PRIMITIVE REFLEXES

BY
DR SONIA SHRIVASTAVA
DEFINITION OF PRIMITIVE REFLEX

These are patterns seen in early stages of development which disappear later on or with
advanced age.
After integration into the CNS , they become part of the motor behaviour , underlying normal
motor control and helps in the development of movement.
Initially lower centers such as spinal cord control these movements later on higher centres
like mid brain and cortex take control over them and dominate the lower ones s thus
integrating them for various voluntary functional task.
Classification

 These primitive reflexes are classified according to the level at which they are controlled.
 Accordingly we have five levels :
 1. spinal cord
 2. brainstem
 3. mid brain
 4. cortex
 5. automatic reflexes
 SPINAL REFLEXES( flexor withdrawal)
POSITION STIMULUS RESPONSE NORMAL SIGNIFICANCE

Supine head in Pinprick to the sole Toes extend, foot 1-2 months Persistence will
neutral position and of the foot dorsiflexes , entire interfere with baby’s
legs extended leg flexes ability to stand and
uncomfortably step
EXTENSOR THRUST

Position Stimulus Response Normal Significance

Supine head Sole of flexed Immediate Present at birth
neutral one leg leg is given extension ,adduct and integrated by
extended and stroking ion and internal 4 months
other flexed rotation of flexed
leg with plantar
flexion of foot
CROSSED EXTENSION

POSITION STIMULUS RESPONSE NORMAL SIGNIFICANC

E

Supine head To the balls of Opposite lower 1-2 month Persistence will
neutral one leg foot of extremity extremity flexes, interfere with
extended and fixed in then adducts and baby’s ability to
other flexed extension extends. stand and step
PLANTAR GRASP

POSITION STIMULUS RESPONSE NORMAL SIGNIFICANC

E

SUPINE WITH Press the sole of The baby 0-9 months If present beyond
LEG EXTENDE the feet below reflexes or claws normal age
the toes toes limits, it
interferes with
child’s ability to
bear weight on
his feet
PALMAR GRASP REFLEX

POSITION STIMULUS RESPONSE NORMAL SIGNIFICANC

E
SUPINE LYING Put finger on The baby will 0-4 months Persistence of
child palm, from fist hand. The this reflex will
ulnar side thumb is across interfere with
the palm of the voluntary grasp
hand and fingers and release
upon the thumb.
The child makes
involuntary
grasp, difficult
to open
SUCKING REFLEX

POSITION STIMULUS RESPONSE NORMAL SIGNIFICANC

E

Any comfortable put finger in the A strong 6-9 months Absent at birth,
position mouth sustained indicates
sucking action neurological
dysfunction,
hypotonia,
immaturity ,
bulbar palsy
ROOTING REFLEX

Position Stimulus Response Normal Significance

Supine or any The corner of the The child turns Upto2 month Absence at birth
comfortable mouth is stroked towards the side of indicate
position stroking neurological
dysfunction,
hypotonia ,
immaturity, bulbar
palsy.
BRAIN STEM LEVEL (ATNR )

Position Stimulus Response Normal Significance

Child is supine, Turning of head Extension of Present at 2 If ATNR is
head neutral and of child towards limbs on face month of age and predominant then
limbs relaxed one side side and flexion integrated by 4to hand to mouth
of limb on the 6 months reaction is
occipital side affected a, hand
coordination is
affected and
midline activity
like rolling over
does not develop
SYMMETRICAL TONIC NECK REFLEX

Position Stimulus Response Normal Significance

Quadripedal The head is either When the head is 4-6 month If persists then the
position flexed or extended in flexion, the chid is unable to
upper limb gets crawl
flexed and lower
lower limb extends,
similarly when the
head is extended
the upper limb
extends and lower
limb goes in to
flexed position
TONIC LABRYNTHINE REFLEX

Position Stimulus Response Normal Significance

Either supine or Position itself is a If child is in Birth to 3-4 months If its is present in
prone stimulus supine, then there supine then lifting
is increase in tone of head, kicking is
in extensor group not possible but
of muscles, and midline activity is
when child is in possible.
prone, then there is If present in prone
increase in tone in then head raising
flexor group of and reaching over
muscles is not possible.
POSITIVE SUPPORTING REACTION

