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PTCNL

-Moro
-Palmar Grasp
-Babinski
-Asymmetrical Tonic Neck reflex
-Tonic Labyrinthine Reflex
-Symmetrical Tonic Neck reflex
-Galant reflex/Spinal Galant
-Stepping Reflex
-Landau Reflex
-Rooting Reflex

THE ROOTING REACTION


Onset - 28 weeks gestation
Integration - 3 months
Testing position - with the infant supine, the head in midline and hands on chest
Procedure - gently stroke the infant from the lips to the cheek
Normal response - the infant should turn his head toward the stimulated side
with the mouth opening and a trial of sucking the finger. May not be present if
the infant is not hungry.
Functional significance - persistence can interfere with sucking. Absence of this
is seen in neurologically impaired infants.
THE SUCK SWALLOW REFLEX
Onset - begins at 28 weeks gestation
Integration - 2-5 months
Testing position - infant supine with the head in midline
Procedure - place a finger of nipple into the infants mouth
Response observed - rhythmical sucking

Functional significance - persistence of this reflex may inhibit voluntary


sucking
MORO
Onset - begins at 28 weeks gestation
Integration - 5-6 months
Testing position - child in supine with head in midline, support the child's head
while pulling the child to a position halfway between supine and upright sitting
Procedure - support the infants head and shoulders with one hand. Allow the
neck to drop back to allow the anterior neck muscles to stretch
Response observed - the shoulders abduct, the elbows, wrists and fingers
extend. Subsequently, the shoulders adduct, and the elbows and fingers flex
Functional significance - asymmetry during this reaction may indicate a brain
lesion or injury or peripheral nerve problems to the upper extremity
THE TRACTION RESPONSE
Onset - begins at 28 weeks gestation
Integration - 2-5 months
Testing position - child in supine with the arms and head in midline
Procedure - grasp the childs wrists and pull up to sitting placing a stretch on
the shoulder adductors and arm flexors
Response observed - the child will flex and elevate shoulders, arms and wrists
Functional significance- traction is a primitive reflex which enables the child to
hold onto the mother when being pulled. Traction helps stabilize the head
before the child has voluntary head control
CROSSED EXTENTION
Onset - begins at 28 weeks gestation

Integration - 1-2 month


Testing position - child in supine, head in midline, lower extremities extended
Procedure - Holding one leg in extension at the knee, apply firm pressure to the
sole of this leg
Response observed - childs opposite leg will flex, adduct, and then extend
Functional significance - this reflex can interfere with reciprocal kicking and
later functional activities
FLEXOR WITHDRAWAL
Onset - begins at 28 weeks gestation
Integration - 2 months for normal child; may persist in developmentally
delayed and/or CP child
Testing position - child supine, head midline, lower extremities extended
Procedure - apply a noxious stimulus to the sole of the foot
Response observed - withdrawal of the foot from the stimulus employing hip
and knee flexion
Developmental significance - failure to attain and integrate this reflex may
indicate sensorimotor delay and/or CNS depression
PLANTAR GRASP
Onset - begins at 28 weeks gestation
Integration - 9 months
Testing position - child supine, head midline, legs relaxed
Procedure - apply firm pressure to the plantar surface of the childs foot
Response observed - plantar flexion of all of the toes

Functional significance - this reflex is referred to as the "readiness tester".


Integrates at the same time that independent gait first becomes possible.
GALANTS RESPONSE
Onset - begins at 32 weeks gestation
Integration - 2 months, though may persist in atypical children
Testing position - infant placed prone in alignment
Procedure - gently stimulate along the paravertebral area from the C7 area to
the buttocks
Response observed - infant will laterally flex toward the stimulated side
Functional significance - often seen with children with athetoid CP
NECK RIGHTING ON THE BODY (NOB)
Onset - begins at 34 weeks gestation
Integration - 4-6 months
Testing position - infant in supine, head midline
Procedure - turn the infants head to one side
Response observed - infants entire body will turn in the direction of the head
Functional significance - early in development the infant uses NOB in order to
transition between supine, sidelying, and eventually prone
BODY RIGHTING REACTION (BOB)
Onset - begins at 34 weeks gestation
Integration - 4-5 months
Testing position - infant supine, head midline

