neuropediatric examination primitive reflexes. dominant form of movement for last 4 months...
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NEUROPEDIATRIC EXAMINATIONPRIMITIVE REFLEXES
Dominant form of movement for last 4 months prenatally and first 4 months postnatally.
Primitive reflexes critical for human survival.
Postural reflexes believed to be foundation for later voluntary movements.
Appearance and disappearance helpful in diagnosing neurological disorders.
The Central Nervous System (CNS) is the control center for all thinking, learning, and moving. The development of an efficient CNS is complex yet a certain amount is understood.
There are many factors which contribute to a person being able to move well, speak fluently, play and develop the skills necessary for every day living and learning.
The development of the CNS commences from conception, develops in a regular sequence and is the same for all humans regardless of cultural influences.
- Survival reflexes occurring sequentially in the first few weeks of fetal development - Automatic, stereotyped movements, directed by a very primitive part of the brain (brainstem). - executed without involvement of higher levels of the brain (the cortex).- Ideally short lived and as each fulfils its function is replaced by more sophisticated structures (Postural Reflexes) which are controlled by the cortex- Considered aberrant and evidence of an immaturity within the CNS if present beyond their time.
Reflexive movements occur during the last 4 months of prenatal life and the first 4 months after birth
Reflexes occur subcortically (below the level of the higher brain centers)
E.g., palmer grasp
Many of the reflexes do not completely disappear
First, they are inhibited by the maturing nervous system
Second, they are integrated into new movement behaviors
Infant reflexes are called primitive reflexes
Asymmetric tonic neck reflexSymmetric tonic neck reflexMoro reflexes
Startle reflex
Primitive reflexes are repressed by 6 months of age
Primitive reflexes are important for
ProtectionNutrition
Sucking reflexRooting reflex
Survival Labyrinthine reflex
Postural reflexes Prevalent belief: automatic movement is
“practice” for future voluntary movement Other experts believe these reflexes may not be
related to future motor development Emanate from higher brain centers These reflexes disappear when voluntary
behavior surfaces
When the stepping reflex is stimulated, walking may begin at an earlier age
Link between stimulation of the reflex preceding the disappearance phase and early movement
Small amounts of practice can lead to significant results
Infant Reflex Future Voluntary Movement
Crawling Crawling
Labyrinthine Upright posture
Palmar grasp Grasping
Stepping Walking
Can help determine the level of neurological maturation
Reflexes are age-specific in normal, healthy infantsMoro reflex
May signify a cerebral birth injury if lacking or asymmetrical
Asymmetric tonic neck reflex May indicate cerebral palsy or other neurological
problem
Reflex Concern when lacking, weak, asymmetrical or persisting
Moro Cerebral birth injury
Asymmetric tonic reflex
Cerebral palsy; other neural damage
Development ExaminationMeasures several infant reflexes from
birth to 24 monthsPurpose: develop profile of child’s
movement in relation to what is expected at a specific age
Useful in determining motor delay
PRIMITIVE REFLEXESGalantPalmar GraspSuckingSearchMoroStartleAsymmetric Tonic NeckSymmetric Tonic NeckPlantar GraspBabinskiPalmar MadibularPalmar Mental
POSTURAL REFLEXESSteppingCrawlingSwimmingHead and Body RightingParachutingLabyrinthinePull Up
If the child is stroke para-vertebrally with one finger, the body will curves
The concavity of pelvis proceed toward the direction of the stimulus given.
The leg and arm ipsilateral will be strach, and the contralateral will be curve
Syn: Spinal reaction Disappear in 2-3 months Patologic: dissapear Spinal
medulla lesion, CNS depression
Palm of hand lifts back of headHand is removed suddenly so that head begins to fall
Head is supportedMoro reflex precedes the startle reflex and causes the arms and legs to extend immediately rather than flexDuration: prenatal 4-6 months postpartumPatologic: disappear CNS depression, persists RM, CNS dysfunction, delay sitting/head control, asymmetrical injury to one side of brain, parese plexus brachialis, fracture clavicula/humerus
Synonim: bow and arrow or fencer’s position
Causes flexion on one side and extension on the other
Not always seen in newborn Facilitates the development of
bilateral body awareness Duration: after birth-3 months Patologic: persist Cerebral palsy
The palmar grasp reflex is one of the most noticeable reflexes to emergeAppears in uteroEndures through the 4th month postpartumNegative palmer grasp: neurological problems (spasticity)Leads to voluntary reaching and grasping
The toes appear to be graspingStimulus is touching the ball of the footThis reflex must disappear before the baby can stand or walkDuration: birth-1 yearsPatologic: negative medula spinalis lesion, perifer nervous system lesion (must disappear before the baby can stand or walk)
Propping reflexesRelated to upright postureThis reflex is a conscious attempt to break a potential fallDuration: 4 months-1 yearsPatologic: (-) CP, asymetris neuromusculer/orthopaedi dysfunction
Stimulus / Response
S: touch of lips R: sucking action
Duration In utero - 3 months postpartum
Concerns No reflex problematic for nutrition
Other Often in conjunction with searching reflex
Stimulus / Response
S: touch cheek R: head moves toward stimuli
Duration Weeks prenatal - 3 months postpartum
Concerns No reflex problematic for nutritionNo reflex or lack of persistence may be sign of CNS or sensorimotor dysfunction.
Other Often in conjunction with sucking reflex. Contributes to head/body-righting reflexes.
Stimulus / Response
S: Same as Moro R: Arms and legs flex
Duration 2-3 months after Moro disappears – 1 year
Other Less severe startle reflexes elicited through lifespan
Stimulus / Response
S: Baby sitting up and tip forward R: Neck and arms flex, legs extend S: Baby sitting up and tip backward R: Neck and arms extend, legs flex
Duration After birth – 3 months
Concerns Persistence may impede many motor skills and cause spinal flexion deformities
Stimulus / Response
S: Stroke bottom or lateral portion of foot R: Great toe turns downward
Duration Birth – 4 months
Concern Test of the pyramidal tract (i.e. ability to perform conscious / voluntary movement)
Stimulus / Response
S: Pressure to both palms or hair to hand R: Eyes close, mouth opens, and/or neck flexes (which tilts the head forward)
Duration Birth – 3 months
Other Also called the Babkin reflex
Stimulus / Response
S: Scratch base of palm R: Lower jaw opens and closes
Duration Birth – 3 months
Stimulus / Response
S: Infant upright with feet touching surface R: Legs lift and descend
Duration After birth – 5-6 months
Concerns Essential forerunner to walking
Other Sometimes called walking reflexDevelopmental changes in reflex over time
Stimulus / Response
S: Prone position on surface, stroke alternate feet R: Legs and arms move in crawling action
Duration Birth – 3-4 months
Concerns Precursor to later voluntary creeping
Stimulus / Response
S: Infant held horizontally R: Arms and legs move in coordinated swimming type action
Duration 2 weeks after birth – 5 months
Other Recognition of reflex led to popularity of infant swim programs
Stimulus / Response
S: Supine, turn body in either direction R: Head “rights” itself with the body S: Supine, turn head in either direction R: Body “rights” itself with the head
Duration Head:1-6 months; Body: 5 months-1 year
Concerns Related to voluntary rolling movements.
Stimulus / Response
S: Baby held upright, tilted in one direction R: Baby tilts head in opposite direction
Duration 2-3 months – 1 year
Concerns Related to upright posture
Other Also considered primitive reflex
Stimulus / Response
S: Sitting/standing, hold hands, tip in one direction R: Arms flex or extend in to maintain upright position
Duration 3 months – 1 year
Concerns Related to upright posture