Professional Documents
Culture Documents
1
Placing reflex:
Stimulation of the dorsum of the foot of the neonate produces
complete flexion of the same leg. Probably, the easiest way to show this;
and the method used in clinical examination, is to hold the infant upright
and to let the dorsum of the foot touches the lower side of the edge of the
examination table. The infant flexes the leg and appears to do so in order
to place the foot on the table. This reflex is readily demonstrable in the
newborn and persistent failure to elicit it at this stage, is thought to
indicate neurological abnormality. It should fade rapidly in the early
months of life.
Rooting reflex:
Light touch of the cheek or stimulation of the edge of the mouth,
results in turning of the head in the direction of the stimulus and
simultaneous opening of the mouth and extension of the tongue. It is
sometimes called the “cardinal-points reflex” because it is elicited by
stimulation of all four quadrants around the mouth. The reflex appears to
have an adaptive and survival function.
Utilization of the reflex during feeding ensures that the infant takes
the nipple well into his widely opened mouth and so avoids painful
pressure upon the nipple end. Unjustified haste over breast feeding or
other faulty techniques which prevent use of this reflex lead to
incomplete acceptance of the nipple into the infant's mouth and cause
discomfort. The reflex is demonstrable in the newborn period and then
fades during the early months. It has been found valuable to use this
reflex to obtain an indication of the infant's alertness by noting its ease of
elicitation.
2
2. Reflex response to pressure and pain:
Although some of the responses to pressure serve a constructive
and functional role (such as the support reaction), the majority has a
protective and survival value (such as the withdrawal response). Many of
these responses are so well ingrained that only the most profound cerebral
depression inhibits them. For example, the persistent absence of balance
response in the neonatal period indicates severe disturbance and a poor
prognosis during infancy and childhood.
Gallant's reflex:
Firm sharp stimulation along sides of the spine with the fingernails
or a pin produces contraction of the underlying muscles and curving of
the back. This response is easily seen when the infant is held upright and
the trunk movement is unrestricted while the stimulus is applied. It is best
seen in the neonatal period and thereafter gradually fades.
Withdrawal reflex:
A pinprick or other sharp painful stimulus to the sole of foot of an
extended leg, results in uncontrolled flexion and withdrawal of the
stimulated limb. This response should not be confused to tickling.
Positive reaction is normal up to 2 months of age. The protective value of
the reflex is obvious.
3
This reflex is present in the neonate and even in the premature baby. The
reflex gradually fades during the first 6 months but it is difficult to
ascribe a precise time, after which it is no longer seen.
4
Babkin reflex:
The stimulus for this reflex consists of deep pressure applied
simultaneously to the palms of both hands while the infant is in an
appropriate position, ideally supine. The stimulus is followed by flexion
or forward bowing of the head, opening of the mouth and closing of the
eyes. The reflex can be demonstrated in the newborn, thus showing a
hand-mouth neurological link, even at that early stage. It fades rapidly
and normally cannot be elicited after 4 months of age.
Stepping reflex:
Pressure upon the sole of the foot of the neonate causes first
flexion then extension of the leg. As this occurs on alternate side, an
impression is created of automatic of the stepping. It is not true walking;
however, because there is no trunk support or pelvic stability; this is
acquired through the support reflex that develops later. Head position has
been proven to affect the ease of elicitation, strength and duration of the
reflex. The stepping reflex should disappear by 6 months of age. This
reflex sometimes persists for many years in children with cerebral palsy,
merely demonstrating the persistence of a primitive reflex.
5
The reflex is elicited with difficulty in the early months of age and
even when it is obtained; it lasts only within a few brief moments. It
gradually becomes more evident as the stepping reflex fades and by 6
months of age, it should be obtained easily and persists for several
minutes. Failure of this reflex to appear at the right time delays locomotor
development. On the other hand, persistence long after it has served its
purpose is a sign of neurological abnormality and produces characteristic
abnormal gait patterns.
6
3. Reflex responses to kinesthetic stimuli:
Many reflex responses originate from stimuli from the tendons,
muscles and joints. Most of these reflexes are important for the
maintenance of posture and orientation of the body in space.
Tendon reflexes:
These are simple monosynaptic reflexes, which are elicited by a
sudden stretch of a muscle tendon such as occurred when the tendon is
tapped. They are present throughout life and are most useful
diagnostically for the detection of upper motor neuron lesions
(exaggerated response), myopathic conditions (depressed or absent
response) and localization of the segmental lesions of the cord.
