Primitive Reflexes.pptx

Primitive reflexes

https://www.youtube.com/playlist?list=PLhpSymrcaX-R_0shZ4M8sQ4drv5xuBveg

1. Primitive Reflexes By: Dr. Miloni Shah Guided: Dr. Rima jani

2. Contents: Introduction Reflex arc Classification of reflexes Significance of reflexes Types of reflexes

3. Introduction A reflex is an involuntary or automatic, action that your body does in response to something without you even having to think about it. Neonatal reflexs are inborn reflex which are present at birth and occur in a predictable fashion. A normally developing newborn should respond to certain stimuli with these reflexes, which eventually become inhibited as the child matures. These reflexes are then replaced by voluntary motor skills. When the reflexes are not inhibited, there is usually a neurological problem at hand.

4. Reflex arc

5. Classification Depending upon their situation of the center Depending upon their function Depending upon whether inborn or acquired

6. Types Automatic reflexes Spinal reflexes Brain stem reflexes Midbrain reflexes Cortical reflexes

7. Automatic reflex Moro reflex Gallants trunk reflex Parachute reflex Landau reflex

8. Moro reflex (startle reflex) protective” response ” A n involuntary protective motor response against abrupt disruption of body balance or extremely sudden stimulation. This reflex is also related to a baby’s development of head control TESTING POSITION: child is in halfway position between supine and upright position STIMULUS:  loud noise, bright light, or even a sudden movement that the infant produces themselves or support is withdrawn from the head RESPONSE: There will be shoulder abduction and elbow wrist and finger extension followed by shoulder adduction and elbow wrist and finger flexion ONSET :birth INTEGRATED: 6 months

9. Retained moro reflex Mood swings/sudden changes in behavior Anxiety Visual challenges Learning difficulties Depression ADHD Autism Emotional and social immaturity Coordination and balance challenges Poor tolerance to change Dyslexia and/or Dyscalculia

10. Integration Visual challenges: More ball games to promote visual tracking skills. Instead of throwing and catching, try something simpler such as rolling a tennis ball back and forth across the table. Reading with a highlighter strip or a piece of paper under the line that is being read. This helps the eyes focus on the line and decreases distracting visual input. Learning difficulties, Dyslexia, and Dyscalculia: Talk with your child’s teacher about strategies in the classroom and accommodations that can be provided.

11. Anxiety: Try calming activities such as deep pressure and heavy work (proprioceptive input) - weighted blanket, massage, movements that work the muscles such as pushing/pulling, animal walks, etc. Visual schedules - this can help the child understand time and space and know when certain things will be happening. Noise-cancelling headphones - if your child is sensitive to sound, this can cause anxiety with certain situations. Try noise-cancelling headphones to decrease the auditory input. Therapeutic Listening Programs Coordination and balance challenges as well as motion sickness: Incorporate more movement into the day. Try obstacle courses, playing on playground equipment, jumping and crashing, balance games, etc.

12. Parachute reflex TESTING POSITION: vertical position STIMULUS: Infant is held in prone in the air and then suddenly thrust head fist towards the examining table or floor RESPONSE: infant will immediately extend and abduct slightly and the fingers spread as if attempt to break the fall. ONSET :5-9 months PRESENT: through out life

13. Abnormality in this reflex Absent or abnormal in children with cerebral palsy and severe motor disorders. Asymmetry in this indicates upper extremity weakness or spasticity This reflex doesn’t require vision so can be done blindfolded

14. Gallants trunk reflex TESTING POSITION: prone position STIMULUS: There will be stroking or tapping on one side of the infant spine RESPONSE: there will be side flexion on the side which is stroked and hips are also raised towards that side ONSET :birth (20 weeks of in utero) INTEGRATED 3-9 months of age The Spinal Galant is believed to play an important role in the natural birthing process. 

15. Retained gallants trunk reflex Delay in preparation of crawling and walking Problem in urination so bed wetting problem occurs Tactile hypersensitive Gait can be affected which can lead to limp contributing to scolosis In ability to sit still, short-term memory loss or an inability to concentrate. Fidgeting is present Prevelance of ADHD

16. Integration Snow angels Vibration, Wilbarger Brushing Protocol  for hypersensitive to tactile & f or fidgeting Proprioceptive input is calming to the nervous system, so complete 5-10 minutes of heavy work activities prior to sitting down for a focused task Try compression clothing - instead of having a shirt or pants that “tickle” the back and stimulate the reflex, try tight compression clothing that won’t rub or move. Bedwetting Decrease the amount of liquids before bed. Change what your child sleeps in, attempting to decrease clothing that moves against the back

