1. Reflexes
Definition ;
Stereotype movement which can be elicited by application of stimulus to the periphery
Importance of reflexes:
1- Diagnostic role:
More reflex more hypertonia No Movement
2- Therapeutic role Iniate elbow flexion ASTNR
3- Serve process of motor development
Putting toy on the side of the child turn head
extension of head eye hand coordination

2. Classification of Reflexes
According to level of CNS maturation
According to type of stimulus

3. According to level of CNS maturation
Spinal Level (Spinal reflexes)
Brain Stem Level(Brain Stem reflexes)
Midbrain Level(Midbrain reflexes)
Cortical Level (Cortical reflexes)
a- (Spinal reflexes) Primitive reflexes , phasic reflexes Movement reflexes A- beta reflexes:
Flexor with drawl (nociceptive reflex)

4. Starting position : Supine lying position, head in midline position,
upper , lower limb extended
Stimulus : Painful Scratching on sole of foot
Response : Mass Flexion or uncontrolled flexion
Age positive : from birth to 2 month
b- extensor thrust :
upper extended, lower ,one is flexed, other extended
Stimulus ; painful stimulus on the sole foot of flexed
Response: Uncontrolled extension of leg
Age: From birth to 2 Month

5. Crossed extension:
Starting position : Supine lying position, head in midline position,
upper , lower limb extended
Stimulus ; Tapping on medial aspect of thigh
Response: Extension , adduction, internal rotation of opposite scissor
Age: birth to 2 months

6. B)Brain stem reflexes(static postural reflexes)(tonic reflexes)(primitive reflexes)
Changing position of the body or head in the space will change distribution of the tone.
1- asymmetrical tonic neck reflex (ATNR):
Starting position : Supine lying position, head in midline position,
upper , lower limb extended
Stimulus ; Turning the head to one side
Response: Face head : extension of upper and lower limb
occipital side: flexion in upper and lower limb
Age: birth to months
ASTNR interfere with ( ROLLING, FEEDING, both hand use)

7. 2- symmetrical tonic neck reflex (STNR):
Starting position : Quadriped or prone on my leg
Stimulus ; Flexion of head
Response: Flexion of upper limb and extension in lower limb
Or vice versa
Age: birth to months
3- Tonic labyrinthine supine (TLS):
Starting position : head in midline position,
Stimulus ; Supine lying position,
Response: increase of extension tone in all over the body
Age: birth to 4 months

8. 3- Tonic labyrinthine prone (TLP):
Starting position : head in midline position,
Stimulus ; Prone lying position,
Response: increase of flexor tone in all over the body
Age: birth to 4 months
4- +ve Supporting reaction:
Starting position :Standing with his back on my face
Stimulus ; Hold the child from pelvic or axilla and bounce him on sole of foot.
Response: Lower limb extension, adduction, internal rotation plantar flexion (scissors).
Age: from 3 to 8 Months

9. 5 -Ve Supporting reaction: Stimulus : Child in weight bearing with leaning forward Response: Semi flexion of lower limb with few steps forward Age: From 8 to continue throughout life

10. Midbrain reflexes righting reaction
A) Neck Righting;
Starting position : Supine lying position, head in midline position, upper , lower limb extended
Stimulus ; Rotation of the head to one side
Response: Rotation of the body as a whole following head
Age: birth to 6 months
B) Body righting acting on body:
Starting position : Supine lying position, head in midline position, upper , lower limb extended
Stimulus ; Turning the head to one side
Response: Segmental rotation of the body
Age: from months

11. C) Labyrinthine righting on head:
First: Starting position: prone in space with blind folded
Stimulus: prone in space on my hand with blind folded
Response: raising head to normal position age from 1-2 month then continue
Second: Starting position: supine lying
Stimulus: Supine in space on my hand with blind folded
Response: raising head to normal position age from 6 month s then continue

12. Third: Starting position: Holding child from pelvis blind folded
Stimulus: tilting the body to right side
Response: raising head to normal position age from 6-8 month then continue
Fourth: Third: Starting position: catching the child from trunk
Stimulus: tilting the body to Left side

13. D) Optical righting acting on head:
THE SAME LIKE LABRYINTHINE (POSITIONS , RESPONSES) WITHOUT EYE BLIND FOLDED
Amphibian Reaction :Starting position: Prone head in midline ,legs extended , arm extended overhead
Stimulus: lift pelvis on one side
Response: Automatic flexion of hip ,knee ankle on the same side Age from 6 month then continue

14. Automatic Movement Reactions:
Moro Reflex
Starting position: Semi recline
Stimulus: Drop head backward
Response: Extension, abduction, external rotation of arms, extension, adduction fingers
Age: Normal from birth to 4 months
Landau Reflex : Starting position: prone in space with holding under thorax
Stimulus: raise head active or passively
Response: Spine and leg extend
Age: Normal from 6 months to 2or 2.5 years

15. Protective extensor Thrust( Parachute reaction)
Starting position: Prone , arms extended over head
Stimulus: Suspend the child from ankle or pelvis suddenly move child to floor
Response: Immediate Extension , of arms,, fingers to protect head
Age: Normal from 6 months continue through out life

16. CORTICAL REFLEXES OR EQUILBRIUM REACTION
SUPINE
Starting position: supine on tail board
Stimulus: Tilt board to one side
Response: Righting head, thorax extension, abduction of arms, legs on raised side
Age: Normal from 6 months continue through out life

17. Prone: Starting position: Prone on tail board
Stimulus: Tilt board to one side
Response: Righting head, thorax extension, abduction of arms, legs on raised side
Age: Normal from 8 months continue through out life
Sitting: Starting position: Sitting on chair
Stimulus: pull child to one side
Age: Normal from 12 months continue through out life

18. Kneel Standing : Starting position: Kneel standing
Stimulus: pull child to one side
Response: Righting head, thorax extension, abduction of arms, legs on raised side
Age: Normal from 15 months continue through out life
Hopping 1, 2and 3:Starting position: Standing holding from upper arms
Stimulus: Move to lift or right, forward, backward
Response: Righting head, thorax extension, hopping steps to sideway, forward, backward to maintain equilibrium
Age: Normal from 15 to 18 months continue through out life

19. Dorsiflexion: Starting position : Standing holding from axilla
Stimulus: Tilt child backward
Response: Righting head, dorsiflexion of feet
Age: Normal from 15 to 18 months continue through out life
See- saw:
Starting position: Standing holding hand , foot with flex hip knee
Stimulus: pull arm gently forward and to lateral side
Response: Righting head, thorax extension, slightly abduction of flexed knee
Age: Normal from 15 months continue through out life

20. Simian position Starting position: Squatting sitting
Stimulus: Tilt child to one side
Response: Righting head, thorax extension, abduction of arms, legs on raised side
Age: Normal from 15 to 18 months continue through out life