REFLEX TESTING
-M.
MYTTHIILI
REFLEXES IN PEDIATRICS
Reflex characterize the sensory and motor
development in early Infants that dominate their
MOVEMENT and BEHAVIOUR. All these reflex will
disappear at one stage.
It is controlled by CNS.
Many of these reflexes are later incorporated into
Complex Actions[Example: Grasp Reflex later
develops as Voluntary reach out].
This reflex examination helps to find out any
NEUROLOGICAL IMPAIRMENTS.
Persistence of Reflexes or Asymmetry in the
performance of reflex indicates PATHOLOGY.
FIVE LEVEL OF REFLEX
Primitive Reflex
Spinal level Reflex
Brainstem level Reflex
Midbrain level Reflex
Cortical Reflex
PRIMITIVE REFLEX
1. Rooting Reflex
2. Sucking Reflex
3. Biting Reflex
4. Palmar Grasp
5. Plantar Grasp
6. Placing Reflex
7. Stepping Reflex
8. Galant Reflex
9. Moro Reflex
[Link] Reflex
ROOTING REFLEX
POS: Supine
STIMULUS: Stroke the cheek from Corner of the
mouth to the Ear on either side(LIGHT TACTILE)
LOCATION: Mouth
RESP: Moving Head towards the
stimulus side.
DUR:28 week gestation to 3 months
RETENTION : Beyond 4 moths,
Difficulty with solid food, Poor Articulation,
Thumb Sucking, Dribbling, Speech Problems,
Poor Manual dexterity while sleeping, Hormonal
imbalances, Hypersensitivity around lips and
mouth, Tongue sits too forward in the mouth.
SUCKING REFLEX BITING REFLEX
POS: Supine Lying Supine Lying
STIMULUS: Introduce Intro one of the finger
one of the Therapist’s into it’s mouth or
Finger to the child’s Touch the Gums.
mouth. Oral Cavity
LOCATION: Oral Child will Bite tightly.
Cavity
RESPONSE: Child Same.
starts to suck
DURATION: 28weeks
RET: Same
Gestation to 2-5
Months.
RETENTION: Oro-
motor Problems,
Babies cannot open
SUCKING REFLEX BITING REFLEX
PALMAR GRASP PLANTAR GRASP
POS: Supine Supine
STI: Palmar Pressure.
Firm Pressure
LOC: Ulnar surface
RES: CATCHING(Quick Ball of foot
flexion and adduction)
And HOLDING Grasp with Toe Flexion
PHASE(sustained finger
flexion)
28 week gestation to 4-9
DUR: Birth to 4-6 Months
months.
RET: Difficulty with fine- Difficulty learning to walk,
motor skills, poor manual Running awkwardly, low
dexterity, Messy back pain during walk/run,
handwriting, Difficulty in shin soreness, recurrent
processing ideas. ankle twist, difficulty
walking in dark.
PALMAR GRASP PLANTAR GRASP
PLACING REFLEX STEPPING REFLEX
POS: Ventral Ventral Suspension
Suspension Tilt upper part of the body
forward and backward
STI: Dorsum Hand-
Stroke/ Foot-Stroke Child takes steps
RES: Place the hand
and foot on the Birth-3 Months
object/table
Toe Walk like an ostrich,
DUR: Birth-3 Months
Tight calf muscle, Poor
RET: Affect Child’s muscle control & balance,
Feet & ankle problem with
POSTURE,
pain & dysfunction, Recurrent
Coordination and the hamstring injury, Mid-low
Ability to sit still back strain, Visual
Problem(Head tilt forward
and Eyes upward)
PLACING REFLEX STEPPING REFLEX
GALANT REFLEX
POS: Prone
STI: Noxious tactile along Paravertebral
Column from 12th rib to iliac crest
RES: Incurvature of Spine
to same side.
DUR: 32 week gestation-2mnths
RET: Interfere with symmetric stability of
the Trunk, independent sitting, Standing,
may lead to SCOLIOSIS.
MORO REFLEX
POS: Supine
STI: Sudden change of head position
>30degree extension
RES: First, UEs Extend & Abduct; Hands
Open; LEs May Extend. Second, UEs Flex
& adduct; Hands Close; May Cry.
DUR: 28 weeks gestation to 5-6 Months
RET: Interfere with Head control, Sitting
Equilibrium, and protective reactions
affecting adaptability of child for
movements in space.