17. Landau reflex TESTING POSITION: supporting the infant horizontally in air in prone position STIMULUS: passive flexion or extension of the head RESPONSE: if flexion hip knee and spine also flexed and elbow If extension of head ,extension of spine hip knee and elbow ONSET: 3 months INTEGRATED: 3 years

18. Retained landau reflex Low muscle tone Poor posture Poor motor development Short term memory difficulty Weak upper body Attention and concentration problem Toe walking

19. Integration Deep pressure Proprioception activities Weight bearing activities swinging pushing and pulling activity

20. Spinal cord reflex Rooting reflex Sucking reflex Palmer reflex Planter reflex Flexor withdrawal reflex Extensor withdrawal reflex Cross extensor withdrawal reflex Stepping reflex Babinski reflex Babinski reflex

21. Spinal cord reflex Rooting reflex Sucking reflex Palmer reflex Planter reflex Flexor withdrawal reflex Extensor withdrawal reflex Cross extensor withdrawal reflex Stepping reflex Babinski reflex Babski reflex

22. Rooting reflex (search reflex) TESTING POSITION: supine lying STIMULUS: initiates when the corner of an infant’s mouth is stimulated by stroking RESPONSE: the newborn will turn his or her head towards the stimulus and open the mouth with tongue thrusting.  ONSET: birth INTEGRATED: 4months This is replaced by voluntary sucking as the child grows

23. Sucking reflex TESTING POSITION: supine lying STIMULUS: initiates when roof of an infant’s mouth is touche the nipple or finger RESPONSE: infant will automatically start sucking the nipple or finger ONSET: birth( 32 weeks of pregnancy ) INTEGRATED: 4months

24. Retained rooting and sucking reflex Tongue lies too far forward Hypersensitive around the mouth Thumb sucking can remain Speech and articulation problems Difficulty in swallowing and chewing Dribbling Difficulty with texture and solid foods

25. Palmar grasp reflex TESTING POSITION: supine lying STIMULUS: examiner inserts his or her finger into the palm of the infant from the ulnar side and applies pressure to the palm RESPONSE:   fingers closing around the object that provided pressure, as well as gripping or holding on ONSET: birth( 11 weeks IU) INTEGRATED: 3 months

26. Retained palmar grasp Challenges with fine motor tasks, including grasp on small objects, handwriting, self-feeding, and manipulation of clothing fasteners Potential challenges with speech and articulation Overflow into the mouth during fine motor tasks (sticking tongue out, etc.) Tactile hypersensitivity  - specifically to hands Challenges with directionality (left vs right) Dysgraphia Voluntary grasp and release is not possible

27. Plantar grasp reflex TESTING POSITION: supine lying STIMULUS: By pressing a thumb against the sole of the foot just behind the toes RESPONSE: It consists of the flexion and adduction of all toes as if the toes were firmly grasping the stimulating object [ ONSET: birth (32 weeks UI) INTEGRATED: 9 months

28. Retained plantar grasp Normal walking is not present Disturbance in gait balance affection occurs Toe walking may be present

29. Flexor withdrawal reflex) (protective reflex) TESTING POSITION: supine lying head in neutral and legs extended STIMULUS: sole of the foot is stroked RESPONSE: there will be flexion of the stimulated foot ONSET: birth(28 weeks of gestation) INTEGRATED: 1-2 months

30. Extensor withdrawal reflex TESTING POSITION: supine lying head in neutral and legs extended STIMULUS: sole of flexed foot is stroked RESPONSE: there will be extension adduction internal rotation of the flexed leg with planter flexion of the foot ONSET: birth INTEGRATED: 4 months

31. Retained reflex Tactile defensive behaviour Abnormality in gait Intergration Joint compression Give maximum weight bearing position

32. Crossed extensor withdrawal TESTING POSITION: supine lying head in neutral and legs extended STIMULUS: noxious stimulus to the ball of the foot RESPONSE: opposite lower limb flexes ,then adducts and extends ONSET: birth(28 weeks of gestation) INTEGRATED: 1-2 months

33. Retained reflex Difficulty in walking Poor posture Balance maintenance will be difficulty Develop hip adductor tightness( scissoring gait )

34. Intergration Butterfly sitting position Joint compressions Calipers might be needed is gait abnormality are severe because of muscle imbalance

35. Stepping reflex TESTING POSITION: baby is hold upright STIMULUS: when sole of the foot touches the couch RESPONSE: leg lift and will try to decent ONSET: birth INTEGRATED: 6 months Retained stepping reflex Premature will try to walk in a toe heel fashion of walking

36. Babinski reflex TESTING POSITION: supine lying STIMULUS: when sole of the foot is stimulated with blunt instrument RESPONSE: extension of the great toe and fanning of other toes ONSET: birth INTEGRATED: 12-24 months Retained Babinski sign indicative of upper motor neuron lesion contributing damage of the corticospinal tract.