7
This is one of the best known and most useful of all the neonatal
reflexes. The afferent stimulus is a sudden movement of the head on the
shoulders, which can be produced in several ways. One way is to allow
the head to drop about 25 mm into the palm of the hand. Another way is
to raise the supine baby a short way from the couch by pulling upon the
hands and then releasing them suddenly. The response consists of wide
abduction of the arms and opening of the hands. Within moments, the
arms come together again. The response often includes tensing of the
back muscles, flexion of the legs and crying.
The response should be symmetrical. Asymmetry indicates a
central or peripheral nervous system lesion or injury to the bones or
muscles of the defective arm. Failure of the arms to move freely or the
hands to open fully indicates hypotonia. Weakness of response occurs
with hypotonia and pre-maturity. The reflex is present at birth and its
persistent absence or asymmetry in a newborn should cause considerable
concern. It fades rapidly and is not normally elicited after 6 months of
age.
8
hand touches the object, the seeds are shown of awareness of distance (at
arm’s length) and eye-hand co-ordination. The reflex fades rapidly and is
not normally seen after 6 months of age. Persistence of the ATNR is the
most frequently observed abnormality of the infantile reflexes in infants
with neurological lesions. Its persistence, usually in an exaggeratedly
strong form, is a clear indication of abnormality of the nervous system
and greatly disrupts development.
9
Similarly, turning of the trunk is followed by reorientation of head
position. These righting reflexes are present early in life and during the
second half of the first year of life, as they reinforce the action of the
visual and labyrinthine righting reflexes. A clear understanding of the
righting reflexes is necessary for the treatment of young children with
central neurological disorders. For example, in the case of a child who
cannot roll sideways, it is necessary to study these reflexes to know
whether it is therapeutically better to rotate the head and have the trunk
follow or vice versa.
10
4. Reflex responses to visual and auditory stimuli:
As our visual and auditory senses are able to receive stimuli from a
distance, they are well equipped to act as warning mechanisms.
Consequently, many of the reflexes produced by visual and auditory
stimuli have a protective and survival value.
Blink reflex:
A bright light suddenly shone into the eyes, a puff of air upon the
sensitive cornea or a sudden loud noise will produce immediate blinking
of the eyes. There may be associated tensing of the neck muscles, turning
of the head away from the stimulus, frowning and crying. These reflexes
are easily seen in the neonate; and continue to be present throughout life.
11
5. Reflex response to labyrinthine stimuli:
The attainment and maintenance of upright postures against gravity
are essential requirements for the successful motor development of the
human infant. The labyrinths are the most important organs concerned
with the development of anti-gravity postures and balance. Movement of
the head in any dimension stimulates the labyrinths; and after the early
weeks of life, it produces the appropriate responses.
12
A series of chain reactions ensue as various reflexes influence the
body position and the attitudes and movements of the limbs. For example,
once an infant can raise his head in the prone position, the way is open for
him to crawl. The sequence is as follows: (Head righting - increases in
strength and extent until shoulders are raised - this facilitates forward
movement of arms - support reflex of arms then enables chest to be raised
- this facilitates raising of pelvis - leads to drawing up of knees - then
support reflex enables pelvis to be raised - as security of support
increases, limbs can be freed in succession to develop an alternating
reciprocal movement - crawling is achieved).
13
B) Postural reactions
2. Equilibrium reactions:
The equalization of opposing forces to maintain balance is attained
by visual, vestibular and other kinesthetic inputs:
a) Visual equilibrium reactions:
Visual equilibrium reactions of the upper extremities appear at 3
months, while those of the lower extremities appear at 4 months. These
visual equilibrium reactions aid in placing, orientation and motion
compensation. The visual equilibrium reactions persist throughout life.
14
b) Vestibular reactions:
* Protective equilibrium reactions: Maturation of these reactions brings
the individual to the human bipedal stage of motor development. They
occur when muscle tone is normalized and provide body adaptation in
response to change of center of gravity in the body. Protective
equilibrium reactions respond to multiple sensory inputs and especially to
vestibular stimuli. They appear between 4 and 18 months and persist
throughout life:
- “Downward protective extension” appears at 4 months.
- “Forward protective extension” appears at 6 months.
- “Sideward protective extension” appears at 9 months.
- “Protective staggering and shifting” appears at 15 to 18 months.
* Tilting equilibrium reactions: They appear between 6 and 21 months
and persist throughout life:
- “Prone tilting reaction” appears at 6 months.
- “Supine tilting reaction” appears at 8 months.
- “Quadruped tilting reaction” appears at 10 months.
- “Standing tilting reaction” appears after 12 months.
15