Primitive Reflexes (PDF) by mikesanye

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									                                                        Primitive Reflexes

    Reflex                 Stimulus                   Expected Response               Duration          Abnormal Indications

Cephalic:

1. Blinking/   shine bright light in eyes     eyelids close                       birth-1 yr      absence indicates poor light
Dazzle                                                                                            perception or blindness

2. Acoustic    create a loud noise about 12   both eyes will blink                birth-6 mo      absence indicates decreased
blink          inches from baby's ear                                                             hearing or congenital deafness


3. Rooting     stroke baby's cheek near       head moves toward side of           birth-4 mo      asymmetric response indicates
               corner of mouth                stimulus and mouth opens                            lesion of brain stem or
                                                                                                  trigeminal nerve; absence may
                                                                                                  be CNS disease; expect minimal
                                                                                                  or no response if baby was just
                                                                                                  fed

4. Suckling    place finger in baby's mouth   tongue should push finger up        disappearance   abnormal function of CN IX, X,
                                              against hard palate with good       variable        and/or XII
                                              strength, note pressure, strength
                                              and pattern

5. Rotation    hold baby under axilla in an  eyes should turn in direction of     disappearance   if eyes do not move in expected
Test/ Doll's   upright position, head held   rotation, then opposite direction    variable        direction suspect vestibular
Eye            steady, facing examiner,      once rotation stops                                  problem or eye muscle paralysis
               rotate baby one way, then the
               other
                                                         Primitive Reflexes

    Reflex                 Stimulus                     Expected Response              Duration           Abnormal Indications

Neck:

1. Moro/       create a loud noise              total extension then flexion       birth-6 mo       beyond 6 mo =neurological
Startle                                                                                             disease; asymmetrical response
                                                                                                    of UE= brachial plexus injury or
                                                                                                    fx of clavicle or humerus, LE=
                                                                                                    low spinal injury or congenital
                                                                                                    hip dislocation


2. Tonic neck/ baby supine, turn head to one extension of arm and leg on side      present at birth, persistance= major cerebral
Fencer         side                          head is turned to, flexion of other   dominant 3        damage
                                             arm and leg                           months, gone
                                                                                   by 6 mo

3. Reverse     suspend baby upside down by      look for arching upon initial     birth-6 mo        arching could indicate meningeal
Fencer         the feet, relax weight off one   suspension; head should rotate                      pull; inability to turn head to
               extremity, then the other;       away from the weight bearing side                   opposite side of extension (or
               place baby supine apply firm     smoothly; acetabular resistance                     twitching) indicates C0, or C1
               pressure of femurs into          should be equal                                     subluxation on that side; softer
               acetabulum bilaterally                                                               acetabular pump indicates C1
                                                                                                    laterality to that side; equal
                                                                                                    acetabular pump indicates C0


                           **Rule out hip instability before suspending infant by legs**
Trunk:

1. Galant/     baby is face down with trunk curvature of trunk towards side        birth-2 mo       absence indicates presence of
Trunk          supported on examiner's lower stroked                                                spinal cord lesion or possibly
Incurvation    arm, run finger 3 cm                                                                 paralysis
               paravertebrally from occiput
               to buttock
                                                         Primitive Reflexes

    Reflex                Stimulus                     Expected Response                Duration           Abnormal Indications


2. Perez      baby is positioned same as     extension of head and spine with       birth -3 mo      absence indicates severe
              above, run finger over spinous flexion of knees on chest; most                         cerebral insult, injury to upper
              from sacrum to occiput         likely elicits urination as well                        cervical cord, advanced anterior
                                                                                                     horn cell disease, severe
                                                                                                     myopathy

3. Landau     baby positioned same as          baby should be able to lift head     3 mo-18 mo       brain stem dysfunction
              above                            above horizontal with extension of
                                               arms, legs and trunk



Upper
Extremity:

1. Palmer     place finger from ulnar side     fingers curl to stimulus             birth- 3 mo      persistence indicates cerebral
Grasp         into baby's hand                                                                       dysfunction




Lower
Extremity:

1. Plantar    touch plantar surface of         toes should curl downward            birth- 3 mo      absence correlates with
Grasp         baby's foot at the base of the                                                         development of spastic cerebral
              toes                                                                                   palsy

2. Babinski   stroke lateral plantar surface   normal (negative) response= toes     positive         persistance beyond 2 yoa
              of foot from heel to base of     curl down and foot moves away;       response         indicates upper motor neuron
              toes, then across ball of foot   abnormal (positive) response=        normal until age lesion; unilateral persistance
              towards first digit              toes spread with dorsiflexion of     2                may indicate cerebral palsy
                                               foot and digit 1
                                                          Primitive Reflexes

    Reflex                 Stimulus                      Expected Response                Duration         Abnormal Indications

3. Clonus      press thumb over ball of foot     rapid, rhythmic plantar flexion of                  sustained clonus is indicative of
               and abruptly dorsiflex it         foot which is unsustained                           severe CNS disease


Suspension &
Stepping:

1. Vertical    suspend baby with your hands head midline, legs flexed at hips         birth-4 mo     scissoring of legs, fixed
suspension     under their axillae          and knees                                                extension & adduction of legs=
                                                                                                     spastic paraplegia or diplegia


2. Placing     baby held upright with back       flexes hip and knee, places          birth- 11 mo   absence could indicate paresis
               and head support, allow           stimulated foot on table top                        or breech presentation at birth
               dorsum of foot to touch
               undersurface of table top

3. Steppage    baby held upright under           alternate flexion and extension of   birth- 11 mo   absence could indicate paresis
               axillae, allow soles of feet to   legs simulating walking                             or breech presentation at birth
               touch surface of table, baby's
               body is inclined slightly
               forward

4. Parachute   baby held upright under           baby extends it's arms and legs      6 mo -         Upper extremity pyramidal tract
Response       axillae, slowly lower baby's      forward as if to protect itself      adulthood      dysfunction; asymmetrical
               head toward surface (prone)                                                           response may be a sign of
                                                                                                     hemiparesis
                                                          Primitive Reflexes

References:

Anrig C, Plaugher G. Pediatric Chiropractic. Baltimore, Williams & Wilkins; 1998

Fysh, P. Chiropractic Care for the Pediatric Patient, 1st ed.Arlington; ICA Council on Chiropractic Pediatrics; 2002

McMullen, M. Assessing Upper Cervical Subluxations in Infants Under Six Months. ICA International Review of Chiropractic
March/April 1990, 39-41.

Seidel H, Ball J, Dains J, Benedict GW. Mosby's Guide to Physical Examination, 3rd ed. St. Louis, Von Hoffman Press Inc.; 1995

								
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