DEVELOPMENTAL REFLEXES

Primitive Reflexes (Spinal Level)

a. Flexor withdrawal
Onset: birth
Integration: 2 mos
Position:supine
Stimulation: stroke on sole of foot
Response: extension of leg that being stimulated
b. Cross extension 1
Onset: birth
Integration: 2 mos
Position: supine with one leg flexed
Stimulation: flexion of extended leg
Response: extension of flexed leg

c. Cross extension 2
Onset: birth
Integration: 2 mos
Position: supine
Stimulation: tapping of medial surface of one leg
Response: abduction, internal rotation and plantarflexion of opposite leg (typical
scissoring gait)

d. Extension thrust
Onset: birth
Integration: 2 mos
Position: supine with flexion of one leg
Stimulation: stroke on sole of foot of flexed leg
Response: extension of flexed leg

e. Automatic reflex walking

Onset: birth
Integration: 2 mos
Position: hold the baby in upright position
Stimulus: on vertical support plantar contact & passive tilting of body forward &
side to side
Response: alternating automatic steps with support

Brainstem Level (Tonic Reflexes)

a. ATNR
 Onset: birth
Integration: 4 – 6 mos
Stimulus: turn head to one side
Response: extension of arm in flexed head and flexion of arm in opposite side

b. STNR 1
Onset: 4 – 6 mos
Integration: 8 – 12 mos
Stimulus: flexion of head
Response: flexion of UE & extension of LE

c. STNR 2
Onset: 4 – 6 mos
Integration: 8 – 12 mos
Stimulus: extension of the head
Response: extension of UE & flexion of LE

d. Tonic Labyrinthine Supine

Onset: birth
Integration: 6 mos
Stimulus: supine position
Response: predominates extensor tone

e. Tonic Labyrinthine Prone

Onset: birth
Integration: 6 mos
Stimulus: prone position
Response: predominates flexor tone

f. Associated Reactions
Onset: birth – 3 mos
Integration: 8 – 9 years
Stimulus: stimulus on one side
Response: affect on one side

g. (+) Supporting
Onset: birth
Integration: 6 mos
Stimulus: light pressure or weight bearing on plantar surface
Reaction: legs extend for partial support of body weight

h. (-) Supporting
Onset: birth
 Integration: 6 mos
Stimulus: standing: weight bearing position
Response: (+) reaction: extension of (B) LE, (-) reaction: flexion of one LE

Automatic Movements Reactions

a. Moro Reflex
Onset: birth
Integration: 4 mos
Stimulus: semi-reclined position
Response: abduction, external rotation, extension of arms, extension & abduction of
fingers

b. Landau Reflex
Onset: 6 mos
Integration: 2 – 2 ½ years
Stimulus: prone in space
Reaction: extension of head, extension of UE/LE, flexion of head & flexion of
UE/LE

c. Parachute Reaction
Onset: 6 mos
Integration: persist
Stimulus: abrupt falling
Response: extension of UE/LE then embracing

Midbrain level (Cortical / Postural reflexes)

 These are higher order automated movements, controlled by the mid-brain,
indicating cortical involvement that allows some voluntary inhibition of otherwise
“automatic responses” to stimulus.
 They pave the way for the dependant infant to become an independent adult
 Classically, postural reflexes are seen as the upper layer of involuntary action and
development

a. Optical righting
Onset: 1-2 months – persist
Test: hold patient in prone while in space
(-) head does not raise automatically
(+) head raises to normal position

b. Labyrinthine righting acting on the head

Onset: 1-2 months – persist
Test: hold patient in prone while in space and blindfolded
(-) head does not raise automatically
(+) head raises to normal position
c. Neck righting
Onset: 4-6 months – integration: 5 years
Test: patient supine, arms and legs ext. then rotate head to one side
(-) body will not rotate
(+) body rotates as a whole in the same direction as head (log roll)

d. Body righting acting on the body

Onset: 4-6 months – integration: 5 years
Test: patient in supine with arms and legs ext. then rotate head to one side
(-) body rotates as a whole and not by parts
(+) segmental rotation of trunk between shoulders and pelvis

e. Optical righting acting on the body

Onset: 6-8 months – persist
Test: hold patient around pelvis and in space then tilt to the right
(-) head does not rise to normal position
(+) head rights itself to normal position

f. Amphibian reaction
Onset: 6-8 months – persist
Test: hold patient in prone while in space then lift pelvis to one side
(-) flex of arm, hip and knee cannot be done
(+) automatic flexion of arm, hip and knee

Cortical level (Equilibrium reactions)

- Emerges from six months onwards
- Positive reaction at any one level indicates the next higher level of motor activity possible

a. Supine
Onset: 6 months – persist
Test: patient supine, arms and legs ext then tilt to one side
(-) head and thorax do not right themselves, no equilibrium or protective reactions
(+) righting of the head and thorax, abd and ext of arm

b. Prone
Onset: 6 months – persist
Test: patient prone with arms and legs ext. then tilt to one side
(-) head and thorax do not right themselves, no equilibrium or protective reactions
(+) righting of the head and thorax, abd and ext of arm

c. Four foot kneeling

Onset: 8 months – persist
Test: patient in quadruped then tilt toward one side
(-) head and thorax do not right themselves, no equilibrium or protective reactions
(+) righting of the head and thorax, abd and ext of arm
d. Sitting
Onset: 10-12 months – persist
Test: patient seated on chair and pulled to one side
(-) head and thorax do not right themselves, no equilibrium or protective reactions
(+) righting of the head and thorax, abd and ext of arm

e. Kneel-standing
Onset: 15 months – persist
Test: patient kneel standing then pulled to one side
(-) head and thorax do not right themselves, no equilibrium or protective reactions
(+) righting of the head and thorax, abd and ext of arm

f. Standing hopping
Onset: 15 – 18 months – persist
Test: patient in standing position and then moved to the left or right side by holding the
upper arms
(-) head and thorax do not right themselves, no hopping steps to maintain balance
(+) righting of the head and thorax, hopping steps sideways to maintain equilibrium

g. Dorsiflexion
Onset: 15- 18 months – persist
Test: patient in standing position and tilted backwards by holding the axilla
(-) head and thorax do not right themselves, no dorsiflexion
(+) righting of the head and thorax, dorsiflexion

h. See saw
Onset: 15 – 18 months – persist
Test: patient in standing position and held on the same side by the hand and foot with
flexed hip and knee, then be pulled forward and gently and slightly lateral
(-) head and thorax do not right themselves, inability to maintain standing balance
(+) righting of the head and thorax, slight abd and full ext of manually flexed knee to
maintaib equilibrium

I. Simian position
Onset: 15 – 18 months – persist
Test: patient in squat sitting position and tilted to one side
(-) head and thorax do not right themselves, inability to assume or maintain position
(+) righting of the head and thorax, abd- ext of arm and leg