PRIMITIVE REFLEX

REFLEX TESTING METHODS for EVALUATING C.N.S. DEVELOPMENT

MARY R. FIORENTINO

TEST POSITION TEST STIMULUS NEGATIVE REACTION POSITIVE REACTION NOTES

SPINAL LEVEL
Spinal reflexes are mediated by areas of the G.N.S. up to the base of the 4th ventricle.
Spinal reflexes are "phasic" or movement reflexes which coordinate muscles of the extremities in patterns of either total flexion or extension. Positive or negative
reactions to spinal reflex testing may be present in the normal child within the first two months of life. Positive reactions persisting beyond two months of age may be
indicative of delayed maturation of the C.N.S. Negative reactions are normal. Complete domination by these primitive spinal reflexes results in an apedal (prone, supine-
lying) creature.
1 Flexor Withdrawal Patient supine. Stimulate sole of Controlled maintenance of stimulated Uncontrolled flexion response of Positive reaction is
Head in mid- foot (noxious leg in extension or volitional stimulated leg (Do not confuse normal up to two
position. stimuli) withdrawal from irritating stimulus with response to tickling) months of age.
Legs extended.
Positive reaction
after two months
of
age may be one
indication of
delayed
reflexive
maturation.

2 Extensor Thrust Patient supine. Stimulate sole of Controlled maintenance of Uncontrolled extension of Positive reaction is
Head in mid- foot of leg in flexion stimulated leg. (Do not confuse normal up to two
position. flexed leg. with response to tickling.) months of age.
One leg extended,
opposite Positive reaction
leg flexed. after
two months of age
may be one
indication of
 delayed reflexive
maturation.

3 Crossed Extension Patient supine. Flex the extended On flexion of the extended leg, the On flexion of the extended leg, the Positive reaction is
Head in mid- leg opposite leg will remain flexed. opposite, or initially normal up to two
position. flexed, leg will extend. months of age.
One leg flexed,
opposite leg Positive reaction
extended. after two months
of age may be one
indication of
delayed
reflexive
maturation.

BRAIN STEM LEVEL

Brainstem reflexes are mediated by areas from the 8th Nerve Nucleus to below the Red Nucleus.
Brain stem reflexes are "static" postural reflexes and effect changes in
distribution of muscle tone throughout the body, either in response to a change of the position of head and body in space (by stimulation of the labyrinths), or in the
head in relation to the body (by stimulation of proprioceptors of the neck muscles). Positive or negative reactions to brain stem reflex testing may be present in the
normal child within the first four to six months of life. Positive reactions persisting beyond six months of age may be indicative of delayed maturation of the C.N.S.
Negative reactions are normal. Complete domination by these primitive brain stem reflexes results in an apedal (prone, supine-lying) creature.
1 Asymmetrical Patient supine. Turn head to one No reaction of limbs on Extension of arm and leg on Positive reaction is
Tonic Neck Head in mid- side. either side. face side, or increase in normal up to six
position. extensor tone; flexion of months of age.
Arms and legs arm and leg on skull side, or
extended. increase in flexor tone. Positive reaction
after six months of
age may be one
indication of
delayed
reflexive
maturation.
2 Symmetrical Tonic Patient in Ventroflex the No change in tone of arms Arms flex or flexor tone Positive reaction is
Neck 1 quadruped head. or legs. dominates; legs extend or normal up to four
position or over extensor tone dominates. to six
tester's knees. months of age.

Positive reaction
after six months of
age may be one
indication of
delayed
reflexive
maturation

3 Symmetrical Tonic Patient in Dorsiflex the No change in tone of arms Arms extend or extensor tone Positive reaction is
Neck 2 quadruped head. or legs. dominates; legs flex or flexor normal up to four
position or over tone dominates. to six
tester's knees. months of age.

Positive reaction
after six months of
age may be one
indication of
delayed
reflexive
maturation
4 Tonic Labyrinthine Patient supine. The supine No increase in extensor tone Extensor tone dominates when Positive reaction is
Supine Head in mid- position, per se. when arms and legs are passively arms and legs are passively flexed. normal up to four
position. flexed. months of age.
 Arms and legs
extended. Positive reaction
after four months
of age may be one
indication of
delayed
reflexive
maturation

5 Tonic Labyrinthine Patient prone. Prone position, No increase in flexor tone; Flexor tone dominates in arms, Positive reaction is
Prone Head in mid- per se. arms, legs or hips can legs and hips. (To test for normal up to four
position. be extended. flexion reaction in hips, months of age.
Legs extended, both knees are flexed
arms simultaneously.) Positive reaction
extended over after four months
head. of age may be one
indication of
delayed reflexive
maturation.