Procedure - flex one limb over the chest and rotate the limb across the body
Response observed - infants upper body will follow the pelvis in a log roll
Functional significance - this reflex assists the child in rolling between supine
and prone
NEONATAL POSITIVE SUPPORTING IN THE LOWER EXTREMITIES
Onset - begins at 35 weeks gestation
Integration - 1-2 months
Testing position - support the infant in a vertical position
Procedure - allow the feet to make firm contact with the floor or table
Response observed - simultaneous contraction of the babys flexor and extensor
muscles of the lower extremities supporting only minimal weight with the hips
and knees remaining in partial flexion
Functional significance - prerequisite for the spontaneous stepping reflex
PROPIOCEPTIVE PLACE OF LOWER EXTREMITY
Onset - begins at 35 weeks gestation
Integration - 2 months
Testing position - supported in a vertical position
Procedure - lift the infant so that the dorsum of the foot presses against the edge
of the table
Response observed - the infant flexes his knee and hip, thereby lifting the foot
above the table
Functional significance - asymmetry may indicate a CNS injury, muscles
weakness, or peripheral nerve damage
SPONTANEOUS STEPPING

Onset - begins at 37 weeks gestation


Integration - 2 months
Testing position supported in the vertical position
Procedure - support the infant upright with the feet touching a hard surface.
Incline the infant forward and gently move the infant forward to accompany
any stepping
Response observed - alternating, rhythmical, and coordinated steps
Functional significance - premature infants will tend to walk in a roe-heel
fashion while more mature infants will walk in a heel-toe pattern.
PALMAR GRASP
Onset - 10 weeks gestation
Integration - 4-6 months
Testing position - supine, head midline, arms and hands free
Procedure - place a finger in infants hand from the ulnar to the palmar surface
Response observed - infants fingers will flex around the finger
Functional significance -following the development of grasp, the infant begins
to reach for objects and utilizes a crude palmer grasp to hold them
UPPER EXTREMITY PROPRIOCEPTIVE PLACING
Onset - birth
Integration - 2 months
Testing position - support the infant in a vertical position
Procedure - move the infant so that the dorsum of one hand rubs against a hard
surface

Response observed - the upper extremity flexes and the hand is brought above
the surface of the surface
Functional significance - this reflex may be obtained at any age as a withdrawal
response if excessive pressure is applied to the hand
ASSYMETRICAL TONIC NECK REFLEX (ATNR)
Onset - 0-2 months
Integration - 4-6 months
Testing position - supine
Procedure - gently turn the infants head to one side
Response observed - a UE flexion tone on the side opposite to the head turn
with an increase in UE extensor tone in the side to which the head is turned
Functional significance - persistence of this reflex may indicate CNS damage
TONIC LABYRINTHINE REFLEX (TLR)
Onset - birth
Integration - 6 months
Testing position - prone or supine
Procedure - prone - lift the infant up to evaluate for the presence of flexor tone;
supine, lift the child to sitting to observe for extensor tone
Response observed - prone - flexor tone will dominate; supine - extensor tone
Functional significance - persistence of TLR will impede activities which
require graded coactivation of flexor and extensor muscles
ASSOCIATED REACTIONS
Onset - birth to 3 months

Integration - never, less common after 8-9 years


Testing position - sitting
Procedure - hand grasp in younger children, rapid arm movements in older
children
Response observed - overflow of movement to the contralateral side should
decrease with age
Functional significance - excessive build-up of movement, or tonal increases in
the opposite extremity indicate brain damage
LABYRINTHINE HEAD RIGHTING
Onset - birth to 2 months
Integration - persists throughout life
Testing position - vertical position
Procedure - tilt the child anterior, posterior, and lateral from the vertical
Response observed - the head orients to the vertical position and is maintained
steady
Functional significance - in order to move around in space, this reflex is
necessary to allow the body to turn freely around the head
OPTICAL RIGHTING
Onset - birth to 2 months
Integration - persists through life
Testing position - vertical position
Procedure - tile the child anterior, posterior, and lateral from the vertical
Response observed - the head orients to the vertical position and is maintained
vertically oriented in the environment

