and front of ankles Client pushes gently against hands whilst breathing out. Change to pressure at back of head Check for muscle tension and adjust pressure Do not use or distribute without written permission.

Trunk Extension Reflex The infant is lifted while being held under the armpits with toes just touching a hard surface. The infant’s body midline comes together with their gravity line, causing automatic extension of the head and straightening the whole body Basis of body righting Similar to when we stretch after we awaken, stimulating the brain, muscle tone and the proprioceptive system At the end of the first month of infant’s life Active from 2 to 7th month Integrated by 9 months Influences body posture, body midline overlaps with gravity line, head- body, core-limbs links, visual and auditory organization Do not use or distribute without written permission.

When not Integrated Blocks and inhibits the links between the brain stem and upper brain level Brainstem has to work too hard – possibility of survival mode, limiting cognitive skills Tendency to bend the body forward Over focusing on details, inadequate generalizing, narrowed imagination Do not use or distribute without written permission.

Trunk Extension Reflex  https://youtu.be/CgegNiqzeFk

The Amphibian Reflex First develops at 4 to 6 months of life – first in prone Elevation of the pelvis causes automatic flexion at the hip to affect knee on the same side Pre-cursor to crawling Inhibits the ATNR – permits independent mobility of extremities Ready for independent and controlled movement – movement of arms and legs no longer dependent upon position of the head Connections between cerebellum, vestibular and prefrontal cortex have been established Foundations are in place Adults – suffer from clumsiness in lower body and tension in legs Do not use or distribute without written permission.

Assessment First supine, then prone Ensure completely relaxed Tester places hands under hip Elevates hip to 45 degree angle Knee on same side should bend Do not use or distribute without written permission.

Scoring 0 = No Response 1 = Whole body rolls rigidly 2 = Leg is so stiff it begins to lift 3 = Leg remains stiff 4 = Integrated Do not use or distribute without written permission.

Intervention Ideas Rolling the bottom side to side Crawling in prone position Windscreen wipers (RMT) – in supine, legs straight, move feet outward and inward simultaneously (RMT) Rolling from prone to supine and back Initiating movement from one portion of the body Bend one leg and slowly bring body across the body to stimulate rolling of upper portion of body Do not use or distribute without written permission.

Under-Developed Impede cross pattern crawling and creeping Contribute to hypertonicity later Impact on gross motor coordination Check for building blocks of ATNR and TLR. Do not use or distribute without written permission.

Segmental Rolling Reflexes Strictly for rotational purposes Infant on side, pressure on side of the body With head turn, the body will follow in line in a “log roll” Head is righted, but body is out of alignment Initiates a wave of stretch reflexes down the body, righting the abdomen and the legs. Two key positions: shoulders and hips Movement starts at the head, then shoulders, thorax and pelvis 0r vice versa Emerges at 6 months to allow rolling, followed by sitting, four point kneeling and standing Do not use or distribute without written permission.

Assessment Supine, then prone Lift shoulders gently to approximately 45 degrees At same time pressing down on opposite shoulder Rotate towards opposite side of the body Repeat procedure for other side Do not use or distribute without written permission.

Scoring 0 = No response 1 = Tendency for knee to bend, although it does not, as shoulder is lifted 2 = Entire body and leg lift as shoulder on same side is lifted 3 = Leg remains stationary as shoulder on same side is lifted 4 = Definite bending of the knee as shoulder on same side is lifted Do not use or distribute without written permission.

Assessment 2 Not with CP = contra-indicated Support client’s left heel in left hand Apply gentle pressure to bent left knee with right hand Rotate knee slowly across client’s body until resistance is met / or floor is touched Repeat procedure for other side Do not use or distribute without written permission.

Scoring 0 = No response at all 1 = Slight tendency, as the knee crosses midline, for the shoulder to lift, or the entire body to rotate 2 = Shoulder lifts but does not rotate over completely 3 = Incomplete rotation of shoulder 4 = Integrated Do not use or distribute without written permission.

Equilibrium Reactions Follows on postural righting reflex action to develop postural control Emerges from 9 months of age Stimulation of the semi-circular canals Compensatory in nature Responds to sudden changes in center of gravity Modifies the patterns of righting reactions. Primarily protective Dependent on visual-stimulation Linked to adult “startle” reflex Do not use or distribute without written permission.

Intervention Ideas Work on Moro and TLR first Do not use or distribute without written permission.

Parachute Reflex (Hands Supporting Reflex) Infant is held in the air, then tilted forward to the ground Arms extend as if to protect the head and trunk from impact (As infant closes in on surface, their hands will automatically reach in the direction of the surface) Infant help upright and suddenly dropped to the ground: lower limbs first extend, tense, then abduct Protective in nature 6 months – sideways “parachute” or “propping” reflex emerges Needed to learn to sit Provides for loss of balance in seated position Compensatory movement of the arm on the side to which the the child is falling Do not use or distribute without written permission.

Parachute Reflex / Reaction - Video https://www.youtube.com/watch?v=6fIIbY0WD_M Do not use or distribute without written permission.

Development Appears at 12th week in utero Active up to 6 months Influences upper body moving symmetrically, mirroring each other in front of body, limbs and core coordination, manual skills such as pushing, protection, and in sports Boundaries of personal space Can lead to isolation later in life Play that involves touching other people, objects and surfaces Proper body organization Being open to easy communication and contact with people Do not use or distribute without written permission.

When non-integrated Injuries in case of falls Poor boundaries Aggressive Standoffish Isolated Easily become a victim Bully or being bullied Poor ability to receive information Do not use or distribute without written permission.

Hands Supporting Reflex https://youtu.be/C7gbcrFBmNM

Assessment Stand in front of wall at arms length distance Both arms at side of body Move body forward, shifting center of gravity Hands automatically raised in front of the chest to protect the body Elbows initially bend, straighten to create distance between body and wall. Hands push against the wall to move head / upper body away from the wall Demonstrate once before expecting performance Do not use or distribute without written permission.

Intervention Ideas Weightbearing activities on forearms in different positions. Pushing hands against partner in sitting, standing or client in supine, creating resistance Push in different directions Cleaning the black or white board Swimming Sports with tools (tennis, hockey, Lacrosse) Do not use or distribute without written permission.

https://maudeleroux.com/ Maude Le Roux, OTR/L, SIPT, IMC Websites https://maudeleroux.com/ Facebook https://www.facebook.com/ATAMaudeLerouxOT/ LinkedIn https://www.linkedin.com/company/a-total-approach Blog http://www.maude-leroux.com/ Do not use or distribute without written permission.