1. NEONATAL REFLEXES
PRIMARY MOTOR PATTERNS
INFANT REFLEXES & REACTIONS

2. Neonatal Reflexes or Primary Motor Patterns and Infant Reflexes & reactions
In neonates & infants, motor behavior influenced by primitive reflexes as a result of immature CNS during first 6-8 months of life as CNS matures, reflexes gradually suppressed
Reflexes generate predictable & stereotypic movements and postures.
Present at birth and become “integrated” or inhibited, or not evident later in development
In CNS lesions, may persist and interfere with motor milestone attainment, or cause deformities

3. Neonatal Reflexes or Primary Motor Patterns and Infant Reflexes & reactions
Reflexes form the basic organized pathways in the spinal cord and regulation from the higher centers is accomplished by excitation and inhibition of these reflexes
Spinal and brainstem level reflexes have to be inhibited
Midbrain and cortical reflexes must be encouraged

4. Level Classification of Reflexes
Spinal Reflexes
Flexor withdrawal
Extensor thrust
Crossed extension
Moro
Startle
Brainstem Reflexes
Tonic neck reflexes
- ATNR
- STNR
2) Static labyrinthine
3) Positive supporting
4) Negative supporting

5. Level Classification of Reflexes
Midbrain Reflexes
Kinetic Labyrinthine
Superior semi-circular canal
Posterior semi-circular canal
Body righting acting on head
Body righting acting on body
Optical righting reflex
Labyrinthine righting reflex
Amphibian reflex
Protective extension
Parachute reflex
Brainstem Reflexes
Equilibrium reflexes
- Side tilting
- Forward tilting
- backward tilting

6. Level Classification of Reflexes
Reflexes without Classification
Sucking reflex
Grasp reflex
Placement reflex
Stepping reflex
Standing reflex

7. Reflex Development (ref: Molnar, ch. 2 Growth & Development )
STIMULUS
RESPONSE
AGE OF SUPPRESSION
Moro
Sudden neck extension
Shoulder abduction; shoulder, elbow & finger extension followed by arm flexion abduction
4-6 months
Startle
Sudden noise, clapping
Same as Moro
Rooting
Stroking lips or around mouth
Moving mouth, head toward stimulus, in search of nipple
4 months
Positive supporting
Light pressure or weight bearing on plantar surface
Legs extend for partial support of body weight
3-5 months
Replaced by volitional weight bearing w support
Asymmetric Tonic Neck
Head turning to side
Extremities extend on face side, flex on occiput side
6-7 months
Symmetric Tonic
Neck flexion
Neck extension
Arms flex, legs extend
Arms extend, legs flex

8. Reflex Development (Molnar)
STIMULUS
RESPONSE
AGE OF SUPPRE
Palmar grasp
Touch or pressure on palm or stretching finger flexors
Flexion of all fingers, hand fisting
5-6 months
Plantar grasp
Pressure on sole distal to metatarsal heads
Flexion of all toes
12-14 months when walking is achieved
Automatic neonatal walking
On vertical support, plantar contact & passive tilting of body forward & side to side
Alternating automatic steps with support
3-4 months
Placement or placing
Tactile contact on dorsum of foot/hand
Extremity flexion to place hand or foot over an obstacle
Before end of 1st year
Neck righting or body derotational
Neck rotation in supine
Sequential body rotation from shoulder to pelvis towards direction of face
4 months. Replaced by volitional rolling
Tonic labyrinthine
Head position in space, strongest at 45* from horizontal:
Supine: extensor tone
Prone : flexor tone
4-6 months

9. Reflex Development (ref: O’Sullivan and Siegelman )
STIMULUS
RESPONSE
AGE OF SUPPRESSION
Babinski
Stroke lateral aspect of the plantar surface of foot
Extension & fanning of toes
0-12 months
Flexor withdrawal
Sharp, quick pressure stimulus to the sole of the foot or palm of hand
Withdrawal of stimulated extremity
0-2 months
Present throughout life?
Crossed extension
Sharp, quick pressure stimulus to sole of foot
Withdrawal of stimulated lower extremity & extension of opposite leg
Galant or trunk incurvation reaction
Sharp stroke along paravertebral line from scapula to top of iliac crest
Lateral trunk flexion towards stimulated side
Primary standing reaction
Hold infant in supported standing
Infant supports some weight & extends lower extremities
If persists, interferes w walking by cause extension of all joints

