REFLEXES 9/4/2019 dr.somaia ali

Objectives Definition Importance of reflex Classification of Reflexes Possible Effects if Reflex Persists Abnormally Inhibition of Primitive Reflexes   9/4/2019 dr.somaia ali

Reflex An involuntary movement in a part excited in response to stimulus applied to the periphery and transmitted to the nervous centers in the brain or spinal cord. 9/4/2019 dr.somaia ali

Importance of reflex 1) They influence the child development as the reflex integration is essential in normal development. Response to reflexes prepares the infant for progressive development such as rolling over, sitting crawling, standing … etc. 9/4/2019 dr.somaia ali

Importance of reflex 2) They provide useful diagnostic sign. The reflex indicate abnormality by their weakness, absence, excessive strength or persistence to an appropriate age. 9/4/2019 dr.somaia ali

Importance of reflex 3) They can be use therapeutically, some reflexes are utilized in therapeutic programs for children with development disorders, for example: Postural reflexes in used to promote the up right posture.   9/4/2019 dr.somaia ali

Classification of Reflexes 1) According to their function e.g.: rooting. (2) According to their time of appearance e.g. primary and secondary reflexes. (3) According to type of stimulus 9/4/2019 dr.somaia ali

Classification of Reflexes reflexes response to pressure and pain e.g. gallant's reflex, stepping, reflex. Reflexes response to kinesthetic stimuli e.g. * Asymmetrical tonic neck reflex. * Symmetrical tonic neck reflex. * Moro reflex. * Head righting on body. * Body righting on body. Reflexes response to visual and auditory stimuli e.g. optical righting Reflexes response to labyrinthine stimuli e.g. labyrinthine righting, tonic labyrinthine. 9/4/2019 dr.somaia ali

Classification of Reflexes (4) According to the level of central nervous system maturations e.g. * Spinal reflexes: Are mediated by areas of C.N.S. Deiters nucleus in lower third of the pons. Are phasic or movement reflexes which coordinate muscle of the extremities in pattern either total flexion or extension. e.g. flexor withdrawal reflex. 9/4/2019 dr.somaia ali

Classification of Reflexes * Brain stem reflexes. (basal ganglia) Are "static" postural reflexes effect changes in distribution of muscle tone through out the body either in response to change of position of head and body in space (by stimulation of labyrinthine) or in head relation to the body (by stimulation of proprioceptors of the neck muscles. e.g. - Asymmetrical T.N.R., - Symmetrical S.T.N.R, - Tonic labyrinthine reflex (supine or prone) 9/4/2019 dr.somaia ali

Classification of Reflexes * Mid brain level: Above red nucleus, not including cortex Righting reaction  relation of head and body in space as well as to each other. e.g. Neck righting/ body righting acting on body.   9/4/2019 dr.somaia ali

Classification of Reflexes Automatic movement reactions. Produced by change in the position of the head and involve either semicircular canals or labyrinths or neck preceptors. e.g. Moro, protective extensor thrust. 9/4/2019 dr.somaia ali

Classification of Reflexes * Cortical level: Efficient interaction of cortex, basal ganglia and cerebellum. Maturation of equilibrium reactions brings the individual to the human bipedal stage of motor development e.g. equilibrium (supine, prone, semi kneeling etc).

Classification of Reflexes (5) According to their relation to the normal sequence of motor development. * A pedal (primitive, lower brain stem level. (prone – supine lying). Quadripedal (mid brain level) Righting reaction, crawling sitting. Bipedal (cortical level) standing, walking. 9/4/2019 dr.somaia ali

Infant Reflexes and Possible Effects if Reflex Persists Abnormally. Primitive reflex Asymmetrical Tonic Neck Reflex (ATNR) Stimulus: Head position, turned to one side Response: Arm and leg on face side are extended, arm and leg on scalp side are flexed, spine curved with convexity toward face side. Normal age of response: Birth to 6 months 9/4/2019 dr.somaia ali