37. Babski reflex STARTING POSITION: supine lying STIMULUS: deep pressure applied simultaneously to the palm of both hands RESPONSE: flexion or forward bowing of the head ,opening of the mouth and closing of eyes. ONSET: birth INTEGRATED: 4 months Retained reflex-there will be problem with have chance of cerebral palsy and mental retardation.

38. Brainstem reflex Aysmterical tonic neck reflex Symetical tonic neck reflex Tonic labrythine neck reflex Positive supporting reflex Negative supporting reflex

39. ATNR (Fencer’s pose) TESTING POSITION: supine lying position STIMULUS: Turing of head to any one side (rt) side RESPONSE: Flexion of arm and leg on the skull side Extension of arm and leg on the face side ONSET: birth Integrated : till 6 months of age

40. Retained ATNR Because the ATNR is directly related to the vestibular system and consists of a physical reaction, it has a direct impact on movement, balance, muscle tone, and coordination. Additionally, due to the movement of the arm in relation to the head, it also has a direct impact on hand-eye coordination. Challenges with crawling as an infant Decreased engagement with toys as an infant Poor balance when learning to walk Gravitational insecurity and fear with movement Challenges  crossing midline Poor hand dominance establishment Challenges with reading and writing Left / right confusion Challenges with visual tracking Poor coordination for bilateral integration tasks Dyslexia and/or Dysgraphia

41. INTEGRATION I f your child is young, under three months old,  Proper tummy time, place toys to the left and the right side, not just in front. Use noise and gentle lights to engage the visual system and encourage head turns to look at objects. Encourage more crawling activities. Use pop up tunnels, create tunnels using chairs and blankets, etc. Try to engage the child visually to facilitate head turns while they are crawling. Facilitate crawling across a variety of floor textures and thresholds.

42. If your child is older, you can still focus on the same developmental movements and increase the challenges, as well as try some other activities. Set up a matching game on the floor - place colored pieces of paper on the floor in a semi-circle around the child, who will lay on their stomach. Call out a color and have the child reach to tap the color. Encourage crossing midline - reaching with left hand to tap a color on the right, and vice versa. S low swinging tasks , simple balance activities with balance beams, hopping on one foot, etc. Try balancing on one foot with eyes closed - time it and try to beat your time . S imply bouncing and rolling activities with therapy ball - give them control over the movement to feel safer. Jumping jacks, cross crawl, , and Obstacle courses are useful.

43. STNR TESTING POSITION: Quadripod STIMULUS: when there neck extension/neck flexion RESPONSE: arms will straighten while the legs will flex / arms will flex while the legs will straighten - moving the infant into a somewhat down dog position. ONSET :6-8 months INTEGRATED: 12 months of age

44. Retained STNR Minimal to no crawling Poor posture W-sitting Lays head on desk during focus tasks Decreased hand-eye coordination Challenges with near-far point tracking May seem clumsy, poor overall coordination May be a messy eater Challenges with attention and focus Challenges with reading and writing Difficulty copying from the board Signs of Dyslexia

45. INTEGRATION Get them crawling Use tunnels to facilitate crawling. Roll balls and push toys through, have motivating toys on the other side, etc. Make your own by placing a blanket over 2 or more objects. Cat-Cow movement , Jumping jacks Prone reach outs Creeping and crawling Midline crossing activities Use therapy ball to activate the core muscles to decrease a slouched position. Provide more rest breaks during physical activity. Poor posture is often accompanied by fatigue. During mealtime, use a mirror to bring attention to what the hands and mouth are doing, notice where food is, etc.

46. Tonic labrynthine reflex (superman pose) This reflex is activated with neck flexion (forward) or extension (backward)  TESTING POSITION: supine or prone STIMULUS: When an infant looks down (neck flexion) or When an infant looks up (neck extension) RESPONSE: causes the arms and legs to flex or curl into the body or this causes the arms and legs to extend (Superman) ONSET :birth INTEGRATED: 6months

47. Retained TLR Challenges in creeping and crawling as an infant Weak muscles / low muscle tone Decreased balance Poor ocular motor skills Visual-perceptual challenges Decreased organization skills Poor sense of space and time Decreased sequencing Frequent falls , bumping here and there Spatial awareness difficulties Dyscalculia and/or Dysgraphia

48. Integration If  your child is young, try engaging them in more tummy time activities: Playing in front of the mirror.   Play ball in tummy time - roll the ball back and forth. Try different animal crawls: worm crawl, snake crawl, etc. Catch and thrown Teach shapes and size

