Primitive and tonic reflex

Primitive and tonic reflex

1. PRIMITIVE AND TONIC REFLEX

2. These reflex are normaly present during infancy and become integrated by the CNS at an early stage. These reflex are not generally present in adults .

3. Patients who exhibit these reflexes typically present with extensive brain damage and either UMN sign. Reflexes important to examine in the patients suspected of abnormal reflex activity include flexor withdrawal

4. A reflex scouring key from is:- 0+ve absent. 1+ve tone change, slight, transient with no movement of the extremities. 2+ve visible movements of extremities.

5. 3+ve exaggerated, full movement of extremities. 4+ve obligatory and sustained movement raising for more than 30 sec.

6. Primitive/spinal reflexes Name - Flexor withdrawal Onset -2-3wks gestation Integrated - 1-2months Stimulus - noxious stimulus(pin prick) to sole of foot. Response -Toes extended, foot DF, entire lower extremity flexes.

7. Name - cross extension Onset -28 wks gestation Integrated - 1-2months Stimulus - noxious stimulus to ball of foot of lower extremity fixed in extension. Response - opposite lower extremity flexes then adduction and extends.

8. Name - Traction Onset -28wks of gestation Integrated - 2-5 months Stimulus- Grasp forearm and pull up from supine into sitting position. Response -grasps and total flexion of upper extremity.

9. Name - Moro Onset - 28 wks of gestation Integrated - 5-6 months Stimulus - head drag method used. Baby held in supine with supported behind the chest and head then head is allowed to drop 10degree Response - elbow extended shoulder abducted , upper limb- hand opening and crying followed by flexion , adduction of arms across chest.

10. Name - Startle Onset - birth Integrated- persist Stimulus - sudden loud or harsh noise. Response - sudden extension or abduction of upper extremity , crying.

11. Name - Grasp(planter/palmer) Onset - palmer birth Integrated - palmer 4-6 months planter 9 months Stimulus - Maintain pressure to palm of hand(palmer grasp) or to ball of foot under toes (planter grasp). Response - Maintain flexion of fingers of hands or toes.

12. Name - STNR Onset - Integrated - 4-6 month Stimulus - Flexion or extension of head. Response - With head flex , flexion of upper extremity , extension of lower extremity - with head extension , extension of upper extremity and flexion of lower extremity

13. Name - symetrical tonic baby ri TLR or STLR Onset - birth Integrated- 6 month Stimulus - Prone or supine position Response - With prone it increases flexor tone/Flexion of all limbs with supine and increase extensor tone / extension of all limbs

14. Name - Positive supporting Onset - birth Integrated - 6 month Stimulus - contact to the ball of the feet in upright standing position. Response - Rigid extension , coactions of the lower extremity.

15. Name - Associated reactions Onset - birth/ 3months Integrated - 8-9 yrs Stimulus - Resisted voluntary movement in any part of body. Response - Involuntary movements in a resting extremity.

16. Name – Asymmetrical tonic neck(ATNR) Onset - birth Integrated – 4-6 months Stimulus – Rotation of the head on one side. Response – Flexion of skull limbs extension of the jaw limbs “bow and arrow ” or “fencing” posture.

17. Name – Neck righting action of the body(NOB) Onset – 4-6 months Integrated – 5 years Stimulus – Passively turn head to one side, tested in supine Response – Body rotates as a whole to align the body with the head.

18. Name – Body righting acting on head(BOH) Onset – birth-2 months Integrated – 5 years Stimulus – Place in prone or supine position. Response – Head orients to vertical position with mouth horizontal.

19. Name – Protective extension(PE) Onset – arms, 4-6 months; legs , 6-9 months. Integrated – persists Stimulus – Displace center of gravity outside the base of support Response – Arms or legs extend and abduct to support and to protect the body against falling

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