1. Postural Reflexes, Landau Reflex,  Babinski Reflex, Hands Grasping / Pulling Reflexes.
Part 1
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2. 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”.
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3. Righting/Equilibrium Reactions - Video
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4. Equilibrium reflexes

5. 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
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6. 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
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7. 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
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8. 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
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9. 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
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10. 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
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11. 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
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12. 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
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13. 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
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14. 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
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15. 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
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16. Landau Reflex  

17. 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.
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18. 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.
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19. 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
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20. Primitive Reflex Landau Reflex Superman -Video
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21. 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
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22. 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
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23. 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
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24. Trunk Extension Reflex 

25. 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
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26. 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
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27. Scoring
0 = No Response 1 = Whole body rolls rigidly 2 = Leg is so stiff it begins to lift 3 = Leg remains stiff 4 = Integrated
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28. 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
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29. 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.
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30. 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
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31. 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
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32. 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
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33. 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
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34. 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
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35. 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
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36. Intervention Ideas Work on Moro and TLR first
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37. 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
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38. Parachute Reflex / Reaction - Video
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39. 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
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40. 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
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41. Hands Supporting Reflex

42. 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
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43. 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)
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44. https://maudeleroux.com/
Maude Le Roux, OTR/L, SIPT, IMC
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