Reflex Checkout

-Vital/Survival-Tactile-Perioral stroking using a nipple or pacifier-Stimulation at corners of mouth elicits head turning toward a stimulus. Stimulation of upper and lower lip elicits mouth opening. Infant attempts to suck the examiner's finger. -1) Persistence may interfere with sucking and other oral behavior. 2) Asymmetry may indicate insult to one side of the brain or facial injury. 3) Absent in babies depressed by barbiturates.-Onset: 28 wks gestation, Integration: by 3 mos, *A baby that has just been fed may turn away from the stimulus.

-Vital/Survival-Tactile-Place a finger or nipple in the infant's mouth.-Rhythmic sucking movements.-1) Persistence may inhibit development of voluntary sucking movements and oral sensory stimulation. 2) Sucking is often less intense and less regular during first few days of life. 3) Failure to develop interferes with nourishment. 4) Slower rate seen in nutritive sucking which may be necessary to coordinate with respiration and swallowing in the feeding process. -Onset: Begins at 28 wks, Integration: by 2-5 mos

-Vestigal-Proprioceptive-Place child supine with head in midline and arms on chest. Supporting the infant's head and shoulders, allow infant's head to drop back suddenly 20-30 degrees with respect to trunk. (This will be upsetting to infant)-1st phase: Abduction of the upper extremities with extension of the elbows, wrists, and fingers. 2nd phase: Subsequent shoulder adduction and elbow flexion (hugging motion), hands closed. -1) The acquisition of adequate strength against gravity, 2) The development of motor skills will suppress the expression of the Moro movement pattern. -Onset: Begins at 28 wks, Integration: by 5-6 mos *Differs from startle reaction, which can be elicited by a loud noise or sudden light, and consists of flexor movement only.

-Vestigal-Proprioceptive-Place child in supine with head in midline. Grasp child's forearms and pull to sitting position, stretching the shoulder adductors and arm flexors.-Flexion of the shoulders, elbows, wrists, and fingers.-1) Easily obtainable in neonate; allows infant to hold rattle when placed.-Persistence may inhibit voluntary reach and grasp

-Vestigal-Tactile-Place infant in supine with head in midline and hands free. Place index finger in infant's palm from the ulnar side and gently press against the palmar surface. -Infant's fingers will flex around the examiner's finger.-1) Persistence may inhibit development of volitional grasp and release. 2) Infants show differential responses to hard and soft objects. -Onset: Birth, Integration: by 4-6 mos

-Vestigal-Tactile-Place child in supine with head in midline and legs relaxed. Exert pressure against the soles of the infant's foot, directly below toes. Can also be tested in standing. -Flexion of the toes-1) Suppression may occur through experience standing at a support, cruising and walking with and without assistance as these activities promote more functional postures for the toes. -Onset: Begins at 28 wks gestation, Integration: 9 mo

-Functional-Tactile and Proprioceptive-Place child supine with head in midline and extremities extended. Rotate head to one side actively or passively. -The child will follow the direction of the head turn and roll toward that side without segmental rotation (this is a log-roll)-1) Allows child to roll supine to side and side to supine. 2) Persistence may interfere with the development of segmental rolling. The individual may have difficulties with other movement patterns that require rotational components and thus be limited to more stereotypical responses. Evolves into NOB.-Onset: Begins at 34 wks gestation, Integration: 4-5 mos

-Functional-Proprioceptive-Place child in supine with head in midline and extremities extended. Turn the child's head to one side and hold this position with jaw over shoulder.-Child will roll segmentally in direction of head turning-1) Allows child to roll supine to prone and prone to supine. 2) Indicative of the development of rotation around the body axis (intra-axial rotation). Allows for rotational patterns necessary for rolling, attaining sitting, sitting and standing. -Onset: Begins at 4-6 mos, Integration: 5 yrs (when child can get into standing without rotation)

-Functional-Tactile and Proprioceptive-Place child in supine with head in midline. Flex one leg up toward the chest and rotate the leg across the body rolling the baby over. -Child's thorax, chest and head will follow the direction of the pelvis and roll toward that side without segmental rotation (this is a log-roll). This evolves into BOB reflex.-1) Allows child to roll supine to side and side to supine. 2) Asymmetry not normal. 3) Persistence interferes with development of segmental rolling and acquisition of other developmental milestones that require rotation (see NOB)-Onset: Begins at 4-6 mos, Integration: 5 yrs (when child can get into standing without rotation)

-Functional-Proprioceptive-Place child in supine with head in midline and extremities extended. Flex one leg and rotate it across the pelvis to the opposite side. -Child will roll segmentally to prone (first trunk, then pectoral girdle, and then head).-1) Allows child to roll from supine to prone and prone to supine. 2) Indicative of the development of rotation around the body axis (intra-axial rotation). 3) Allows for rotational patterns necessary for rolling, attaining sitting, sitting, and standing.-Onset: Begins at 4-6 mos, Integration: 5 yrs (when child can get into standing without rotation)

-Functional-Tactile (Noxious)-Place child supine with head in midline, legs relaxed and semi-flexed. Apply noxious stimulus, such as pin prick to sole of one foot.-Brisk flexion of the stimulated limb, withdrawing from the stimulus; includes toe extension, dorsiflexion, and hip/knee flexion. -1) Persistence may indicate a delay in postural maturation.-Onset: Begins at 28 wks gestation; Integration by 1-2 mos or when independent walking occurs. *This is a protective response that is never completely inhibited even though it loses dominance.

-Functional-Tactile/Noxious-Place child supine with head in midline. Hold one lower extremity extended at the knee and apply firm pressure or noxious stimulus to sole of the foot. -Flexion, adduction, and then extension of the opposite lower extremity as if to push the examiner away. If the stimulated extremity is not fixed, the stimulated leg will withdraw and opposite extremity will extend. -1) Failure to obtain or late persistence may indicate general depression of CNS or sensorimotor dysfunction. 2) Persistence may prevent normal reciprocal kicking and subsequent walking. -Onset: Begins at 28 wks gestation, Integration: 4 mo

-Functional-Proprioceptive-Hold the child in a vertical position with the examiner's hands under the arms and around the chest. Move the child so that the dorsum of one hand or foot presses lightly against the edge of the table.-Infant will flex arm or leg respectively and place hand or foot on the table. -1) Correlates with Spontaneous Stepping (stepping reflex), 2) May be obtained at any age if traction is exerted against the ankle or the wrist to the point of discomfort. -Onset: UE begins at birth, LE begins at 35 wks gestation, integration: by 2 mos

-Functional-Tactile-Hold the child vertically under the arms and around the chest. Advance the child toward a supporting surface such as a table top.-Child will lift hand, extend and place it on the support with fingers extended and abducted or immediately orient and place foot on top of supporting surface. -1) Requires visual response, relied on for both postural control and guidance for locomotor progression. 2) Associated with independent walking-Onset: Begins 3-5 mos, Integration: Persists throughout life.

-Functional (important to weight bear)-Proprioceptive and tactile-Hold infant in vertical position with examiner's hands under the arms and around the chest. Allow feet to make firm contact with the tabletop or other flat surface. -Simultaneous contraction of flexors and extensors in Les so as to bear weight on the lower extremities. The child supports only minimal amount of body weight. Characterized by partial flexion of the hips and knees. This evolves into Positive supporting reaction of LE and positive supporting reflex of UE.-1) Prerequisite for spontaneous stepping reflex, 2) Normal response that is needed for erect standing and bipedal locomotion. -Onset: Begins at 35 wks gestation, Integration: by 1-2 mos (astasia-abasia- no wt. bearing occurs due to poor extensor control)