Primitive Reflexes

Quick Review
Dpt. Aamir Memon
8/20/2013

Primitive Reflexes
Reflex
Cephalic:
1. Blinking/ Dazzle 2. Acoustic blink 3. Rooting
shine bright light in eyes create a loud noise about 12 inches from baby's ear stroke baby's cheek near corner of mouth eyelids close both eyes will blink birth-1 yr birth-6 months absence indicates poor light perception or blindness absence indicates decreased hearing or congenital deafness

Stimulus

Expected Response

Duration

Abnormal Indications

head moves toward side of stimulus and mouth opens

birth-4 months

asymmetric response indicates lesion of brain stem or trigeminal nerve; absence may be CNS disease; expect minimal or no response if baby was just fed abnormal function of CN IX, X, and/or XII

4. Suckling

place finger in baby's mouth

tongue should push finger up against hard palate with good strength, note pressure, strength and pattern eyes should turn in direction of rotation, then opposite direction once rotation stops

disappearance variable

5. Rotation Test/ Doll's Eye

hold baby under axilla in an upright position, head held steady, facing examiner, rotate baby one way, then the other

disappearance variable

if eyes do not move in expected direction suspect vestibular problem or eye muscle paralysis

Neck:
1. Moro/ Startle create a loud noise total extension then flexion birth-6 months beyond 6 mo =neurological disease; asymmetrical response of UE= brachial plexus injury or fx of clavicle or humerus, LE= low spinal injury or congenital hip dislocation persistance= major cerebral damage

2. Tonic neck/ Fencer

baby supine, turn head to one side suspend baby upside down by the feet, relax weight off one extremity, then the other; place baby supine apply firm pressure of femurs into acetabulum bilaterally baby is face down with trunk supported on examiner's lower arm, run finger 3 cm paravertebrally from occiput to buttock baby is positioned same as above, run finger over spinous from sacrum to occiput baby positioned same as above

extension of arm and leg on side head is turned to, flexion of other arm and leg look for arching upon initial suspension; head should rotate away from the weight bearing side smoothly; acetabular resistance should be equal

3. Reverse Fencer

present at birth, dominant 3 months, gone by 6 months birth-6 months

arching could indicate meningeal pull; inability to turn head to opposite side of extension (or twitching) indicates C0, or C1 subluxation on that side; softer acetabular pump indicates C1 laterality to that side; equal acetabular pump indicates C0

Trunk:
1.Galant/Trunk Incurvation curvature of trunk towards side stroked birth-2 months absence indicates presence of spinal cord lesion or possibly paralysis

2.Perez

3. Landau

extension of head and spine with flexion of knees on chest; most likely elicits urination as well baby should be able to lift head above horizontal with extension of arms, legs and trunk

birth -3 months

absence indicates severe cerebral insult, injury to upper cervical cord, advanced anterior horn cell disease, severe myopathy brain stem dysfunction

3 mo-18 months

Reflex
Upper Extremity:
1. Palmer Grasp

Stimulus
place finger from ulnar side into baby's hand

Expected Response
fingers curl to stimulus

Duration
birth- 3 months

Abnormal Indications
persistence indicates cerebral dysfunction

Lower Extremity:
1. Plantar Grasp touch plantar surface of baby's foot at the base of the toes stroke lateral plantar surface of foot from heel to base of toes, then across ball of foot towards first digit press thumb over ball of foot and abruptly dorsiflex it suspend baby with your hands under their axillae baby held upright with back and head support, allow dorsum of foot to touch undersurface of table top baby held upright under axillae, allow soles of feet to touch surface of table, baby's body is inclined slightly forward baby held upright under axillae, slowly lower baby's head toward surface (prone) toes should curl downward birth- 3 months absence correlates with development of spastic cerebral palsy persistance beyond 2 yoa indicates upper motor neuron lesion; unilateral persistance may indicate cerebral palsy sustained clonus is indicative of severe CNS disease birth-4 months scissoring of legs, fixed extension & adduction of legs= spastic paraplegia or diplegia absence could indicate paresis or breech presentation at birth absence could indicate paresis or breech presentation at birth

2. Babinski

3. Clonus

normal (negative) response= toes curl down and foot moves away; abnormal (positive) response= toes spread with dorsiflexion of foot and digit 1 rapid, rhythmic plantar flexion of foot which is unsustained head midline, legs flexed at hips and knees flexes hip and knee, places stimulated foot on table top alternate flexion and extension of legs simulating walking

positive response normal until age 2

Suspension & Stepping:

1. Vertical suspension

2. Placing

birth- 11 months

3. Steppage

birth- 11 months

4. Parachute Response

baby extends it's arms and legs forward as if to protect itself

6 months - adulthood

Upper extremity pyramidal tract dysfunction; asymmetrical response may be a sign of hemiparesis