REFLEXESDefinition ;
Stereotype movement which can be elicited by application of
stimulus to the periphery
Importance of reflexes:
1- Diagnostic role:
More reflex ------more hypertonia ------No Movement
2- Therapeutic role Iniate elbow flexion-------ASTNR
3- Serve process of motor development
Putting toy on the side of the child-----------turn head
--------------extension of head--------------- eye hand
coordination
A C C O R D I N G T O L E V E L O F C N S M AT U R AT I O NSpinal Level (Spinal reflexes)
Brain Stem Level(Brain Stem reflexes)
Midbrain Level(Midbrain reflexes)
Cortical Level (Cortical reflexes)
a- (Spinal reflexes) Primitive reflexes ,
phasic reflexes Movement reflexes A- beta
reflexes:
Flexor with drawl (nociceptive reflex)
Starting position : Supine lying position, head in midline position,
upper , lower limb extended
Stimulus : Painful Scratching on sole of foot
Response : Mass Flexion or uncontrolled flexion
Age positive : from birth to 2 month
b- extensor thrust :
Starting position : Supine lying position, head in midline position,
upper extended, lower ,one is flexed, other
extended
Stimulus ; painful stimulus on the sole foot of flexed
Response: Uncontrolled extension of leg
Age: From birth to 2 Month
Crossed extension:
Starting position : Supine lying position, head in
midline position,
upper , lower limb extended
Stimulus ; Tapping on medial aspect of thigh
Response: Extension , adduction, internal rotation
of opposite scissor
Age: birth to 2 months
B)BRAIN STEM REFLEXES(STATIC POSTURAL REFLEXES)(TONIC
REFLEXES)(PRIMITIVE REFLEXES)
Changing position of the body or head in the space will change distribution of the tone.
1- asymmetrical tonic neck reflex (ATNR):
Starting position : Supine lying position, head in midline position,
upper , lower limb extended
Stimulus ; Turning the head to one side
Response: Face head : extension of upper and lower limb
occipital side: flexion in upper and lower limb
Age: birth to 4- 6 months
ASTNR interfere with ( ROLLING, FEEDING, both hand use)
2- symmetrical tonic neck reflex (STNR):
Starting position : Quadriped or prone on my leg
Stimulus ; Flexion of head
Response: Flexion of upper limb and extension in lower limb
Or vice versa
Age: birth to 4- 6 months
3- Tonic labyrinthine supine (TLS):
Starting position : head in midline position,
Stimulus ; Supine lying position,
Response: increase of extension tone in all over the body
Age: birth to 4 months
3- Tonic labyrinthine prone (TLP):
Starting position : head in midline position,
Stimulus ; Prone lying position,
Response: increase of flexor tone in all over the body
Age: birth to 4 months
4- +ve Supporting reaction:
Starting position :Standing with his back on my face
Stimulus ; Hold the child from pelvic or axilla and bounce him on sole of
foot.
Response: Lower limb extension, adduction, internal rotation plantar
flexion (scissors).
Age: from 3 to 8 Months
5 -Ve Supporting reaction:
Stimulus : Child in weight bearing with leaning forward
Response: Semi flexion of lower limb with few steps forward
Age: From 8 to continue throughout life
MIDBRAIN REFLEXESRIGHTING REACTION
A) Neck Righting;
Starting position : Supine lying position, head in midline position, upper , lower
limb extended
Stimulus ; Rotation of the head to one side
Response: Rotation of the body as a whole following head
Age: birth to 6 months
B) Body righting acting on body:
Starting position : Supine lying position, head in midline position, upper , lower
limb extended
Stimulus ; Turning the head to one side
Response: Segmental rotation of the body
Age: from 6-18 months
C) Labyrinthine righting on head:
First: Starting position: prone in space with blind
folded
Stimulus: prone in space on my hand with blind
folded
Response: raising head to normal position age
from 1-2 month then continue
Second: Starting position: supine lying
Stimulus: Supine in space on my hand with blind
folded
Response: raising head to normal position age
from 6 month s then continue
Third: Starting position: Holding child from pelvis
blind folded
Stimulus: tilting the body to right side
Response: raising head to normal position age
from 6-8 month then continue
Fourth: Third: Starting position: catching the child
from trunk
Stimulus: tilting the body to Left side
Response: raising head to normal position age
from 6-8 month then continue
D) Optical righting acting on head:
THE SAME LIKE LABRYINTHINE (POSITIONS ,
RESPONSES) WITHOUT EYE BLIND FOLDED
Amphibian Reaction :Starting position: Prone head
in midline ,legs extended , arm extended overhead
Stimulus: lift pelvis on one side
Response: Automatic flexion of hip ,knee ankle on
the same side Age from 6 month then continue
Automatic Movement Reactions:
Moro Reflex
Starting position: Semi recline
Stimulus: Drop head backward
Response: Extension, abduction, external rotation of
arms, extension, adduction fingers
Age: Normal from birth to 4 months
Landau Reflex : Starting position: prone in space with
holding under thorax
Stimulus: raise head active or passively
Response: Spine and leg extend
Age: Normal from 6 months to 2or 2.5 years
Protective extensor Thrust( Parachute reaction)
Starting position: Prone , arms extended over head
Stimulus: Suspend the child from ankle or pelvis
suddenly move child to floor
Response: Immediate Extension , of arms,, fingers
to protect head
Age: Normal from 6 months continue through out
life
CORTICAL REFLEXES OR EQUILBRIUM REACTION
SUPINE
Starting position: supine on tail board
Stimulus: Tilt board to one side
Response: Righting head, thorax extension,
abduction of arms, legs on raised side
Age: Normal from 6 months continue through out
life
Prone: Starting position: Prone on tail board
Stimulus: Tilt board to one side
Response: Righting head, thorax extension, abduction
of arms, legs on raised side
Age: Normal from 8 months continue through out life
Sitting: Starting position: Sitting on chair
Stimulus: pull child to one side
Response: Righting head, thorax extension, abduction
of arms, legs on raised side
Age: Normal from 12 months continue through out life
Kneel Standing : Starting position: Kneel standing
Stimulus: pull child to one side
Response: Righting head, thorax extension, abduction of
arms, legs on raised side
Age: Normal from 15 months continue through out life
Hopping 1, 2and 3:Starting position: Standing holding
from upper arms
Stimulus: Move to lift or right, forward, backward
Response: Righting head, thorax extension, hopping steps
to sideway, forward, backward to maintain equilibrium
Age: Normal from 15 to 18 months continue through out
life
Dorsiflexion: Starting position : Standing holding from
axilla
Stimulus: Tilt child backward
Response: Righting head, dorsiflexion of feet
Age: Normal from 15 to 18 months continue through out life
See- saw:
Starting position: Standing holding hand , foot with flex hip
knee
Stimulus: pull arm gently forward and to lateral side
Response: Righting head, thorax extension, slightly
abduction of flexed knee
Age: Normal from 15 months continue through out life
Simian position Starting position: Squatting
sitting
Stimulus: Tilt child to one side
Response: Righting head, thorax extension,
abduction of arms, legs on raised side
Age: Normal from 15 to 18 months continue
through out life