Position Stimulus Response Normal Significance

Hold the child in In erect position , Exaggerated Birth to 3-4 month Persistence
erect position lift him up and extension of the interferes with the
bounce up and lower limbs baby’s ability to lift
down on plinth till his head from the
sole of the foot mat.
touches the plinth
NEGATIVE SUPPORTING REACTION

Position Stimulus Response Normal Significance

Hold the child in Feet touching the Sudden flexion Birth to 4 months Persistence will
weight bearing supporting of lower limbs interfere the
position surface and baby’s ability to
suddenly lift him bear weight
up actively on
extended legs,
assume and
maintain
standing
position.
MID BRAIN REFLEXS (OPTICAL
RIGHTING REFLEX)

Position Stimulus Response Normal Significance

Hold the child Alter body Eyes will always 1-2 yrs till whole If its absent,
from armpit in a position by move to same life interferes with
suspended tipping body in side as head. orientation of
position all directions head to change in
the body posture
and also vision.
LABRYNTHINE HEAD RIGHTING

Position Stimulus Response Normal Significance

Supine position Occulde vision, Head orients to Persists from 2-3 If it is absent it
alter body vertical direction months of age interferes
position by till age. orientation of
tipping body in head to change in
all directions the body posture.
BODY ON NECK

Position Stimulus Response Normal Significance

Supine blind Rotate body to Head turns in 6month to till If absent affects
folded one side line of body. life psoture
BODY ON BODY

Position The trunk and Response Normal Significance

rotation of shoulder follow
pelvis to one direction
side
Blind folded Rotation of pelvis The trunk and 6 months onwards If absent affects
to one side shoulder follow and remain body posture
direction of pelvis. throughout one’s
Its called as life
segmental rolling
CORTICAL LEVEL REFLEX(PROTECTIVE
EXTENSION)

Position Stimulus Response Normal Significance

sitting Displace centre Arms and legs Persists If it is absent , it

of gravity extend and interferes with
outside the base abduct to support the protective
of support and protect the reaction of upper
person from and lower limbs
falling
 EQUILIBRIUM REACTION -TILTING

Position Stimulus Response Normal Significance

Prone Displace the centre of Curvature of the trunk Persists If it is absent, balance
gravity by tilting or to the upward side reactions are not
moving the support along with extension developed
surface gradually and abduction of
extremities on that side
EQUILIBRIUM REACTION –POSTURAL
FIXATION

Position Stimulus Response Normal Significance

Supine , sitting or Applying a Curvature of the Persists If it is absent ,
standing displacing force to trunk towards the balance reactions
the body, altering external force with are not developed.
the centre of extension and
gravity in its abduction of
relation to the base extremities on the
of support side to which force
was applied
AUTOMATIC REACTIONS (MORO’S
REACTION)

Position Stimulus Response Normal Significance

Supine Either sudden loud Sudden abduction Birth to 3-4 months If its present
noise like clapping of upper beyond 6 months
or lift head and let extremities with its is considered
it drop back in extension followed pathological.
extension by flexion and (LMN lesion )
adduction Also affects baby’s
stability and hand
function, rolling
over and
asymmetry of
body.
LANDAU’S REACTION

Position Stimulus Response Normal Significance

Ventral Either active or Hyperextension 3-8 months Beyond 10

suspension passive extension of spine and months its
of neck lower limbs pathological
GALLANTS TRUNK INCURVATUM

Position Stimulus Response Normal Significance

Ventral Stroking para Lateral flexion Birth to 6 months If persistence
suspension spinally from and curvature of seen in athetoid
12th rib to iliac trunk to the side child, may give
crest. of stimulus rise to scoliosis.
Disappearance of
this reflex
suggests trunk
control is
developing
PARACHUTE REFLEX

Position Stimulus Response Normal significance

Child in prone Suddenly lifted Sudden 6month to till Absence shows

position on either by holding extension of whole life cerebellar lesion
plinth ankle or pelvis upper limb
which is in order
to protect head,