LANDAU REFLEX
POS: Prone
STI: Stretch on Neck Extensors
RES: Increase Prone Extension Tone.
DUR: 3-4 months to 12-24 months
FUN: Dissociate flexor Posture and assist neck
extensors in prone coming to sit and stand.
ABSENCE: Motor weakness and MR.
EARLY/EXAGGERATED: Spasticity & increased
Muscle Tone
DELAY: Retard the development of Prone
extension, sitting & standing, Related
developmental adaptations.
SPINAL REFLEXES
Flexor Withdrawal
Extensor Thrust
Crossed Extension
FLEXOR WITHDRAWAL
POS: Supine
STI: Noxious tactile of sole of foot.
RES: Withdrawal with flexion of hip and
knee, Dorsiflexion of foot with toe
extension
DUR: 28 week gestation to 1-2 months.
FUN: Protection or Defense.
RET: If Persists, it interferes with Weight
Bearing in Standing
FLEXOR WITHDRAWAL
EXTENSOR THRUST
POS: Supine Lying- One limb in flexion &
Other in Extension.
STI: Give PRESSURE on flexed foot
RES: Fast/Sudden Extension of that foot
DUR: Birth to 2-3 month
RET:
CROSSED EXTENSION
POS: Supine
STI: Pull the flexed limb(Noxious tactile
on ball of foot)
RES: First Flexion and then Extension
and Adduction of opposite LE
DUR: Birth to 2-3 months
FUN: Preparing the Reciprocal LE use
RET: Indicates Pathology and
Interference in RECIPROCATION and in
WALKING
CROSSED EXTENSION
BRAINSTEM REFLEX
ATNR
STNR
TLR
Positive supporting Reaction
Associative Reaction
ASYMMETRIC TONIC NECK
REFLEX(ATNR)
POS: Supine/Head Midline/Arms Neutral
STI: Hold the hand and turn it to one side(Do it in
both the sides)
RES: Extension on face side & flexion on skull side
DUR: 2 to 4-6 months
FUN: Contributes to supportive framework of non
stressful movement
RET: Lack of symmetrical posture, reach & grasp,
normal rolling, unsupported sitting, def in walking,
lack of ability to develop motorically, structural
deformity(i.e. SCOLIOSIS), Hip subluxation on skull
side, Non obligatory presence interferes in Motor
planning, bilateral integration & reading
Comprehension
ATNR
SYMMETRICAL TONIC NECK
REFLEX(STNR)
POS: Prone
STI: Flex Neck & observe; Extend the
Neck& observe
RES: With neck flexion, Arms FLEX &
Legs EXTEND and Viceversa
DUR: 4-6 months to 8-12 months
FUN: Works along with ATNR & TLR to
influence tonic postural stability
RET: Interferes with reciprocal creeping,
sitting, standing & walking.
STNR
TONIC LABYRINTHINE REFLEX
POS: Supine/Prone
STI: Position itself is a stimuli
RES: Total Extension of body(Supine) &
Total flexion of body(Prone)
DUR: 2 to 4-6 month
RET: Interferes with Head Control,
Coming to Sit, Crawling, Creeping &
Standing
TLR-Supine TLR-Prone
POSITIVE SUPPORTING REACTION
POS: Vertical Suspension
STI: Bounce Child’s Feet on bed
RES: LE goes to total Extension
DUR: 2 to 4-6 months
FUN: Facilitates Weight Bearing/Standing and
Provides Generalized support(not rigid) for
activity and movement.
RET: Increased obligatory extensor tone with Hip
abduction and Plantar flexion of ankle indicates
pathologic influence and prevents Normal Gait,
Sitting & stair walking. Structured deformity may
occur secondarily to increased extensor tone.
POSITIVE SUPPORTING REFLEX
ASSOCIATIVE REACTION
POS: Supine lying/Arms at Sides
STI: Make the child to grasp some object
in one side.
RES: Other side the same finger also goes
for Flexion
DUR: 4-6 months
RET:
ASSOCIATIVE REACTION
MIDBRAIN LEVEL REFLEX
Neck Righting on Neck Reflex
Neck righting on body reflex
Body righting on Body Reflex
Body righting on neck reflex
Labyrinthine righting reaction(4)
Optical righting reaction(4)
BODY RIGHTING REFLEX
ON BODY ON NECK
POS: Supine POS: Supine
STI: Hold the part of STI: Hold the head
body and turn it to one and turn to one side.
side.
