REFLEXESDefinition ;

Stereotype movement which can be elicited by application of stimulus to the periphery

Importance of reflexes:

1- Diagnostic role:

More reflex ------more hypertonia ------No Movement

2- Therapeutic role Iniate elbow flexion-------ASTNR

3- Serve process of motor development

Putting toy on the side of the child-----------turn head

--------------extension of head--------------- eye hand coordination

CLASSIFICATION OF REFLEXES

According to level of CNS maturation

According to type of stimulus

A C C O R D I N G T O L E V E L O F C N S M AT U R AT I O NSpinal Level (Spinal reflexes)

Brain Stem Level(Brain Stem reflexes)

Midbrain Level(Midbrain reflexes)

Cortical Level (Cortical reflexes)

a- (Spinal reflexes) Primitive reflexes , phasic reflexes Movement reflexes A- beta reflexes:Flexor with drawl (nociceptive reflex)

Starting position : Supine lying position, head in midline position,

upper , lower limb extended

Stimulus : Painful Scratching on sole of foot

Response : Mass Flexion or uncontrolled flexion

Age positive : from birth to 2 month

b- extensor thrust :

Starting position : Supine lying position, head in midline position,

upper extended, lower ,one is flexed, other extended

Stimulus ; painful stimulus on the sole foot of flexed

Response: Uncontrolled extension of leg

Age: From birth to 2 Month

Crossed extension:Starting position : Supine lying position, head in midline position,

upper , lower limb extended

Stimulus ; Tapping on medial aspect of thigh

Response: Extension , adduction, internal rotation of opposite scissor

Age: birth to 2 months

B)BRAIN STEM REFLEXES(STATIC POSTURAL REFLEXES)(TONIC

REFLEXES)(PRIMITIVE REFLEXES)

Changing position of the body or head in the space will change distribution of the tone.

1- asymmetrical tonic neck reflex (ATNR):

Starting position : Supine lying position, head in midline position,

upper , lower limb extended

Stimulus ; Turning the head to one side

Response: Face head : extension of upper and lower limb

occipital side: flexion in upper and lower limb

Age: birth to 4- 6 months

ASTNR interfere with ( ROLLING, FEEDING, both hand use)

2- symmetrical tonic neck reflex (STNR):

Starting position : Quadriped or prone on my leg

Stimulus ; Flexion of head

Response: Flexion of upper limb and extension in lower limb

Or vice versa

Age: birth to 4- 6 months

3- Tonic labyrinthine supine (TLS):Starting position : head in midline position,

Stimulus ; Supine lying position,

Response: increase of extension tone in all over the body

Age: birth to 4 months

3- Tonic labyrinthine prone (TLP):Starting position : head in midline position,

Stimulus ; Prone lying position,

Response: increase of flexor tone in all over the body

Age: birth to 4 months

4- +ve Supporting reaction:

Starting position :Standing with his back on my face

Stimulus ; Hold the child from pelvic or axilla and bounce him on sole of

foot.

Response: Lower limb extension, adduction, internal rotation plantar flexion

(scissors).

Age: from 3 to 8 Months

5 -Ve Supporting reaction:

Stimulus : Child in weight bearing with leaning forward

Response: Semi flexion of lower limb with few steps forward

Age: From 8 to continue throughout life

MIDBRAIN REFL EXESRIGHTING REACTIO N

A) Neck Righting;Starting position : Supine lying position, head in midline position, upper , lower

limb extended

Stimulus ; Rotation of the head to one side

Response: Rotation of the body as a whole following head

Age: birth to 6 months

B) Body righting acting on body:

Starting position : Supine lying position, head in midline position, upper , lower

limb extended

Stimulus ; Turning the head to one side

Response: Segmental rotation of the body

Age: from 6-18 months

C) Labyrinthine righting on head:

First: Starting position: prone in space with blind folded

Stimulus: prone in space on my hand with blind folded

Response: raising head to normal position age from 1-2 month then continue

Second: Starting position: supine lying

Stimulus: Supine in space on my hand with blind folded

Response: raising head to normal position age from 6 month s then continue

Third: Starting position: Holding child from pelvis blind folded

Stimulus: tilting the body to right side

Response: raising head to normal position age from 6-8 month then continue

Fourth: Third: Starting position: catching the child from trunk

Stimulus: tilting the body to Left side

Response: raising head to normal position age from 6-8 month then continue

D) Optical righting acting on head:

THE SAME LIKE LABRYINTHINE (POSITIONS , RESPONSES) WITHOUT EYE BLIND FOLDED

Amphibian Reaction :Starting position: Prone head in midline ,legs extended , arm extended overhead

Stimulus: lift pelvis on one side

Response: Automatic flexion of hip ,knee ankle on the same side Age from 6 month then continue

Automatic Movement Reactions:Moro Reflex

Starting position: Semi recline

Stimulus: Drop head backward

Response: Extension, abduction, external rotation of arms, extension, adduction fingers

Age: Normal from birth to 4 months

Landau Reflex : Starting position: prone in space with holding under thorax

Stimulus: raise head active or passively

Response: Spine and leg extend

Age: Normal from 6 months to 2or 2.5 years

Protective extensor Thrust( Parachute reaction)

Starting position: Prone , arms extended over head

Stimulus: Suspend the child from ankle or pelvis suddenly move child to floor

Response: Immediate Extension , of arms,, fingers to protect head

Age: Normal from 6 months continue through out life

CORTICAL REFL EX ES OR EQU IL BR IU M R EACTIO N

SUPINE

Starting position: supine on tail board

Stimulus: Tilt board to one side

Response: Righting head, thorax extension, abduction of arms, legs on raised side

Age: Normal from 6 months continue through out life

Prone: Starting position: Prone on tail board

Stimulus: Tilt board to one side

Response: Righting head, thorax extension, abduction of arms, legs on raised side

Age: Normal from 8 months continue through out life

Sitting: Starting position: Sitting on chair

Stimulus: pull child to one side

Response: Righting head, thorax extension, abduction of arms, legs on raised side

Age: Normal from 12 months continue through out life

Kneel Standing : Starting position: Kneel standing

Stimulus: pull child to one side

Response: Righting head, thorax extension, abduction of arms, legs on raised side

Age: Normal from 15 months continue through out life

Hopping 1, 2and 3:Starting position: Standing holding from upper arms

Stimulus: Move to lift or right, forward, backward

Response: Righting head, thorax extension, hopping steps to sideway, forward, backward to maintain equilibrium

Age: Normal from 15 to 18 months continue through out life

Dorsiflexion: Starting position : Standing holding from axilla

Stimulus: Tilt child backward

Response: Righting head, dorsiflexion of feet

Age: Normal from 15 to 18 months continue through out life

See- saw:Starting position: Standing holding hand , foot with flex hip knee

Stimulus: pull arm gently forward and to lateral side

Response: Righting head, thorax extension, slightly abduction of flexed knee

Age: Normal from 15 months continue through out life

Simian position Starting position: Squatting sitting

Stimulus: Tilt child to one side

Response: Righting head, thorax extension, abduction of arms, legs on raised side

Age: Normal from 15 to 18 months continue through out life