6 Associated Patient supine. Have patient No reaction, or minimal Mirroring of opposite limb Positive reaction
Reactions squeeze an reaction or increase of tone and /or increase of tone in in patients with
object. (With a in other parts of the other parts of the body. other abnormal
hemiplegic, body. reflexology may
squeeze be an indication
with uninvolved of delayed
hand.) reflexive
maturation
7 Positive Hold patient in Bounce several No increase of tone (legs volitionally Increase of extensor tone Positive reaction is
Supporting standing position. times on soles of flex). in legs. Plantar flexion normal up to four
Reaction feet. of feet, genu recurvatum months of age.
may occur.
Positive reaction
after four months
of age may be one
indication of
delayed reflexive
maturation.
8 Negative Hold patient in Bounce several No increase in flexor tone. Increase of flexor tone Positive reaction
Supporting standing position. times on soles in legs. is normal up to
Reaction of feet. four
Hold patient in months of age.
space.
Positive reaction
after four
months of age
may be one
indication of
delayed reflexive
maturation.

MIDBRAIN LEVEL
RIGHTING reactions are integrated at the midbrain level above the Red Nucleus.
Righting reactions interact with each other and work toward establishment of normal head and body relationship in space as well as in relation to each other. These are
the first such reactions to develop after birth and reach maximal concerted effect about age ten to twelve months. As cortical control increases, they are gradually
modified and inhibited and disappear towards the end of the fifth year. Their combined actions enable the child to roll over, sit up, get on his hands and knees, and make
him a quadrupedal creature.
1 Neck Righting Patient supine. Rotate head to Body will not rotate. Body rotates as a whole in Positive reaction
Head in mid- one side, the same direction as the is normal from
position. actively or head. birth
Arms and legs passively. to six months of
extended age.

Positive reaction
beyond six
months of age
may be one
indication of
delayed reflexive
maturation.
 Negative
reaction over
one month of
age is one
ndication of
delayed reflexive
maturation.

2 Body Righting Patient supine. Rotate head to Body rotates as a whole Segmental rotation of trunk Positive reaction
Acting on the Head in mid- one side, (neck righting), and not between shoulders and pelvis, emerges about
Body position. actively or segmentally. e.g., head turns, then shoulders, finally six
Arms and legs passively. the pelvis. months of age.
extended.
Negative
reaction over six
months of age
may be one
indication of
delayed reflexive
maturation.

3 Labyrinthine Hold blindfolded Prone position Head does not raise automatically to the Head raises to normal position, face Positive reaction
Righting Acting patient in space. in space, per se. normal position. vertical, mouth horizontal. is normal about
on the Head 1 Prone position. one to two
months of age
and continues
throughout life.
 Negative
reaction after
two months of
age may be one
indication of
delayed reflexive
maturation.

4 Labyrinthine Hold blindfolded Supine position Head does not raise automatically to the Head raises to normal position, face Positive reaction
Righting Acting patient in space. in space, per se. normal position. vertical, mouth horizontal. is normal about
on the Head 2 Supine position. six months of age
and continues
throughout life.

Negative
reaction after six
months of
age may be one
indication of
delayed
reflexive
maturation.
5 Labyrinthine Hold blindfolded Tilt to the right. Head does not right itself automatically Head rights itself to normal position, Positive reaction
Righting patient in space. to the normal position. face vertical, mouth horizontal. is normal about
Acting on the Hold around six to eight
Head 3 pelvis. months of age
and continues
throughout life.

Negative
reaction after
eight months of
age may be one
indication of
 delayed reflexive
maturation.

6 Labyrinthine Hold blindfolded Tilt to the left. Head does not right itself automatically Head rights itself to normal position, Positive reaction
Righting patient in space. to the normal position. face vertical, mouth horizontal. is normal about
Acting on the Hold around six to eight
Head 4 pelvis. months of age
and continues
throughout life.

Negative
reaction after
eight months
of age may be
one indication of
delayed reflexive
maturation.
7 Optical Righting Hold patient in Prone position Head does not raise automatically to the Head raises to normal position, face Positive reaction
1 space. in space, per se. normal position. vertical, mouth horizontal. normally appears
Prone position. soon after
Labyrinthine
Righting acting
on the head (1 -2
months) and
continues
throughout life.