Possible negative effect on movement Interferes with: Feeding Visual Tracking Midline use of hands Bilateral hand use Rolling Development of crawling Can lead to skeletal deformities (e.g., scoliosis, hip subluxation, hip dislocation) 9/4/2019 dr.somaia ali

Symmetrical Tonic Neck Reflex (STNR) Stimulus: Head position, flexion or extension Response: When head is in flexion, arms are flexed, legs extended. When head is in extension, arms are extended, legs are flexed Normal age of response: up to 6 months 9/4/2019 dr.somaia ali

Ability to prop on arms in prone position Interferes with: Ability to prop on arms in prone position Attaining and maintaining hands - and – knees position Crawling reciprocally Sitting balance when looking around Use of hands when looking at object in hands in sitting position 9/4/2019 dr.somaia ali

Tonic Labyrinthine Reflex (TLR) Stimulus: Position of labyrinth in inner ear – reflected in head position Response: In the supine position, body and extremities are held in extension; in the prone position, body and extremities are held in flexion Normal age of response: Birth to 6 months 9/4/2019 dr.somaia ali

Interferes with: Ability to initiate rolling   Interferes with: Ability to initiate rolling Ability to prop on elbows with extended hips when prone Ability to flex trunk and hips to come to sitting position from supine position Often causes full body extension, which interferes with balance in sitting or standing 9/4/2019 dr.somaia ali

Stimulus: Touch to skin along spine from shoulder to hip Galant Reflex Stimulus: Touch to skin along spine from shoulder to hip Response: Lateral flexion of trunk to side of stimulus Normal age of response: 30 weeks of gestation to 2 months Interferes with: Development of sitting balance can lead to scoliosis 9/4/2019 dr.somaia ali

Stimulus: Pressure in palm on ulnar side of hand Palmar Grasp Reflex Stimulus: Pressure in palm on ulnar side of hand Response: Flexion of fingers causing strong grip. Normal age of response: Birth to 4,5 months 9/4/2019 dr.somaia ali

Ability to grasp and release objects voluntarily Interferes with: Ability to grasp and release objects voluntarily Weight bearing on open hand for propping, crawling, protective responses 9/4/2019 dr.somaia ali

Stimulus: Pressure to base of toes Response: Toe flexion Plantar Grasp Reflex Stimulus: Pressure to base of toes Response: Toe flexion Normal age of response: 28 weeks of gestation to 5 months 9/4/2019 dr.somaia ali

Ability to stand with feet flat on surface Interferes with: Ability to stand with feet flat on surface Balance reactions and weight shifting in standing 9/4/2019 dr.somaia ali

Rooting Reflex Stimulus: Touch on cheek Response: Turning head to same side with mouth open 28 weeks of gestation to 3,4 months 9/4/2019 dr.somaia ali

Oral – motor development Development of midline control of head Interferes with: Oral – motor development Development of midline control of head Optical righting, visual tracking, and social interaction 9/4/2019 dr.somaia ali

Moro Reflex Stimulus: Head dropping into extension suddenly for a few inches Response: Arms abduct with fingers open, then cross trunk into adduction; cry Normal age of response: 28 weeks of gestation to 5,6 months 9/4/2019 dr.somaia ali

Interferes with: Balance reactions in sitting Protective responses in sitting Eye – hand coordination, visual tracking 9/4/2019 dr.somaia ali

Startle Reflex Stimulus: Loud, sudden noise Response: Similar to Moro response but elbows remain flexed and hands closed Normal age of response: 28 weeks of gestation to 5 months 9/4/2019 dr.somaia ali

Interferes with: Sitting balance Protective responses in sitting Eye – hand coordination, visual tracking Social interaction, attention 9/4/2019 dr.somaia ali

Positive Support Reflex Stimulus: Weight placed on balls of feet when upright Response: Stiffening of legs and trunk into extension Normal age of response: 3 to8 months 9/4/2019 dr.somaia ali

