1. REFLEXES
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2. Objectives Definition Importance of reflex Classification of Reflexes
Possible Effects if Reflex Persists Abnormally
Inhibition of Primitive Reflexes
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3. 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.
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4. 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.
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5. 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.
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6. 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.
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7. 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
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8. 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.
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9. 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.
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10. 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)
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11. 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.
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12. 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.
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13. 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).

14. 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.
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15. 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
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16. 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)
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17. 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
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18. 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
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19. 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
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20. 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
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21. 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
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22. 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
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23. 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
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24. 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
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25. 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
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26. Rooting Reflex Stimulus: Touch on cheek
Response: Turning head to same side with mouth open
28 weeks of gestation to 3,4 months
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27. 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
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28. 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
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29. Interferes with: Balance reactions in sitting
Protective responses in sitting
Eye – hand coordination, visual tracking
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30. 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
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31. Interferes with: Sitting balance Protective responses in sitting
Eye – hand coordination, visual tracking
Social interaction, attention
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32. 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
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33. Interferes with: Standing and walking
Balance reactions and weight shifting in standing
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34. 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
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35. 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
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36. Inhibition of Primitive Reflexes
Inhibition of Primitive Reflexes
1. Asymmetrical tonic neck reflex (ATNR)
Interfere with?
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37. 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.
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38. 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.
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39. 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.
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40. 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
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41. 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).
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42. Grasp reflex Interfere with → Hand weight bearing,
Volitional grasp and release.
Quadriped , Protective
reaction (Para shot).
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43. Inhibition Hand weight bearing. Quadriped.
RIP (distal key point of control extension, abduction, thumb) (all outward rotation).
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44. Positive supporting reaction:
Interfere with  Walking
Sitting.
Balance from standing.
Weight shift.
Rolling From upper limb
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45. 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).
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46. 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. -
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47. Inhibition Pressure on medial tibial plateau.
ES one electrode on head of fibula and the other on tendon of dorsiflexors (in front of ankle).
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48. More reflex Interfere with  Rolling Eye hand coordination
Balance and equilibrium from sitting position.
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49. 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.
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50. Assignment -How to inhibit Moro reflex - How to Stimulate dorsiflexors
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