Presented by:

Emily
Nyanumba
 Content
sSignificance of reflexes
Introduction

Types of reflexes
Conclusion
Introduction
A reflex is an involuntary or automatic action that
your body does in response to something without
even having to think about it

Neonatal reflexes – inborn reflexes present at birth

& occur in a predictable fashion

Normally developing newborn should respond to

certain stimuli with these reflexes
 Significance of reflexes
Helps a Physiotherapist to identify whether the child is
developing normally or not

Tells about what abnormalities the child may be

having if all reflexes are not proper

Knowledge of development of motor skills – helps to

identify whether development is going on at a proper rate
or not
Types of reflexes
 General body reflexes :
 Moro reflex/Startle reflex
 Palmar/grasp reflex
 Plantar grasp reflex
 Walking/stepping reflex
 Asymmetric tonic neck reflex
 Symmetric tonic neck reflex
 Babinski’s reflex
 Parachute reflex
 Landau reflex
 Gallant’s reflex
 Tonic labyrinthine reflex
 Rooting reflex
 Sucking reflex
 Gag reflex
 General body reflexes
Moro reflex/ startle reflex

 Begins at 28 weeks of gestation

 Initiated by any sudden movement of

the neck

 Elicited by -- pulling the baby

halfway to sitting position from supine
& suddenly let the head fall back

 Consists of rapid abduction & extension

of arms with the opening of hands,
tensing of the back muscles, flexion of
the legs and crying
 Within moments, the arms come together again

Clinical significance
 Its nature gives an indication of muscle tone

 Failure of the arms to move freely or the hands to

open fully indicates hypotonia.

 It fades rapidly and is not normally elicited after

6 months of age.
Palmar/grasp reflex

 Begins at 32 weeks of gestation

 Light touch of the palm produces

reflex flexion of the fingers

 Most effective way -- slide the

stimulating object, such as a
finger or pencil, across the palm
from the lateral border

 Disappears at 3-4 months

 Replaced by voluntary grasp at

45 months
Clinical significance

 Exceptionally strong grasp reflex -- spastic form of

cerebral palsy & Kernicterus

 May be asymmetrical in hemiplagia & in cases of

cerebral damage

 Persistence beyond 3-4 months indicate spastic form of

palsy
Plantar/grasp reflex

 Placing object or finger beneath

the toes causes curling of toes
around the object
 Present at 32 weeks of gestation
 Disappears at 9-12 months

• Clinical significance :
 This reflex is referred to as
the "readiness tester".
 Integrates at the same time
that independent gait first
becomes possible.
Walking/
stepping reflex

 When sole of foot is pressed

against the couch, baby tries
to walk
 Legs prance up & down as if
baby
is walking or dancing
 Present at birth, disappears
at approx 2-4 months
 With daily practice of reflex,
infants may walk alone at 10
months
Clinical significance
 Premature infants will tend to walk in a toe-
heel fashion while more mature infants will
walk in a heel-toe pattern.
Asymmetric tonic neck
reflex

 Most evident between 2-3 months of age

• Clinical significance
 The reflex fades rapidly and is not
normally seen after 6 months of age.
 Persistence is the most frequently observed
abnormality of the infantile reflexes in
infants with neurological lesions
 Greatly disrupts development
Symmetric tonic
neck reflex
 Extension of the head
causes extension of the fore
limbs and flexion of the hind
limbs

 Evident between 2-3 months

of age

 Clinical significance
 Not normally easily seen or elicited
in
normal infants
 May be seen in an exaggerated
Babinski’s reflex

 Stimulus consists of a firm painful stroke

along the lateral border of the sole from
heel to toe

 Response consists of movement (flexion or

extension) of the big toe and sometimes
movement (fanning) of the other toes

 Present at birth, disappears at approx 9-

10 months

 Presence of reflex later may indicate

disease
• Clinical significance
 Reflex can be demonstrated in the newborn, thus
showing a hand-mouth neurological link, even at that
early stage
Parachute reflex
 Reflex appears at about 6-9 months
& persists thereafter

 Elicited by holding the child in ventral

suspension & suddenly lowering him to the
couch

 Arms extend as a defensive reaction

• Clinical significance
 Absent or abnormal in children with
cerebral palsy
 Would be asymmetrical in spastic
hemiplagia
Landau reflex
 Seen in horizontal suspension with the
head, legs & spine extended

 If the head is flexed, hip knees &

elbows also flex

 Appears at approximately 3
months,
disappears at 12-24 months

• Clinical significance
 Absence of reflex occurs in hypotonia,
hypertonia or mental abnormality
Trunk incurvation reflex
 Stroking one side of spinal column
while baby is on his abdomen
causes
 Crawling motion with legs
 Lifting head from surface

 Present in utero, seen at

approximately 3rd or 4th day

 Persists for 2-3 months

Gallant’s reflex
 Firm sharp stimulation along sides
of the spine with the fingernails or a
pin produces contraction of the
underlying muscles and curving of
the back.

 Response is easily seen when the

infant is held upright and the trunk
movement is unrestricted

 Best seen in the neonatal period and

thereafter gradually fades.
Clinical significance
 Useful diagnostically for :
 Detection of upper motor neuron lesions (exaggerated
response)

 Myopathic conditions (depressed or absent response)

 Localization of the segmental lesions of the cord.

Tonic labyrinthine reflex
 Labyrinths -- most important
organs concerned with the
development of anti-gravity postures
and balance

 Movement of the head in any

dimension stimulates the labyrinths;
and produces the appropriate
responses

 Arms & legs extend when head moves

backwards, & will curl in when the
head moves forward

 Emerges in utero until approximately

4 months postnatally
Rooting reflex
 Baby’s cheek is stroked :
 They respond by turning their head
towards the stimulus
 They start sucking, thus allowing for
breast feeding

 When corner of mouth is touched, lower

lip is lowered, tongue moves towards the
point stimulated

 When finger slides away, head turns to

follow it

 When center of lip is stimulated, lip

elevates
Onset -- 28 weeks IU
Well established – 32-34 weeks IU
Disappears – 3-4 months

Clinical significance
 Persistence can interfere with sucking
 Absence of this is seen in neurologically impaired
infants.
Sucking /
Swallowing reflex
Touching lips or placing something in
baby’s mouth causes baby to draw
liquid into mouth by creating
vacuum with lips, cheeks & tongue

 Onset – 28 weeks IU
 Well established – 32-34weeks IU
 Disappears around 12 months
Clinical significance :
 Persistence may inhibit voluntary sucking
 Conclusion
Appropriate knowledge of reflexes enables a
physiotherapist:

 to identify whether the child is developing normally or

not
 to identify whether development is going on at a proper
rate or not
 Knowledge of abnormalities if all reflexes are not
proper
Tendon reflexes
 Simple monosynaptic reflexes, which are elicited by a
sudden stretch of a muscle tendon

 Occurs when the tendon is tapped

 Present throughout life