Interferes with: Standing and walking Balance reactions and weight shifting in standing 9/4/2019 dr.somaia ali

Walking (Stepping) Reflex Stimulus: Supported upright position with soles of feet on firm surface Response: Reciprocal flexion/extension of legs Normal age of response: 38 weeks of gestation to 3 months 9/4/2019 dr.somaia ali

Balance reactions and weight shifting in standing Interferes with: Standing and walking Balance reactions and weight shifting in standing Development of smooth, coordinated reciprocal movements of lower extremities 9/4/2019 dr.somaia ali

Inhibition of Primitive Reflexes   Inhibition of Primitive Reflexes 1. Asymmetrical tonic neck reflex (ATNR) Interfere with? 9/4/2019 dr.somaia ali

Inhibition (1) Positioning (avoid supine lying position). Sided lying (prevent stimulus) Quadruped (prevent response). (2) Prevent the stimulus. Maintain head in mid – position. (3) Break pattern of response. 9/4/2019 dr.somaia ali

Inhibition RIP  head and proximal key point of shoulder by opposite the response  on face side make flexion in upper and lower limb, on occipit side make extension in upper and lower limb. (4) Facilitation of rolling. (5) Facilitation of righting and equilibrium reaction. (6) Facilitation of head control. 9/4/2019 dr.somaia ali

Tonic labyrinthine supine TLS and Tonic labyrinthine prone (TLP). Interfere with. TLS  pull to sit and rolling TLP  prone hand support or prone on hand. 9/4/2019 dr.somaia ali

Inhibition (1) Positioning: TLS  Avoid supine lying position  position on prone lying, side lying, quadriped. TLP  Avoid prone position Position on supine, side lying, quadriped. (2) Prevent the stimulus: TLS  position on prone lying TLP  position on supine lying 9/4/2019 dr.somaia ali

Inhibition (3) Break the pattern of response: TLS  RIP to break the extension in upper limb (all inward rotation) and in lower limb (all out word rotation). TLP  Reflex inhibiting pattern to break the flexion in upper limb (bilateral extension diagonal) and on lower limb (all in ward rotation). 9/4/2019 dr.somaia ali

Grasp reflex Interfere with → Hand weight bearing, Volitional grasp and release. Quadriped , Protective reaction (Para shot). 9/4/2019 dr.somaia ali

Inhibition Hand weight bearing. Quadriped. RIP (distal key point of control extension, abduction, thumb) (all outward rotation).   9/4/2019 dr.somaia ali

Positive supporting reaction: Interfere with  Walking Sitting. Balance from standing. Weight shift. Rolling From upper limb 9/4/2019 dr.somaia ali

Inhibition (1) Positioning  sitting on roll Quadriped. (2) Break the pattern of response - RIP (distal key point of control  extension. of lateral 3 toes). (Proximal key point of control  all outward rotation. (Proximal key point of control  flexion, abduction, external rotation hip). 9/4/2019 dr.somaia ali

Inhibition (3) Stimulation of dorsiflexors: HVG.S  on spastic and  intensity  strong tetanic contraction, until occur muscle fatigue. - Faradic  on antispastic muscle. - Painful stimuli on sole of foot. - Tapping on tendon of dorsi flexors. - 9/4/2019 dr.somaia ali

Inhibition Pressure on medial tibial plateau. ES one electrode on head of fibula and the other on tendon of dorsiflexors (in front of ankle). 9/4/2019 dr.somaia ali

More reflex Interfere with  Rolling Eye hand coordination Balance and equilibrium from sitting position. 9/4/2019 dr.somaia ali

Inhibition Positioning: Hand weight bearing quadruped, side lying. - Facilitation of head control. - Facilitation of rolling. - Facilitation of' protective reaction (Para shot). - RIP (Proximal key point of control  flexion head.   9/4/2019 dr.somaia ali

Assignment -How to inhibit Moro reflex - How to Stimulate dorsiflexors 9/4/2019 dr.somaia ali