49. Challenges with organization, sense of time, and sequencing: Use more visuals. Visual schedules are great to help with sequencing and organizing tasks. Use pictures of where items belong to help with organization. Use visual timers to help with sense of time. Ocular motor challenges: Play more ball games. Instead of catch and throw, try bounce and catch or even rolling back and forth. Reading with a highlighter strip or a piece of paper under the line that is being read. This helps the eyes focus on the line and decreases distracting visual input. Decreased balance: Practice! Complete activities on a balance beam or place a strip of painter’s tape on the floor and Engage in core strengthening tasks using a therapy ball, jumping and climbing, and yoga stretches, etc.

50. Positive supporting reflex TESTING POSITION: vertical position STIMULUS: weight placed on ball of the feet when upright RESPONSE: leg and trunk into extension ONSET :birth INTEGRATED: 6 months

51. Negative supporting reflex TESTING POSITION: vertical position STIMULUS: weight placed on ball of the feet when upright RESPONSE: leg and trunk into flexion ONSET :birth INTEGRATED: 6 months

52. Retained positive and negative supporting reflex Pattern of extensor spasticity is developed Disturbance in gait Balance can be affected Posture is affected Integration Proprioceptive exercise Weight bearing activities Strengthening activities

53. Mid brain (postural reflexes) Neck righting reflex Body on body reflex Body on neck reflex Optic righting reflex Labyrinthine righting reflex

54. Neck righting reflex TESTING POSITION: supine lying blind folded STIMULUS: head is turned towards one side RESPONSE: rotation of shoulder, trunk and pelvis towards that side occasionally followed by a turn of the entire body ONSET: birth INTEGRATED:10 months

55. Retained Difficulty in maintaining balance Difficulty in maintaining posture Walking and gait disturbance Trunk rotations will be difficult

56. Body on body TESTING POSITION: supine lying STIMULUS: Rotation of pelvis on one side RESPONSE: trunk and shoulder follow direction of pelvis( segmental rolling ) ONSET: 6 months PRESENT: Through out life ABNORMALITY Difficulty in sitting and quadripod position

57. Body on neck TESTING POSITION: supine lying STIMULUS: Rotation of body to one side RESPONSE: neck turns in the line of the body ONSET: 6 months INTEGRATED: through out life

58. Abnormality There are two forms of this reflex: the immature form, resulting in log rolling which is present at birth and the mature form which subsequently develops producing segmental rotation of the body.

59. Labyrinthine righting reflex This reflex is tested with eyes close TESTING POSITION: upright holding in air STIMULUS: Hold the child from armpit in a suspended position then change position of head from side to side and forward and backward RESPONSE: If the body moves forward, chin lifts and head moves backward and vice versa If the body tilts right ,the head moves in left and vice versa ONSET: birth-2 months of age PRESENT: through out life

60. Intergration Sensory integration focusing on vestibular Prone on swing Prone on physioball and move ball side to side front and back Visual tracking

61. Optical righting reflex TESTING POSITION: upright holding in air STIMULUS: Hold the child from armpit in a suspended position then change position of head from side to side forward and backward as well RESPONSE: head moves in opposite to the direction of motion ONSET: birth-2 months of age PRESENT: through out life

62. Abnormality Maintenance of orientation will be difficult Maintain of position will be difficulty Reading ,comprehension, can be difficulty Difficulty to maintain visual fixation when body is moving Poor outdoor sports and targeting activities

63. Integration Lot of targeting and reach out given while child is on moving surface like balance board, wobble board, swing. Use of tyre and balancing on them n then catch and thrown activity on them Moving the target on a trolly and then hitting the target by standing on the dynamic surface

64. Cortical reflex (tilt response) They are highly integrated and complex mechanism which are automatic response to changes in posture and movements aimed to- restore balance. It can be done in various positions: -supine -prone -quadruped -sitting -kneeling -standing -squatting

65. cortical Stimulus: pushing the child from the static posture in different positions by using balance board. response : extension of the lowered side Abd and extension of the raised side limbs with flex of the trunk. Duration: Prone-6 months to life long Supine- 8months to life long Quadruped- 8 to 10 months Sitting- 8 to 10 months Kneeling- up to 15 months Standing- 15 to 18 months

66. References Physical rehabilitation by Susan . B .O Sullivan Sophie Levitt- Treatment of cerebral palsy and motor delay Harkla site Darcy A. Umphered textbook of neurological rehabilitation https://www.youtube.com/playlist?list=PLhpSymrcaX-R_0shZ4M8sQ4drv5xuBveg

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