1. NEUROPEDIATRIC EXAMINATION
PRIMITIVE REFLEXES

2. Why is the study of infant reflexes important?
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.

3. INTRODUCTION
The Central Nervous System (CNS) is the control center for all thinking, learning, and moving. The development of an efficient CNS is complex yet a certain amount is understood.
There are many factors which contribute to a person being able to move well, speak fluently, play and develop the skills necessary for every day living and learning.
The development of the CNS commences from conception, develops in a regular sequence and is the same for all humans regardless of cultural influences.

4. PRIMITIVE REFLEXES
- Survival reflexes occurring sequentially in the first few weeks of fetal development
- Automatic, stereotyped movements, directed by a very primitive part of the brain (brainstem).
- executed without involvement of higher levels of the brain (the cortex).
- Ideally short lived and as each fulfils its function is replaced by more sophisticated structures (Postural Reflexes) which are controlled by the cortex
- Considered aberrant and evidence of an immaturity within the CNS if present beyond their time.

5. Importance of Infant Reflexes
Reflexive movements occur during the last 4 months of prenatal life and the first 4 months after birth
Reflexes occur subcortically (below the level of the higher brain centers)
E.g., palmer grasp

7. Infant vs. Lifespan Reflexes
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

8. Role of the Reflexes in Survival
Infant reflexes are called primitive reflexes
Asymmetric tonic neck reflex
Symmetric tonic neck reflex
Moro reflexes
Startle reflex
Primitive reflexes are repressed by 6 months of age
Primitive reflexes are important for
Protection
Nutrition
Sucking reflex
Rooting reflex
Survival
Labyrinthine reflex

9. Role of Reflexes in Developing Future Movement
Postural reflexes
Prevalent belief: automatic movement is “practice” for future voluntary movement
Other experts believe these reflexes may not be related to future motor development
Emanate from higher brain centers
These reflexes disappear when voluntary behavior surfaces

10. Role of Reflexes in Developing Future Movement
When the stepping reflex is stimulated, walking may begin at an earlier age
Link between stimulation of the reflex preceding the disappearance phase and early movement
Small amounts of practice can lead to significant results

11. Role of Reflexes in Developing Future Movement
Infant Reflex
Future Voluntary Movement
Crawling
Labyrinthine
Upright posture
Palmar grasp
Grasping
Stepping
Walking

12. Reflexes as Diagnostic Tools
Can help determine the level of neurological maturation
Reflexes are age-specific in normal, healthy infants
Moro reflex
May signify a cerebral birth injury if lacking or asymmetrical
Asymmetric tonic neck reflex
May indicate cerebral palsy or other neurological problem

13. Reflexes as Diagnostic Tools
Concern when lacking, weak, asymmetrical or persisting
Moro
Cerebral birth injury
Asymmetric tonic reflex
Cerebral palsy; other neural damage

14. Reflexes as Diagnostic Tools
Development Examination
Measures several infant reflexes from birth to 24 months
Purpose: develop profile of child’s movement in relation to what is expected at a specific age
Useful in determining motor delay

15. PRIMITIVE REFLEXES
Galant
Palmar Grasp
Sucking
Search
Moro
Startle
Asymmetric Tonic Neck
Symmetric Tonic Neck
Plantar Grasp
Babinski
Palmar Madibular
Palmar Mental
POSTURAL REFLEXES
Stepping
Crawling
Swimming
Head and Body Righting
Parachuting
Labyrinthine
Pull Up

16. GALANT REACTION
If the child is stroke para-vertebrally with one finger, the body will curves
The concavity of pelvis proceed toward the direction of the stimulus given.
The leg and arm ipsilateral will be strach, and the contralateral will be curve
Syn: Spinal reaction
Disappear in 2-3 months
Patologic: dissapear  Spinal medulla lesion, CNS depression

17. MORO REFLEX Palm of hand lifts back of head
Hand is removed suddenly so that head begins to fall
Head is supported
Moro reflex precedes the startle reflex and causes the arms and legs to extend immediately rather than flex
Duration: prenatal 4-6 months postpartum
Patologic: disappear  CNS depression, persists  RM, CNS dysfunction, delay sitting/head control, asymmetrical  injury to one side of brain, parese plexus brachialis, fracture clavicula/humerus