Negative
reaction after
this time may
be one indication
of delayed
reflexive
maturation
8 Optical Righting Hold patient in Supine position Head does not raise automatically to the Head raises to normal position, face Positive reaction
2 space. in space, per se. normal position. vertical, mouth horizontal. is normal about
Supine position. six months of age
and continues
throughout life.

Negative
reaction after six
months of age
may be one
indication of
delayed reflexive
maturation.

9 Optical Righting Hold patient in Tilt to the right. Head does not right itself automatically Head rights itself to normal position, Positive reaction
3 space. to the normal position. face vertical, mouth horizontal. is normal about
Hold around six to eight
pelvis. months of age
and continues
throughout life.

Negative
reaction after
eight months
of age may be
one indication of
delayed reflexive
maturation.

10 Optical Righting Hold patient in Tilt to the left. Head does not right itself automatically Head rights itself to normal position, Positive reaction
4 space. to the normal position. face vertical, mouth horizontal. is normal about
 Hold around six to eight
pelvis. months of age
and continues
throughout life.

Negative
reaction after
eight months
of age may be
one indication of
delayed reflexive
maturation.

11 Amphibian Patient prone. Lift pelvis on Flexion of arm, hip and knee cannot be Automatic flexion of arm, hip and knee Positive reaction
Reaction Head in mid- one side. elicited. on same side. is normal at six
position. months of age
Legs extended, and remains
arms extended throughout life.
over head.
Negative
reaction after six
months of age
may be one
indication of
delayed reflexive
maturation.

AUTOMATIC MOVEMENT REACTIONS

These are described as a group of reflexes observed in infants and young children which are not strictly righting reflexes, but which are movements produced by
stimulation of the semicircular canals. Like righting reflexes, they appear at certain stages of development and their persistence, or absence, can be observed in patients
under pathological conditions.
1 Moro Reflex Patient supine. Elicited by a Minimal or no startle reaction. Abduction-extension reaction of the Positive reaction
Arms and legs number of arms, and /or movement in other parts is normal from
extended. stimuli, such as, of the body. birth to four to
sudden noise, six months of
movement of age.
supporting
surface, Positive reaction
dropping after six months
patient of age may be
backwards one indication of
while held in delayed reflexive
semi-sitting maturation.
position.
Negative
reaction is
normal after six
months of age.

2 Landau Reflex Patient held in Head raised, Spine and legs remain in flexed position. Spine and legs extend. (When head is Positive reaction
space, supporting actively or ventroflexed, spine and legs flex.) is normal from
thorax. passively. six months to
Prone position. two or two and
one half years of
age.

Negative
reaction is
normal from
birth to six
months of age
and from two
and one half
 years throughout
life.

Positive reaction
after two and
one half years of
age may be one
indication of
delayed reflexive
maturation.
3 Protective Patient prone. Suspend patient Arms do not protect head, but show Immediate extension of arms with Positive reaction
Extensor Thrust Arms extended in air by ankles primitive reflex reaction, such as, abduction and extension of fingers to is normal about
overhead. or pelvis and asymmetrical or symmetrical tonic neck protect the head. six
move head reflexes. months of age
suddenly and remains
towards throughout
floor. life.

Negative
reaction after six
months of
age may be one
indication of
delayed
reflexive
maturation.

CORTICAL LEVEL
These reactions are mediated by the efficient interaction of cortex, basal ganglia and cerebellum. Maturation of equilibrium reactions brings the individual to the human
bipedal stage of motor development. They occur when muscle tone is normalized and provide body adaptation in response to change of center of gravity in the body.
They emerge from six months on. Positive reaction at any one level indicates the next higher level of motor activity is possible.
1 Supine Patient supine on Tilt board to one Head and thorax do not right- Righting of head and thorax, abduction Positive
tiltboard. side. themselves; no equilibrium or protective and extension of arm and leg on raised reactions normal
Arms and legs reactions. (It is possible to have positive side (equilibrium reaction), protective about six months
extended. reactions in some body parts but not in reaction on lowered side of board. of age and
others.) continue
throughout life.
 Negative
reaction after six
months of
age may be one
indication of
delayed
reflexive
maturation.

