PRIMITIVE AND TONIC REFLEX

These reflex are normaly present during infancy and become integrated by the CNS at an early stage.These reflex are not generally present in adults .

Patients who exhibit these reflexes typically present with extensive brain damage and either UMN sign.Reflexes important to examine in the patients suspected of abnormal reflex activity include flexor withdrawal

A reflex scouring key from is:-• 0+ve absent.• 1+ve tone change, slight, transient with no movement of the extremities. • 2+ve visible movements of extremities.

• 3+ve exaggerated, full movement of extremities.• 4+ve obligatory and sustained movement raising for more than 30 sec.

Primitive/spinal reflexes

• Name- Flexor withdrawal• Onset-2-3wks gestation• Integrated- 1-2months• Stimulus- noxious stimulus(pin prick) to sole

of foot.• Response-Toes extended, foot DF, entire lower

extremity flexes.

Name- cross extensionOnset-28 wks gestationIntegrated- 1-2monthsStimulus- noxious stimulus to ball of foot of lower extremity fixed in extension.Response- opposite lower extremity flexes then adduction and extends.

Name- Traction Onset-28wks of gestationIntegrated- 2-5 monthsStimulus- Grasp forearm and pull up from supine into sitting position.Response-grasps and total flexion of upper extremity.

Name- MoroOnset- 28 wks of gestationIntegrated- 5-6 monthsStimulus- head drag method used. Baby held in supine with supported behind the chest and head then head is allowed to drop 10degreeResponse- elbow extended shoulder abducted , upper limb- hand opening and crying followed by flexion , adduction of arms across chest.

Name- Startle Onset- birthIntegrated- persistStimulus- sudden loud or harsh noise.Response- sudden extension or abduction of upper extremity , crying.

Name- Grasp(planter/palmer) Onset- palmer birthIntegrated- palmer 4-6 months planter 9 monthsStimulus- Maintain pressure to palm of hand(palmer grasp) or to ball of foot under toes (planter grasp).Response- Maintain flexion of fingers of hands or toes.

Name- STNROnset-Integrated- 4-6 month Stimulus- Flexion or extension of head. Response - With head flex , flexion of upper extremity , extension of lower extremity - with head extension , extension of upper extremity and flexion of lower extremity

Name- symetrical tonic baby ri TLR or STLR Onset- birthIntegrated- 6 monthStimulus- Prone or supine positionResponse- With prone it increases flexor tone/Flexion of all limbs with supine and increase extensor tone / extension of all limbs

Name- Positive supportingOnset- birthIntegrated- 6 monthStimulus- contact to the ball of the feet in upright standing position.Response- Rigid extension , coactions of the lower extremity.

Name - Associated reactionsOnset - birth/ 3months Integrated - 8-9 yrs Stimulus - Resisted voluntary movement in any part of body.Response - Involuntary movements in a resting extremity.

Name – Asymmetrical tonic neck(ATNR)Onset - birthIntegrated – 4-6 months Stimulus – Rotation of the head on one side.Response – Flexion of skull limbs extension of the jaw limbs “bow and arrow ” or “fencing” posture.

Name – Neck righting action of the body(NOB)Onset – 4-6 months Integrated – 5 years Stimulus – Passively turn head to one side, tested in supineResponse – Body rotates as a whole to align the body with the head.

Name – Body righting acting on head(BOH)Onset – birth-2 months Integrated – 5 years Stimulus – Place in prone or supine position. Response – Head orients to vertical position with mouth horizontal.

Name – Protective extension(PE)Onset – arms, 4-6 months; legs , 6-9 months.Integrated – persistsStimulus – Displace center of gravity outside the base of supportResponse – Arms or legs extend and abduct to support and to protect the body against falling

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