PRIMITIVE REFLEXES

PRIMITIVE REFLEXES
 Dominant form of movement for last 4 months
prenatally and first 4 months postnatally.
 Primitive reflexes critical for human survival.
 Postural reflexes believed to be foundation for
later voluntary movements.
 Appearance and disappearance helpful in
diagnosing neurological disorders.
 Introduction of Reflex

 A reflex is an involuntary muscular response to

a sensory stimulus.
 The presence and strength of a reflex is an
important indication of neurological
development and function.
 Many of the infantile reflexes disappear as the
infant matures, though some remain
throughout adulthood.
 The Theory Behind Integration

 As the CNS develops, reflexes are either

integrated or transformed. If this does not
occur, these reflexes will interfere with
subsequent development and may be an
indication of neurological damage.
 About 70 primitive reflexes have been
discovered.
 These are many different reflexes that can be
integrated and the reflexes that need to be
integrated will be dependent on the individual
child.
Reflexive movements occur during the last 4
months of prenatal life and the first 4 months
after birth
 Reflexes occur sub cortically (below the
level of the higher brain centers)
 E.g., palmer grasp
Many of the reflexes do not completely
disappear
 First, they are inhibited by the
maturing nervous system
 Second, they are integrated into new
movement behaviors
 Classification of Reflexes

 According to their function

 Some reflexes are protective and have a

survival value i.e. reflex saving life.
 Other promote appropriate orientation
for feeding i.e. rooting reflex.
 Other promote postural control and
balance.
 According to level of CNS mature

 Spinal level reflexes

 Brain stem level reflexes
 Mid brain level reflexes
 Automatic movement reactions
 Cortical level reflexes
 Spinal level reflexes
 1- flexor withdrawal reflex
 2- extensor thrust
 3- crossed extension
 They are mediated by areas of the CNS Deiters
nucleus which is the lower 1/3 of pons.
 They are ‘’phasic’’ or ‘’movement ‘’reflexes
which coordinate muscles of extremities in
patterns of either total flexion or extension.
 Complete domination of these primitive spinal
reflexes results in an apedal (prone-supine
lying) creature.
 Brain stem level reflexes

 1- ATNR
 2- STNR
 3- Tonic labyrinthine reaction
 4- positive supporting reaction
 5- negative supporting reaction
 They are mediated by areas from the Deiters
nucleus to the red nucleus which is at the most
caudal level of basal ganglia.
 They are static postural reflexes.
Mid brain level reflexes or Righting reactions
 1- Neck righting
 2- Body righting
 3- Labyrinthine righting acting on head (different
position)
 4- Optical righting (different position)
 They are integrated at the midbrain level above the red
nucleus, not including cortex.
 They interact with each other and work toward
establishment of normal head and body relationship in
space as well as in relation to each other.
 Their combined actions enable the child to roll over, sit
up, get on hands and knees, and make him a
qudripedal creator.
 Automatic movement reactions

 1- Moro reflex
 2- Landau reflex
 3- Parachute reaction ‘’protective extensor
thrust’’
 They are group of reflex observed in infants
and young children which are not strictly
righting reflexes, but reaction produced by
changes in position of head, including
semicircular canal, labyrinths or neck
proprioceptor.
 Cortical level reflexes or equilibrium
reactions
 They are highely integrated and complex mechanism
which are automatic response to changes in posture
and movements aimed to- restore balance.
 It can be done in various positions:
 -supine
 -prone
 -quadruped
 -sitting
 -kneeling
 -standing
 -squatting
 According to their time of appearance

 Primitive reflexes which are present at

birth and then fade on (disappear).

 Postural reflexes which play an

important role in regulating tone.
 PRIMITIVE REFLEXES
 ATNR
 STNR
 Moro reflex
 Tonic Labyrinthine reaction
 Galant reaction
 Palmar grasp
 Planter grasp
 Sucking reflex
 Rooting reflex
 Swallowing reflex
 Search, startle reflexes
 Babinski reflex
 Palmar Mandibular and palmar Mental
 Asymmetrical Tonic Neck Reflex
Stimulus S:passively turned the head 90
Respons degree to one side.
e R:increase flexor tone-
facial side
increase extensor tone-occipital
side
Duration After birth – 3 months
Stimulus / S: Baby sitting up and tip forward
Response R: Neck and arms flex, legs extend
S: Baby sitting
up and tip backward R: Neck and
arms extend, legs flex
Duration After birth – 3 months
 Moro reflex
Stimulus S: dropping the baby’s head
Respons backwards from semi sitting position.
e R:
sudden abd of upper extremities with
ext followed by flex and add.
Duration After birth- 3 months
 Tonic labyrinthine reaction prone- supine
Stimulus S: position itself ( supine – prone).
Respons R:
e supine- increase ext tone
prone- increase flex tone
Duration After birth – 3 months.
 Galant reaction
Stimulus S: stroke paravertebraly with one
Respons finger, the body will curves. The
e concavity of the pelvis proceed
toward the direction of the stimulus
given.
R: The leg and arm ipsilateral will be
stretch and the contra lateral will be
curve.
Duration Disappear in 2-3 months.
 Palmar grasp
Stimulus S: apply pressure on the palm of the
Respons hand from ulnar side.
e R: finger flexion with
strong grip.
Duration After birth- 3 months.
 Plantar grasp
Stimulus S: apply strong pressure on the ball of
Respons the foot.
e R: flexion of the toes.
Duration After birth- 10 months.
Stimulus / S: touch of lips
Response R: sucking action
Duration After birth – 3 months.
 Rooting reflex

Stimulus S: touch around the lips.