2 Prone Patient prone on Tilt board to one Head and thorax do not right- Righting of head and thorax, abduction Positive
tiltboard. side. themselves; no equilibrium or and extension of arm and leg on raised reactions normal
Arms and legs protective reactions. (It is possible to side (equilibrium reaction), protective about six months
extended. have positive reactions in some body reaction on lowered side of board. of age and
parts but not in others.) continue
throughout life.

Negative
reaction after six
months of
age may be one
indication of
delayed
reflexive
maturation.

3 Four-foot Patient in Tilt to one side. Head and thorax do not right Righting of head and thorax, abduction- Positive
Kneeling quadruped themselves; no equilibrium or protective extension of arm and leg on raised side reactions normal
position. reactions. (It is possible to have positive (equilibrium reaction), and protective about eight
reactions in some body parts but not in reactions on lowered side. months of age
others.) and continue
throughout of
life.
 Negative
reactions after
eight months
age may be one
indication of
delayed
reflexive
maturation.

4 Sitting Patient seated on Pull or tilt Head and thorax do not right Righting of head and thorax, abduction- Positive
chair. patient to one themselves; no equilibrium or extension of arm and leg on raised side reactions normal
side. protective reactions. (It is possible to (equilibrium reaction), and protective about ten to
have positive reactions in some body reaction on lowered side. twelve months of
parts but not in others.) age and continue
throughout life.

Negative
reactions after
twelve months
of age may be
one indication of
delayed
reflexive
maturation.

5 Kneel-standing Patient in kneel- Pull or tilt Head and thorax do not right Righting of head and thorax, abduction- Positive
standing position. patient to one themselves; no equilibrium or extension of arm and leg on raised side reactions normal
side. protective reactions. (It is possible to (equilibrium reaction), and protective about fifteen
have positive reactions in some body reaction on lowered side. months of age
parts but not in others.) and continue
throughout of
life.
 Negative
reactions after
fifteen months
age may be one
indication of
delayed
reflexive
maturation.

6 Hopping 1 Patient in Move to the left Head and thorax do not right Righting of head and thorax, hopping Positive
standing position. or to the right themselves; no hopping steps to steps sideways to maintain equilibrium. reactions normal
Hold by upper sides. maintain balance. about fifteen
arms. to eighteen
months of age
and continue
throughout life.

Negative
reactions after
eighteen
months of age
may be one
indication of
delayed reflexive
maturation.

7 Hopping 2 Patient in Move forward. Head and thorax do not right Righting of head and thorax, hopping Positive
standing position. themselves; no hopping steps to steps forward to maintain equilibrium. reactions normal
Hold by upper maintain balance. about fifteen
arms.
 to eighteen
months of age
and continue
throughout life.

Negative
reactions after
eighteen
months of age
may be one
indication of
delayed reflexive
maturation.

8 Hopping 3 Patient in Move Head and thorax do not right Righting of head and thorax, hopping Positive
standing position. backwards. themselves; no hopping steps to steps backwards to maintain equilibrium. reactions normal
Hold by upper maintain balance. about fifteen
arms. to eighteen
months of age
and continue
throughout life.

Negative
reactions after
eighteen
months of age
may be one
indication of
delayed reflexive
maturation.
9 Dorsiflexion Patient in Tilt patient Head and thorax do not right Righting of head and thorax, feet Positive
standing position. backwards. themselves; no dorsiflexion of feet. dorsiflex. reactions normal
Hold under xillae. about fifteen
to eighteen
months of age
and continue
throughout life.

Negative
reactions after
eighteen
months of age
may be one
indication of
delayed reflexive
maturation.

10 See-Saw (Patient must be Pull arm Head and thorax do not right Righting of head and thorax, slight Positive
able to maintain forward gently themselves; inability to maintain abduction and full extension of manually reactions normal
standing balance.) and slightly to standing balance. flexed knee to maintain equilibrium. about fifteen
Patient in lateral side. months of age
standing position. and continue
On same side, throughout
hold by hand and life.
foot, flex hip and
knee. Negative
reactions after
fifteen months
of age may be
one indication of
delayed
reflexive
maturation.
11 Simian Position Patient in squat- Tilt to one side. Head and thorax do not right Righting of head and thorax, abduction- Positive
sitting position. themselves; inability to assume or extension of arm and leg on raised reactions normal
maintain position, lack of equilibrium side (equilibrium reaction), and about fifteen to
or protective reactions. protection on the lowered side. eighteen months
of age and
continue
throughout life.

Negative
reactions after
eighteen
months of age
may be one
indication
of delayed
reflexive
maturation.