Infant Reflexes

ARE THOSE WEIRD MOVEMENTS NORMAL?

Early diagnosis of persistent abnormal reflexes may be of great significance to a more effective functioning of the child. Knowledge of normal and abnormal reflex responses and their effect upon motor development is needed to provide a basis for evaluation in the diagnosis and treatment of the child with cerebral palsy or with certain other cerebral dysfunctions.

Primitive reflexes are essential in normal development. Response to these reflexes prepares the child for progressive development, such as, rolling over, crawling, sitting. standing etc.

When inhibitory control of higher centers is disrupted or delayed, primitive patterns dominate to the exclusion of higher, integrated sensorimotor activities.

Normal Sequential Development

The reflexes are normal within certain age limits and should be interpreted as abnormal beyond these limits. Normal growth and developmental levels vary somewhat; therefore, age levels are approximate.

What do these Reflexes tell us?

• Assessment of primitive and postural reflexes at key stages in development can be used to identify signs of immaturity in the functioning of the nervous system (identification). Many of the primitive reflexes are tested as a matter of routine at birth, as part of the neonatal neurological examination, but are rarely carried out later in development unless a neurological problem is suspected.
• Reflex evaluation can also provide indications of the type and developmental level of intervention needed to integrate abnormal reflexes (remediation).
• Reflex tests can be used again at later stages of development on school‐aged children, but when these are used on older children, the examiner looks for signs of inappropriately retained retained primitive reflexes and under‐developed postural reflexes (assessment).
• Reflex tests can also be used during and after an intervention program to measure the changes that have occurred as a result of remedial intervention (evaluation).

REFLEXES MEDIATED AT DIFFERENT LEVELS AND THEIR TESTING

SPINAL LEVEL

Spinal reflexes are mediated by areas of C.N.S. up to the base of 4th ventricle. These are movement reflexes which coordinates muscles of the extremities in patterns of either total flexion or extension

BRAIN STEM LEVEL

These reflexes are mediated by areas from the 8th nerve nucleus to below the red nucleus. These are static postural reflexes and effect changes in distribution of muscle tone throughout the body.

MID-BRAIN LEVEL

Righting reactions are integrated at the mid brain level above the red nucleus. They work towards establishment of normal head and body in space as well as in relation to each other. Their combined actions enable the child to roll over, sit up, get on his hands and knees, and make him a quadrupedal creature.

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 the stimulation of semicircular canals.

CORTICAL LEVEL

These reactions are mediated by efficient interaction of cortex, basal ganglia and cerebellum. Maturation of equilibrium reactions brings the individual to the human bipedal stage of development.

IMPLICATIONS OF RETAINED REFLEXES

1. MORO REFLEX

• Hypersensitivity to vestibular stimulation.
• Child can become easily “overloaded” by competing sensory stimuli and reacts without the cortex being involved in deciding if the reaction is appropriate, a case of act first — think later.
• Hypersensitivity, hyper‐vigilance to previously aversive stimuli and over‐reactivity to certain types of sensory stimulus.
• Retention of the Moro reflex can also affect physiological processes and emotional behavior.
• The Moro reflex tends to lower the threshold of response to potentially frightening situations.
• Discrepancy between verbal, emotional, and social behavior often exists, causing problems with social integration, particularly peer relationships.
• Can also be present in adults who suffer from anxiety and panic disorder.
• Poor balance and coordination.
• Vestibular‐related problems such as motion sickness, which continues beyond puberty, gravitational insecurity.
• Attention — easily distracted.

2. TONIC LABYRINTHINE REFLEX (FLEXION)

• Insecure balance
• Posture
• Hypotonus
• Gravitational insecurity
• Vertigo
• Spatial problems

3. TONIC LABYRINTHINE REFLEX (EXTENSION)

• Insecure balance
• Postural problems
• Coordination problems
• Hypertonus (predominance of extensor tone when the head is extended)
• Toe walking
• Articulation problem

4. ASYMMETRICAL TONIC NECK REFLEX (ATNR)

• Interfere with the following motor abilities:

Rolling over

Commando style crawling

Control of upright balance when the head is turned

Ability to cross the mid line of the body affecting bilateral integration, eye movements, and hand–eye coordination

• Difficulty with activities that require the same sequence of movements (e.g., front crawl when swimming, marching using the opposite arm and leg)
• A “mismatch” between intent (motor planning) and body reaction when the head is turned to the affected side.
• Difficulty in crossing the mid line has implications for writing and reading.
• Eye movements will also be affected if other reflex immaturities exist such as underdeveloped head righting reflexes in combination with an ATNR.