Respons R: turning of head,
e lower lip and the tongue on the side of
the stimulus.
Duration After birth – 3 months.
 Swallowing reflex
Stimulus S: touch of lips.
Respons R: will try to swallowing
e than, followed by sucking.
Duration After birth – 3 months.
Stimulus / S: touch cheek
Response R: head moves toward stimuli
Duration After birth – 3 months.
Stimulus / S: dropping the baby’s head backwards
Response from semi sitting position.
R: Arms and legs flex.
Duration 2-3 months after Moro disappears – 1 year
Stimulus / S: Stroke bottom or lateral portion of foot
Response R: Great toe turns downward and
flattening of the toes.
Duration Birth – 4 months
Stimulus / S: Pressure to both palms or hair to hand
Response R: Eyes close, mouth opens,
and/or neck flexes (which tilts the head
forward)
Duration Birth – 3 months
Stimulus / S: Scratch base of palm
Response R: Lower jaw opens and closes
Duration Birth – 3 months
 POSTURAL REFLEXES
 Head and Body Righting reactions
 Optical righting reactions( different position)
 Labyrinthine righting acting on head (different position)
 Flexor withdrawal reflex
 Crossed extension
 Extensor thrust
 Positive supporting reaction
 Negative supporting reaction
 Landau reflex
 Parachute reaction
 Equilibrium reactions (different position)
 crawling, swimming reactions
 Pull Up
 stepping
Stimulus / S: Supine, turn body in either direction
Response R: Head “rights” itself with the body
S: Supine, turn head in either direction
R: Body “rights” itself with the head
Duration Head:1-6 months; Body: 5 months-1 year
 Neck righting
Stimulus S: turn the head to one side
Respons R: body rotate on the same side
e
Duration After birth – 6 months.
 Body righting
Stimulus S: turn the head to one side actively
Respons or passively.
e R: segmental rolling on turn
side
Duration 6 months- 4 years.
 Optical righting
Stimulus / S: Baby held upright, tilted in different
Respons directions (right and left).
e Baby held supine and prone suspension,
tilted in downward direction.
R: Baby tilts head in opposite direction
(neutral). Eyes are parallel to the surface.
Duration 2-3 months – 1 year
 Labyrinthine righting reaction
Stimulus / S: Blind fold baby held upright, tilted in
Respons different directions (right and left).
e Blind fold baby held supine and prone
suspension, tilted in downward direction.
R: Baby tilts head in opposite direction
(neutral). Eyes are parallel to the surface.
Duration 2-3 months – 1 year
 Flexor withdrawal reflex

Stimulus S:applied to the sole of the foot.

Respons R:
e uncontrolled flex of the hip and knees.
Duration After birth – 2 months to life long
 Crossed extension
Stimulus S: one leg ext and other leg flex, than
Respons passively flex the ext leg.
e R: ext of opp leg
with add and int rotation.
Duration After birth- 2 months
 Extensor thrust
Stimulus S: one leg ext and other leg flex,
Respons apply pressure on the ball of the foot
e of flex leg.
R: uncontrolled ext of same leg.
Duration After birth- 4 months
 Positive supporting reaction
Stimulus S: lift him up and bounce up and
Respons down on plinth till sole of the foot
e touches the plinth.
R: exaggerated ext of
the lower limbs.
Duration After birth – 3 to 4 months.
 Negative supporting reaction
Stimulus S: lift him up and bounce up and
Respons down on plinth till sole of the foot
e touches the plinth.
R: sudden flex of the
lower limbs.
Duration After birth – 4 months.
 Landau reflex

Stimulus S: active or passive ext of the neck in

Respons ventral suspension.
e R: Hyperextension of
spine and lower limbs.
Duration 3 – 8 months.
 Parachute reflex
Stimulus S: suddenly lifted either by holding
Respons ankle or pelvis in prone position.
e R: sudden
ext of upper limb
Duration 6 months – life long
 Equilibrium reactions
Stimulus S: pushing the child from the static
Respons posture in different positions by using
e balance board.
R: -protective ext of the
lowered side
-Abd and ext of the raised side
limbs with flex of the trunk.
Duration Prone-6 months to life long
Supine- 8months to life long
Quadruped- 8 to 10 months
Sitting- 8 to 10 months
Kneeling- up to 15 months
Stimulus / S: Prone position on surface, stroke
Response alternate feet
R: Legs and arms move in crawling action
Duration Birth – 3-4 months
Stimulus / S: Infant held horizontally
Response R: Arms and legs move in
coordinated swimming type action
Duration 2 weeks after birth – 5 months
Stimulus / S: Sitting/standing, hold hands, tip in one
Response direction
R: Arms flex or extend in to maintain
upright position
Duration 3 months – 1 year
Stimulus / S: Infant upright with feet touching surface
Response R: Legs lift and descend
Duration After birth – 5-6 months
 References

 1- Sussan B O’sullevan
 2- Anne Shumway cook
 3- Suzzan K Campbell
 4- Glady Samuel Raj