Functional significance - allows the head and body to be upright to the horizon
BODY RIGHTING REACTION ON THE HEAD (BOH)
Onset - birth to 2 months
Integration - persists through life
Testing position - upright
Procedure - observe during play
Response observed - righting of the head in relation to the body
Functional significance - important in controlling the head in relation to the
body in all positions
LANDAU
Onset - 3 -4 months
Integration - 12 - 24 months
Testing position - prone, supported in air
Procedure - wait for a reaction after placement
Response observed - the head will extend and the back and hips will extend in
sequence ("superman" appearance)
Functional significance - breaks up the total flexion pattern seen at birth
UPPER EXTREMITY POSITIVE SUPPORT
Onset - on elbows at 3 months
Integration - persists through life
Testing position - prone

Procedure - keep infant horizontal and rise slowly up so that the upper
extremities contact the floor
Response observed - simultaneous contraction of the UE flexors and extensors
leading to full weight bearing on hands
Functional significance -allows for sitting and standing positions to be attained
UPPER EXTREMITY VISUAL PLACING
Onset - 3 - 4 months
Integration - persists through life
Testing position - vertically held under the arms
Procedure - advance the infant toward a supporting surface
Response observed - the infant will lift both UE, extend and then place them on
the supporting surface with fingers abducted and extended
Functional significance - asymmetry may indicate hemispheric insult,
peripheral nerve damage, or muscle weakness
LOWER EXTEMITY VISUAL PLACING
Onset - 3 - 5 months
Integration - persists through life
Testing position - infant held vertically in space
Procedure - advance the infant slowly toward a supporting surface feet first
Response observed - the infant will orient to the surface and place both feet on
top of the supporting surface
Functional significance - needed for independent ambulation
PROTECTIVE EXTENSION DOWNWARD

Onset - 4 months
Integration - persists through life
Testing position - vertically suspended in air
Procedure - plunge the infant downward
Response observed - the legs externally rotate and abduct with the feet
dorsiflexing in preparation for weight-bearing
Functional significance - preparation for standing and breaks a fall
POSTURAL FIXATION IN PRONE
Onset - 6 months
Integration - persists through life
Testing position - prone
Procedure - encourage the child to support on one extremity while reaching for
an object
Response observed - the child will not loose balance when reaching
Functional significance - postural fixation is necessary for the preservation of
the center of gravity in prone
TILTING REACTION IN PRONE
Onset - 6 months
Integration - persists through life
Testing position - prone on a tilt board
Procedure - slowly tile the board and wait for a response
Response observed - the child will curve his trunk against the displacement the
center of gravity. The upper arm and leg may abduct

Functional significance - part of the balance mechanism to tolerate


perturbations
PROTECTIVE EXTENSION FORWAD
Onset - 6-7 months
Integration - persists through life
Testing position - vertically supported
Procedure - plunge the child downward head first
Response observed - the child should extend and abduct the arms with the
fingers extended and spread as if to break a fall
Functional significance - necessary for prop sitting
SYMMETRICAL TONIC NECK REFLEX (STNR)
Onset - 4-6 months
Integration - 8 - 12 months
Testing position - child in quadruped position on the floor
Procedure - passively flex the head forward and then extend it backwards
Response observed - forward head flexion will produce flexion of the upper
extremities and extension of the lower extremities; extension of the head will
produce extension of the upper extremities and flexion of the lower extremities
Functional significance - necessary to achieve quadruped crawling
POSITIVE SUPPORT WEIGHT BEARING ON LOWER EXTREMITIES
Onset - 6-9 months
Integration - persists through life
Testing position - vertically positioned