5. SYMMETRICAL TONIC NECK REFLEX (STNR)

• Postural disturbances
• Head position is everything when it comes to posture, and posture affects ambulation. In the elderly, skeletal, joint, and muscular problems can all affect posture as a result of skeletal changes, and the first reflex to re‐emerge in old age as a result of either structural or CNS degeneration is the STNR.
• A retained or residual STNR can affect both stance and gait. Sitting posture will also be affected because a residual STNR interferes with upper‐ and lower‐body integration.
• Young children, with a retained STNR whose hips are more flexible, tend to sit using a “W” leg position.
• As the STNR results in poor control of the arm and hand when the head is moved forward or down, it can affect coordination when trying to bring the hand toward the mouth, resulting in a “messy eater.
• Problems with coordination, attention, and concentration can all be secondary outcomes of a retained STNR in the older child.
• In cases where there is a combination of a retained ATNR and lack of head righting reflexes, these have been linked to impaired visual horizontal tracking (needed for reading and writing)

6. PALMAR REFLEX

• Poor manual dexterity.
• Palm of the hand may remain hypersensitive to tactile stimuli.
• Poorly developed pincer grip, which can affect fine muscle skills such as use of feeding implements, tools such as scissors, and pencil grip for drawing and writing.
• Mouth and hand movements do not become independent. This can affect speech as well as manipulation.

7. ROOTING REFLEX

• It includes hypersensitivity to tactile stimuli around the lips and the mouth.
• Tongue may remain forward in the mouth, making the chewing and swallowing of certain foods difficult.
• It causes dribbling.
• It can result in immature control of the muscles of the lips, tongue, and jaw, resulting in articulation problems.
• It can result in continued hand/mouth connection affecting independent hand and mouth movements.

8. RIGHTING REACTIONS

• It affects control of balance and associated eye movements.
• Cannot process the visual information quickly enough to filter out irrelevant information and to orient themselves in space.
• When there is a lack of integration in signals passing from the body, the vestibular system, or the eyes up to the brain, start to experience not only altered perception but also associated physiological changes. e.g. Motion sickness also occurs as a result of a similar process, when movement in a particular plane or combination of planes of movement upsets the normal relationship between body, balance, and vision
• Disturbances between body position, vestibular functioning, and the eye movements involved in gaze control.
• Problems in visual fixation and visual attention.
• Difficulty shifting gaze without the head also having to move. This affects clarity and the stability of the visual image seen by the brain and can interfere with reading.

9. GALANT REFLEX

• It can result in difficulty in sitting still.
• It can result in general restlessness.
• It can result in lack of attention and concentration.
• It can be associated with continued bed‐wetting in older children.
• It can contribute to the development of scoliosis of the spine.

WHAT IS INTEGRATION?

The brain and neurological system mature and modify the reflex in such a way that the response is no longer as expected.

When reflexes are not integrated, they can cause motor, emotion, behavior and learning problems.

Incomplete integration may be mild to severe.

Incomplete integration can contribute to diagnosis such as depression, ADHD, ASD, learning disorders, developmental delay, sensory processing, etc.

CAUSES OF UNINTEGRATED REFLEXES

Lack of proper movement in early childhood

Stress of mother during pregnancy, breech birth, birth trauma, C-section, or exposure to sonograms

Illness, trauma, injury, or chronic stress

Environmental toxins, plastics, and pollution

Complications with vaccines

Reflexes that are completely integrated may reactivate later by trauma, injury, toxins, and extreme stress.

POSITIONS TO INTEGRATE RETAINED REFLEXES

EXERCISES TO INTEGRATE REFLEXES

MORO REFLEX

ASYMMETRICAL TONIC NECK REFLEX (ATNR)

SYMMETRICAL TONIC NECK REFLEX (STNR)

TONIC LABYRINTHINE REFLEX

GALANT REFLEX

MORO REFLEX

LANDAU REFLEX

By integrating these reflexes the child becomes more calm, less reactive to unexpected events and able to enjoy life’s moments better. There is also greater ability to process sensory information, thus dramatically improving sensory issues.

Thank you for reading.

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