18. ASYMMETRIC TONIC NECK REFLEX
Synonim: bow and arrow or fencer’s position
Causes flexion on one side and extension on the other
Not always seen in newborn
Facilitates the development of bilateral body awareness
Duration: after birth-3 months
Patologic: persist  Cerebral palsy

19. PALMAR GRASP
The palmar grasp reflex is one of the most noticeable reflexes to emerge
Appears in utero
Endures through the 4th month postpartum
Negative palmer grasp: neurological problems (spasticity)
Leads to voluntary reaching and grasping

20. PLANTAR GRASP The toes appear to be grasping
Stimulus is touching the ball of the foot
This reflex must disappear before the baby can stand or walk
Duration: birth-1 years
Patologic: negative  medula spinalis lesion, perifer nervous system lesion (must disappear before the baby can stand or walk)

21. POSTURAL REFLEXES: Parachuting Reflexes
Propping reflexes
Related to upright posture
This reflex is a conscious attempt to break a potential fall
Duration: 4 months-1 years
Patologic: (-) CP, asymetris  neuromusculer/orthopaedi dysfunction

22. Thank You !

23. Primitive Reflexes ~ Sucking
Stimulus / Response
S: touch of lips R: sucking action
Duration
In utero - 3 months postpartum
Concerns
No reflex problematic for nutrition
Other
Often in conjunction with searching reflex

24. Primitive Reflexes ~ Search
Stimulus / Response
S: touch cheek R: head moves toward stimuli
Duration
Weeks prenatal - 3 months postpartum
Concerns
No reflex problematic for nutrition
No reflex or lack of persistence may be sign of CNS or sensorimotor dysfunction.
Other
Often in conjunction with sucking reflex. Contributes to head/body-righting reflexes.

25. Primitive Reflexes ~ Startle
Stimulus / Response
S: Same as Moro R: Arms and legs flex
Duration
2-3 months after Moro disappears – 1 year
Other
Less severe startle reflexes elicited through lifespan

26. Primitive Reflexes ~ Symmetric Tonic Neck
Stimulus / Response
S: Baby sitting up and tip forward 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
Concerns
Persistence may impede many motor skills and cause spinal flexion deformities

27. Primitive Reflexes ~ Babinski
Stimulus / Response
S: Stroke bottom or lateral portion of foot R: Great toe turns downward
Duration
Birth – 4 months
Concern
Test of the pyramidal tract (i.e. ability to perform conscious / voluntary movement)

28. Primitive Reflexes ~ Palmar Mandibular
Stimulus / Response
S: Pressure to both palms or hair to hand R: Eyes close, mouth opens, and/or neck flexes (which tilts the head forward)
Duration
Birth – 3 months
Other
Also called the Babkin reflex

29. Primitive Reflexes ~ Palmar Mental
Stimulus / Response
S: Scratch base of palm R: Lower jaw opens and closes
Duration
Birth – 3 months

30. Postural Reflexes ~ Stepping
Stimulus / Response
S: Infant upright with feet touching surface R: Legs lift and descend
Duration
After birth – 5-6 months
Concerns
Essential forerunner to walking
Other
Sometimes called walking reflex
Developmental changes in reflex over time

31. Postural Reflexes ~ Crawling
Stimulus / Response
S: Prone position on surface, stroke alternate feet R: Legs and arms move in crawling action
Duration
Birth – 3-4 months
Concerns
Precursor to later voluntary creeping

32. Postural Reflexes ~ Swimming
Stimulus / Response
S: Infant held horizontally R: Arms and legs move in coordinated swimming type action
Duration
2 weeks after birth – 5 months
Other
Recognition of reflex led to popularity of infant swim programs

33. Postural Reflexes ~ Head and Body Righting
Stimulus / Response
S: Supine, turn body in either direction 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
Concerns
Related to voluntary rolling movements.

34. Postural Reflexes ~ Labyrinthine
Stimulus / Response
S: Baby held upright, tilted in one direction R: Baby tilts head in opposite direction
Duration
2-3 months – 1 year
Concerns
Related to upright posture
Other
Also considered primitive reflex

35. Postural Reflexes ~ Pull Up
Stimulus / Response
S: Sitting/standing, hold hands, tip in one direction R: Arms flex or extend in to maintain upright position
Duration
3 months – 1 year
Concerns
Related to upright posture