10. Reflex Development (ref: O’Sullivan and Siegelman )
STIMULUS
RESPONSE
AGE OF SUPPRE
Primary walking
Hold infant in supported standing, tilt trunk forward slightly
Reciprocal Extension & fanning of toes
0-2 months
Neonatal neck righting (Neck rightng on body, NOB
Turn head when infant is in supine
Body logrolls toward same side
0-6 months
Rooting
Stroking of perioral region
Head turning to that side with mouth opening
0-3 months
Impt feeding reflex
Sucking
Touch to lips, tongue, palate
Results to automatic sucking
Palmar grasp
Pressure stimulus against palm
Grasping of object with slow release
0-4 months
Plantar grasp
Pressure stimulus to sole or lowering feet to floor
Curling of toes
0-9 months

11. Reflex Development (ref: O’Sullivan and Siegelman )
STIMULUS
RESPONSE
AGE OF SUPPRE
Tonic labyrinthine reflex
Prone position
Supine position
Maximal flexor tone
Maximal extensor tone
0-6 months
If reflex persist, block rolling from supine due to increased extensor tone
Asymmetric tonic neck reflex
Rotation of head
Extension of face side extremities & flexion of skull side extremities
0-5 months. *If persists, results in scoliosis/hip dislocation; interferes w grasping & hand to mouth activities
Placing reactions
Drag dorsum of foot or back of hand against edge of table
Placing of foot or hand onto to table top
Traction or pull-to-sit
Pull infant to sit from supine
Upper extremities will flex & there will be head lag
Until about 4-5 months
Optical & labyrinthine righting
Body is tilted
Head orients to vertical position
1 month-throughout life

12. Reflex Development (ref: O’Sullivan and Siegelman )
STIMULUS
RESPONSE
AGE OF SUPPRE
Protective extension
Quick displacement of trunk in downward direction while held or while sitting in forward, sideward or backward direction
Extension of legs in downward & extension of arms in the sitting position to catch weight
Downward begins 4 mo
Sideward sitting 6 mos
Forward sitting 7 mos
Backward sitting 9 mos
These reactions persist through life
Body-righting reaction acting on the head
(BOH)
Contact of the body with a solid surface
Head righting with respect to gravity
Interacts with labyrinthine-righting reaction on head to maintain orientation of head in space
Begins at 4-6 months & persists throughout life
Body-righting acting on the body (BOB)
Rotation of head or thorax
Rolling over with rotation between trunk & pelvis
Begins at 6-8 months and persists

13. Reflex Development (ref: O’Sullivan and Siegelman )
STIMULUS
RESPONSE
AGE OF SUPPRE
Symmetrical tonic neck reflex
Extension of cervical spine joints
Flexion of cervical joints
Extension of upper extremities & flexion of lower extremities
Flexion of upper extremities & extension of lower extremities
6-8 months
If reflex persist, may interfere w development of stable quadruped position & creeping
Landau’s reaction
Infant held in ventral suspension
Extension of neck, trunk & hips
4-18 months
Tilting reactions
Slow shifting of base of support or slow displacement of body in space
Lateral flexion of spine toward elevated side of support, abduction of extremities on elevated side; sometimes trunk rotation toward elevated side
Prone 5 mos
Supine 7 mos
8 mos
12 mos
These reactions persist throughout life

14. Reflex Development (ref: O’Sullivan and Siegelman )
STIMULUS
RESPONSE
AGE OF SUPPRESSION
Moro reflex
Sudden extension of the neck
Flexion, abduction of shoulders, extension of elbows  extension, abduction of shoulders, flexion of elbows
Usually also results in crying
Test last!
0-4 months
Startle

17. Plantar Response: Babinski Reflex