1. The Symmetrical Tonic neck Reflex (STNR) and Leg Cross Flexion / Extension
Do not use or distribute without written permission.

2. Symmetrical Tonic Neck Reflex
Head flexion causes arms to bend causing a tendency for legs to extend – Quadruped position
Gravity center shifts in the direction of the upper core and head
Head extension causes arm extension and leg flexion
Gravity center shifts in direction of the lower core and lower limbs
18th week in utero
Continues to develop after birth
Active from 6th to 10th month of infant life
Fully integrated by 10th to 11th month
Helps the baby to defy gravity by getting up from the floor
Do not use or distribute without written permission.

3. Influences on Development
Bilateral patterns of body movement
Effectively divides the body in half at the horizontal midline – breaking up the TLR at the pelvic line
Information processing right and left hemispheres
Crawling on all fours in cross-lateral style
Calming down the body motion activity, freezing reaction, activate perception of seeing and hearing
Standing up in vertical position
Coordination Front-Back and Up-Down to help create coordination between vestibular, proprioceptive, and vision systems.
Feeling balanced, in equilibrium
Perception of space, depth, and time orientation
Do not use or distribute without written permission.

4. Crawling inhibited by active STNR
Rather look like they “bear” walk on hands and feet
Shuffle on their bottoms
Simply pull themselves up to standing and walking
Crawl in unusual fashions: hands rotated outwards, locking elbows, feet may be raised
Upper and lower will be out of sync – not quite match
Do not use or distribute without written permission.

5. Vision Important role in binocular vision and binaural hearing
At birth vision extends out to about 6.7 inches/17cm.
During development of ATNR, distance of focus grows to length of outstretched hand
6th month of life – focus near and organize vision at far distance
Head extension encourages “fixating” eyes at far-distance
Head flexion brings about near distance
Essential for eyes learning to cross midline – focus from one hand to the other – later reading and following hand in handwriting
Do not use or distribute without written permission.

6. Symptoms Poor posture Tendency to “slump” when sitting
Simian “ape” like walk
“W” sitting
Poor eye-hand coordination
Messy eater
“clumsy child” syndrome
Difficulties with readjustment of binocular vision
Slow at copying tasks
Difficulty learning to swim, or unsynchronized movements
Do not use or distribute without written permission.

7. Non-integrated Slide on bottom to move around
Go from seated to rising up on both legs and walking, omitting crawling
Academic Issues: reading, writing, art, music, copying from the board
Poor body posture – may sit like a sack of potatoes
Suporting head with hand during table top work – can obstruct breathing
Reactivity between head and muscles of the hands, arms and upper back
ADHD – discomfort and fatigue sitting with limbs bent and standing with limbs straight
Poor balance, depth perception, spatial and temporal awareness
Problems with athletics, social issues (underachievement, frustration, avoidance)
Do not use or distribute without written permission.

8. Things you can look for
Anchoring feet behind chair legs controls the urge to straighten legs when arms are bent
Bending legs to sit causes arms to straighten
Sitting up straight with both legs and arms flexed is too uncomfortable
Reading and writing are easier on the floor with legs extended
W-sitting
Poor eye-hand coordination
Rotated pelvis almost always indicates active reflex
Discrepancy between upper and lower limb ability.
Do not use or distribute without written permission.

9. Symmetrical Tonic Neck Reflex 

10. Assessment Four point kneeling or “table” position
Asked to maintain position, but slowly move the head to look down “as if looking at your thighs”
Hold position for up to 5 secs
Slowly move the head upwards as if “looking at the ceiling”
Repeat 3 to 6 times.
Check for hand and finger position – no locking of elbows with hands turned in-or outward – no cupped fingers
Do not use or distribute without written permission.

11. Scoring
0 = No response
1 = Bending of the arms to the floor, or movement of the bottom back onto the ankles, so that the client is sitting in the “cat position”
2 = Bending of the arms on head flexion or movement of the bottom back on head extension
3 =Movement of the elbow on either side and / or definite movement in the hips, or arching of the back.
4 = Integrated
Do not use or distribute without written permission.

12. Symmetrical Tonic Neck Reflex (STNR): "The Stretching Cat” - Video
Do not use or distribute without written permission.

13. Intervention Ideas
Rocking in prone position helps to inhibit and get ready to crawl
Crawling, all 4’s position with projected action sequences, over different surfaces
Vision up/down tasks while in movement
Passing ball through legs to back and taking it from overhead again (with play partner)
Jumping jacks
Supine flexion hold/“egg hold”/“meatball”
Ball kicks
SWINGS! Trapeze, bolster, moon swing
Climbing: ladder, rope, rock wall
Crawling: over cushions, through tunnels
Wheelbarrow walk
Animal walks
Prone over ball with hands down
Work in quadruped
Cat arches
Somersault rolling
Push ups on hands and knees
Creeping on hands and knees
Provide a sloping or tilted desk surface
Do not use or distribute without written permission.

14. Rocking Balance Child in prone, pushes up to elbows
Proceed to straighten arms while pushing upper body back over hips
Stay in position 5 to 10 seconds
Then retreat back onto elbows, then to prone position again
Repeat as clinically judged necessary
Apply grading through pressure / resistance
Follow up with crawling activity
Do not use or distribute without written permission.

15. Leg Cross Flexion / Extension
When you touch the center of the infant’s foot with your finger, the opposite leg should first flex with abduction, then adduct, and lastly fully extend
At level of medulla oblongata
Emerges at 28th week in utero
Active up to 2nd month of infant’s life, when it also integrates
Influences homolateral movement, cross lateral movement, gross motor coordination (gravity, grounding, stability, and balance)
Intentional movement as seen walking, running, jumping, and sport activities
Do not use or distribute without written permission.

16. Leg Cross Flexion / Extension 

17. When Non-integrated Hyperactivity in movement and behavior
Chronic leaning to one side (gravity influence)
Creates stress and inability to coordinate the movements in the midline
Excessive muscle tension creates fatigue and inefficient motor control
Affects leg differentiation, skipping, walking, jumping
Do not use or distribute without written permission.

18. Cross Extension Reflex -Video
Do not use or distribute without written permission.

19. https://maudeleroux.com/
Maude Le Roux, OTR/L, SIPT, IMC
Websites
Facebook
LinkedIn
Blog
Do not use or distribute without written permission.