Procedure - allow the infants feet to make firm contact with a flat surface
Response observed - simultaneous contraction of the lower extremity flexors
and extensors bilaterally
Functional significance -needed for upright standing and walking
MATURE NECK RIGHTING ACTING ON THE BODY (NOB)
Onset - 4-6 months
Integration - 5 years
Testing position - supine
Procedure - flex the childs head and slowly turn to one side; hold this position
and observe, repeat on the opposite side
Response observed - child will segmentally roll in the direction of the head
rotation
Functional significance - allows for mature rolling and gait rotation
MATURE BODY RIGHTING REACTION ACTING ON THE BODY (BOB)
Onset - 4-6 months
Integration - 5 years
Testing position - supine with head in midline
Procedure - flex one leg and rotate it across the pelvis to the opposite side
Response observed - child will roll sideways segmentally
Functional significance - working with NOB, promotes segmental rolling and is
important for sitting, quadruped and standing positions
PROTECTIVE EXTENSION SIDEWARD OF THE UPPER EXTREMITY
Onset - 7 months

Integration - persists through life


Testing position - long sitting position
Procedure - apply a force to the shoulder to displace the center of gravity
Response observed - the arms should abduct and extend of the side toward the
fall with weight borne on the open palm and fingers
Functional significance -needed for independent sitting
POSTURAL FIXATION IN SUPINE
Onset - 7 - 8 months
Integration - persists through life
Testing position - supine
Procedure - encourage the child to reach, exert a minimal force on the shoulder
of the reaching arm
Response observed - the child will loose his balance in response to the push and
demonstrate a slight curving of the spine
Functional significance - necessary for the preservation of the center of gravity
in supine
POSTURAL FIXATION IN SITTING
Onset - 7 - 8 months
Integration - persists through life
Testing position - sitting on a stool
Procedure - encourage the child to reach while exerting a minimal force to the
opposite shoulder or trunk
Response observed - will not lose balance

Functional significance -necessary for preservation of sitting balance


TILTING REACTION IN SUPINE
Onset - 7 - 8 months
Integration - persists through life
Testing position - supine on a tilt board
Procedure - slowly tile the board laterally, wait for a response, and tilt to the
opposite side
Response observed - childs trunk will curve against the tile with the concavity
of the spine upward; the head will rotate for the face to look toward the upper
side of the board
Functional significance -allows for maintenance of the body while fine motor
tasks are being undertaken; indicates the presence of previous righting reactions
POSTURAL FIXATION IN QUADRAPED
Onset - 9 - 12 months
Integration - persists through life
Testing position - place the child in a quadruped on the floor
Procedure - apply force to the shoulder and observe; to the extremity and
observe; contralateral leg and observe; and ipsilateral leg and arm and observe
Response observed - observe rotation of the body in the plane of the applied
force
Functional significance - necessary for the preservation of the quadruped
position
PROTECTIVE EXTENSION BACKWARD
Onset - 9 - 10 months

Integration - persists through life


Testing position - symmetrical sitting posture with legs extended
Procedure - push the child backward with enough force to displace the center of
gravity
Response observed - the child will extend the arms backward
Functional significance - necessary for independent sitting
PROTECTIVE STAGGERING OF LOWER EXTREMITIES
Onset - 15 - 18 months
Integration - persists through life
Testing position - standing
Procedure - push the child in all directions
Response observed - the child will make corrective movements in order to
restore center of gravity
Functional significance - protects the upright posture
POSTURAL FIXATION IN STANDING
Onset - 12 - 21 months
Integration - persists through life
Testing position - standing and one-legged standing
Procedure - exert minimal force to the pelvis in all four directions
Response observed - observe for force fields of the lower extremities to prevent
falling or tipping
Functional significance - allows for the preservation of the center of gravity and
balance in standing and walking

TILTING REACTION IN STANDING


Onset - 12 - 21 months
Integration - persists through life
Testing position - standing on a tilt board
Procedure - tilt and wait for response, repeat the opposite direction
Response observed - the body should flex against the tilt with the upper leg
flexed and arm abducted while the lower leg is extended and braced
Functional significance - the inner ear labyrinths need to be intact in order for
the reaction to occur