ppt - york university
TRANSCRIPT
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© 2007 McGraw-Hill Higher Education. All rights reserved.
Infant Reflexes and Stereotypies
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Objectives
• Explain the infant reflexes and their importance.
• Pinpoint and explain the number of infant reflexes.
• Describe the primitive reflexes.
• Describe the postural reflexes.
• List and explain some stereotypies.
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What are Infant Reflexes?
• Involuntary stereotyped movement responses to a particular stimuli.
• Dominant movement form during the last 4 months of prenatal life and first 4 months after birth.
• Occur subcortically (below the level of the higher brain centers)
• Examples?
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Infant vs. Lifespan Reflexes
• Most “infant” reflexes do not last beyond the first year.
• Infant reflexes may not completely disappear.– May be inhibited by maturing CNS. – May be integrated into new movements.
• Reflexes that endure are called “lifespan” reflexes.– Examples?
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Infant reflexes and stereotypies are very
important in the process of development.
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Why is the study of infant reflexes important?
• Dominant form of movement for last 4 months prenatally and first 4 months postnatally.
• Primitive reflexes critical for human survival.
• Postural reflexes believed to be foundation for later voluntary movements.
• Appearance and disappearance helpful in diagnosing neurological disorders.
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Role of the Reflexes in Survival
• Human infants essentially helpless.– Highly dependent on their caretakers and reflexes for
protection and survival.
• Primitive reflexes occur during gestation or at birth and most are repressed by 6 months of age.
• Primitive reflexes are important for protection, nutrition, and survival.
• Examples?
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Role of Reflexes in Developing Future Movement
• Postural reflexes are related to the development of later voluntary movement.
– Reflexes integrated, modified, and incorporated into more complex patterns to form voluntary movements.
– Automatic movement is “practice” for future voluntary movements.
– Some believe reflexes may not be related to future motor development.
– Examples?
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Infant Reflex Future Voluntary Movement
Crawling Crawling
Labyrinthine Upright posture
Palmar grasp Grasping
Stepping Walking
Role of Reflexes in Developing Future Movement
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Reflexes as Diagnostic Tools
• Reflexes can determine level of neurological maturation.– Reflexes are age-specific in normal, healthy infants– Severe deviations from normal time frame may indicate
neurological immaturity or dysfunction.
• Reflexes should be tested carefully and only by trained professionals. – Need state of quiet. – If baby restless, crying, sleepy, or distracted, may not
respond to applied stimulus.
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Reflex Concern
Moro reflex May signify cerebral birth injury if lacking or asymmetric.
Asymmetric tonic reflex
May indicate cerebral palsy or other neurological problem if persists past normal time.
Reflexes as Diagnostic Tools
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• Milani Comparetti Neuromotor Development Examination
– Measures several infant reflexes from birth to 24 months.
– Develops profile of child’s movement in relation to what is expected at a specific age.
– Especially valuable with children suspected of motor delay.
Reflexes as Diagnostic Tools
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• Primitive Reflex Profile– Quantification of the level of presence or strength
of primitive reflexes– 3 reflexes: moro, asymmetric tonic neck,
symmetric tonic neck– 5 point classification system (0 for absent, 4 for
so strong it dominates individual).
Reflexes as Diagnostic Tools
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Pinpointing the Number of Infant Reflexes
• Different terminologies used for same reflex by experts– Rooting reflex = search reflex; cardinal points
reflex
• Reflexes are often poorly defined and more complex than once thought– Palmar grasp vs. traction response
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Primitive Reflexes
• Palmar Grasp• Sucking• Search• Moro• Startle• Asymmetric Tonic Neck• Symmetric Tonic Neck• Plantar Grasp• Babinski• Palmar Madibular• Palmar Mental
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Stimulus / Response
S: Palm stimulated R: 4 fingers (not thumb) close
Duration 5 months gestation - 4 months postpartum
Concerns No palmer grasp may indicate neurological problems (spasticity)
Other One of the most noticeable reflexes May lead to voluntary reaching / graspingMay predict handedness in adulthood
Primitive Reflexes ~ Palmar Grasp
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Stimulus / Response
S: touch of lips R: sucking action
Duration In utero - 3 months postpartum
Concerns No reflex problematic for nutrition
Other Often in conjunction with searching reflex
Primitive Reflexes ~ Sucking
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Stimulus / Response
S: touch cheek R: head moves toward stimuli
Duration Weeks prenatal - 3 months postpartum
Concerns No reflex problematic for nutritionNo reflex or lack of persistence may be sign of CNS or sensorimotor dysfunction.
Other Often in conjunction with sucking reflex. Contributes to head/body-righting reflexes.