RES: Same
RES: Whole body moves
to that side in a
SEGMENTAL MANNER. DUR: 4-6 months – 5
DUR: 4-6 months - 5 Years
Years
FUN: Facilitates rolling FUN: Same
for pursuits and for
RET: diminished
proceeding to sitting,
creeping, standing and bilateral integration.
walking
RET: Same
BODY RIGHTING
ON BODY ON NECK
NECK RIGHTING
ON BODY ON NECK
POS: Supine POS: Supine
STI: Hold the body and STI: Hold neck & turn
turn it to one side towards one side
RES: Entire body turn to
RES: Entire body
that side in LOG
ROLLING MANNER. turns towards that
DUR: Until 1 month. After side in a LOG
that body righting has to ROLLING MANNER
start. DUR: Until 1 month
FUN: Facilitates rolling FUN : Same
for pursuits and for
proceeding with Head
Control to sitting,
creeping
NECK RIGHTING
ON BODY ON NECK
LABYRINTHINE RIGHTING RECTION
4 Labyrinthine righting reaction are Present.
BLIND FORT THE CHILD
POS: Vertical Suspension/ If child has more
postural balance, Hold at Hip
STI: Lab1- Tilt Forwards
Lab2- Tilt Backwards
Lab3- Tilt on Right Side
Lab4- Tilt on Left side
RES: Lab1- Neck extension followed by trunk
extension
Lab2- Neck & Trunk Flexion
Lab3 & Lab4- Lateral Flexion of Neck &
Trunk To the Opposite Side
DUR: Birth – 2months
FUN: Allow for normal standing position,
preserve balance while changing from
Prone or Supine to fully upright position,
head control in normal upright position,
Infant use this reaction to clear the head
in prone position, It suppresses Primitive
abnormal reflex and facilitate normal
movement for sitting, creeping, standing,
walking.
Contributes to the ability to move in
forward direction. Detects functioning of
the OTOLITH organs housed in the
labyrinth of inner ea
RET: If persist, Block rolling from supine
due to increased extensor tone.
OPTICAL RIGHTING REACTION
4 Reactions are present
Do Not Blind fort the child
Stimulus & Response are same as
Labyrinthine righting reaction.
DUR:
FUN: Visual stimuli that enable the
person to maintain it’s correct position of
head in space, by bringing about
movements if muscles of the neck &
limbs.
RET:
OPTICAL RIGHTING REACTION
EQUILIBRIUM REACTION
PRONE SUPINE
POS: Prone POS: Supine
STI: Vestibular, STI: Vestibular,
Proprioceptive and Proprioceptive and visual
Visual LOC: Displace the body
LOC: Displace the body supine laterally.
in prone laterally RES: Curvature of spine,
RES: Curvature of spine, concave to the side being
concave to the side being stressed or upward side,
stressed or upward side, with abduction and
with abduction and extension of extremities.
extension of extremities. Head turns towards
Head turns towards forward side.
upward side. DUR: 7-8 months and
DUR: 5 months & persist Persists
For Both..,
In General, These are automatic
reactions which preserves body’s centre
of balance when the supporting base is
unstable. Also, it facilitates movement
and postural adaptation to different
gravitational changes.
SITTING STANDING
POS: Sitting POS: Standing
STI: Displace the body in STI: Displace the body
sitting to right and left, in standing
forward and backward
RES: Curvature if the
RES: Curvature of the
spine concave to the side spine, concave to the
of being stressed or side being stressed
upward side, with with abduction and
abduction and extension extension of UEs and
of the UEs. LEs
DUR: 7-8 months & DUR: 12 – 21 months
persists
and persist
ADAPTATION: Stable,
RET: Interfere with
prone and supine with
beginning sitting all form of volitional
equilibrium are necessary movement and restrict
for sitting without mobility and
support adaptability
QUADRUPED
POS: Quadruped
STI: Displace the body on all fours
RES: Curvature of spine concave to the
side being stressed with increased UE &
LE Extension on stressed side
DUR: 9-12 months and Persists
ADAP: stable prone, supine and sitting
equilibrium with beginning equilibrium
in quadruped is needed for creeping