Primitive Reflexes ~ Search
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Stimulus / Response
S: Suddenly but gently lower baby’s head S: Hit surface beside baby R: Arms and legs extend
Duration Prenatal – 4-6 months postpartum
Concerns May signify CNS dysfunction if lackingMay signify sensory motor problem if persistsMay delay sitting & head control if persistsMay indicate injury to one side of brain if asymmetical
Other Reaction time increases with age Preceeds startle refle
Primitive Reflexes ~ Moro
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Primitive Reflexes ~ Moro
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Stimulus / Response
S: Same as Moro R: Arms and legs flex
Duration 2-3 months after Moro disappears – 1 year
Other Less severe startle reflexes elicited through lifespan
Primitive Reflexes ~ Startle
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Stimulus / Response
S: Prone/supine position, turn head to one side R: Limbs flex on one side, extend on other side
Duration After birth – 3 months
Concerns Facilitates bilateral body awarenessFacilitates hand-eye coordination
Other Also called ‘bow and arrow’ or ‘fencer’s’ position
Primitive Reflexes ~ Asymmetric Tonic Neck
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Stimulus / Response
S: Baby sitting up and tip forward R: Neck and arms flex, legs extend S: Baby sitting up and tip backward R: Neck and arms extend, legs flex
Duration After birth – 3 months
Concerns Persistence may impede many motor skills and cause spinal flexion deformities
Primitive Reflexes ~ Symmetric Tonic Neck
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Stimulus / Response
S: Touching the ball of foot R: Toes grasp
Duration Birth – 1 year
Other Must disappear before the baby can stand or walk.Issue of shoes versus no shoes?
Primitive Reflexes ~ Plantar Grasp
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Stimulus / Response
S: Stroke bottom or lateral portion of foot R: Great toe turns downward
Duration Birth – 4 months
Concern Test of the pyramidal tract (i.e. ability to perform conscious / voluntary movement)
Primitive Reflexes ~ Babinski
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Stimulus / Response
S: Pressure to both palms or hair to hand R: Eyes close, mouth opens, and/or neck flexes (which tilts the head forward)
Duration Birth – 3 months
Other Also called the Babkin reflex
Primitive Reflexes ~ Palmar Mandibular
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Stimulus / Response
S: Scratch base of palm R: Lower jaw opens and closes
Duration Birth – 3 months
Primitive Reflexes ~ Palmar Mental
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Postural Reflexes
• Stepping
• Crawling
• Swimming
• Head and Body Righting
• Parachuting
• Labyrinthine
• Pull Up
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Stimulus / Response
S: Infant upright with feet touching surface R: Legs lift and descend
Duration After birth – 5-6 months
Concerns Essential forerunner to walking
Other Sometimes called walking reflexDevelopmental changes in reflex over time
Postural Reflexes ~ Stepping
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Stimulus / Response
S: Prone position on surface, stroke alternate feet R: Legs and arms move in crawling action
Duration Birth – 3-4 months
Concerns Precursor to later voluntary creeping
Postural Reflexes ~ Crawling
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Stimulus / Response
S: Infant held horizontally R: Arms and legs move in coordinated swimming type action
Duration 2 weeks after birth – 5 months
Other Recognition of reflex led to popularity of infant swim programs
Postural Reflexes ~ Swimming
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Stimulus / Response
S: Supine, turn body in either direction R: Head “rights” itself with the body S: Supine, turn head in either direction R: Body “rights” itself with the head
Duration Head:1-6 months; Body: 5 months-1 year
Concerns Related to voluntary rolling movements.
Postural Reflexes ~ Head and Body Righting
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Stimulus / Response
S: Off balance in upright position R: Protective movement in direction of fall
Duration 4 months – 1 year
Concerns Assessed in preterm babies as markers of neurological development Related to upright posture
Other Also called propping reflexOccurs downward, sideways, & backward
Postural Reflexes ~ Parachuting
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Stimulus / Response
S: Baby held upright, tilted in one direction R: Baby tilts head in opposite direction
Duration 2-3 months – 1 year
Concerns Related to upright posture
Other Also considered primitive reflex
Postural Reflexes ~ Labyrinthine
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Stimulus / Response
S: Sitting/standing, hold hands, tip in one direction R: Arms flex or extend in to maintain upright position
Duration 3 months – 1 year
Concerns Related to upright posture
Postural Reflexes ~ Pull Up
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Stereotypies
• Reflexes are most studied form of human movement during first few months.
• Stereotypies are another form of movement observable during infancy.
• Characterized by patterned, stereotyped, highly intrinsic, and involuntary movements of the body
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Stereotypies
• Lourie (1949)– Unusual movements are inherent and crucial to
life of a healthy child– Decrease tension and anxiety– Provide stimulation for development of later
voluntary movements
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Stereotypies
• Thelen (1979)– Serve no purpose – Not regulated by the nervous system– Infants spent up to 40% of time exhibiting
stereotypies (peaks at 24-42 weeks).– Grouped stereotypies by body region
• Legs and feet• Hands and arms• Fingers• Torso• Head and face
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Stereotypies
• Common stereotypies– Single leg kick– Two-leg kick– Alternate leg kick– Arm wave– Arm wave with object– Arm banging against a surface– Finger flexion
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Video Clips of Infant Reflexes
• http://www.babyzone.com/baby/newborns/photos_infant_reflexes/10