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NEUROPEDIATRIC EXAMINATION

PRIMITIVE 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

reflex
Symmetric tonic neck
reflex
Moro reflexes

Primitive reflexes are


repressed by 6 months of
age

Primitive reflexes are


important for
Protection
Nutrition
Sucking reflex
Rooting 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 infants

Moro reflex

May signify a cerebral birth injury if lacking or


asymmetrical

Asymmetric tonic neck reflex

May indicate cerebral palsy or other neurological


problem

Reflex
Moro

Concern when lacking, weak,


asymmetrical or persisting
Cerebral birth injury

Asymmetric Cerebral palsy; other neural


tonic reflex damage

Development Examination
Measures several infant reflexes from

birth to 24 months
Purpose: develop profile of childs
movement in relation to what is expected
at a specific age
Useful in determining motor delay

PRIMITIVE REFLEXES
POSTURAL REFLEXES
Galant
Stepping
Palmar Grasp
Crawling
Sucking
Swimming
Search
Head and Body Righting
Moro
Parachuting
Startle
Labyrinthine
Asymmetric Tonic Neck
Pull Up
Symmetric Tonic Neck
Plantar Grasp
Babinski
Palmar Madibular
Palmar Mental

If the child is stroke paravertebrally 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 head


Hand is removed suddenly so
that head begins to fall
Head
Moro

is supported

reflex precedes the


startle reflex and causes the
arms and legs to extend
immediately rather than flex
Duration: prenatal 4-6 months
postpartum
Patologic: 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 fencers


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
emerge
Appears in utero
Endures through the 4th month postpartum
Negative palmer grasp: neurological
problems (spasticity)
Leads to voluntary reaching and grasping

The

toes appear to be grasping


Stimulus is touching the ball of
the foot
This reflex must disappear before
the baby can stand or walk
Duration: birth-1 years
Patologic: negative medula
spinalis lesion, perifer nervous
system lesion (must disappear
before the baby can stand or
walk)

Propping

reflexes
Related to upright posture
This reflex is a conscious attempt
to break a potential fall
Duration: 4 months-1 years
Patologic: (-) CP, asymetris
neuromusculer/orthopaedi
dysfunction

Reflek primitif

Cara

Timbul umur

Menghilang umur

Keterangan

Refleks Gallant
(reaksi spinal)

Goresan pada kulit sejajar vertebra pada posisi


tengkurap akan menyebabkan panggul fleksi
(meliuk) ke arah sisi goresan

Lahir

2-3 bulan

Lesi medula spinalis,


depresi SSP

Reflkes Moro

Bila bayi diangkat dalam posisi terlentang


kemudian kepala dijatuhkan tiba-tiba, maka ia
akan membuka mulutnya, mengembangkan
lengan, kemudian terjadi gerakan seperti
memeluk, serta jari tangan melebar seperti
kipas. Setelah itu bayi menutup mulut kembali,
dan posisi seperti biasa

Lahir, menetap s/d 4-6


minggu

5-6 bulan

Menghilang pada depresi


SSP, menetap pada
retardasi mental &
kerusakan otak. Asimetris
pada kelumpuhan flexus
brachialis, fraktur clavicula
& humerus

Refleks leher tonik


asimetrik ((posisi
memanah, atau
bermain anggar))

Bila dalam posisi terlentang kepala bayi


menoleh kesatu sisi baik secara pasif/aktif,
maka lengan ipsilateral melakukan ekstensi,
sedangkan lengan berlawanan akan fleksi

Lahir, menetap s/d 1218 minggu

3 bulan

Menetap pada cerebral


palsy

Refleks genggam
palmar

Sentuh telapak tangan bayi dengan jari


pemeriksa, sehingga menyebabkan jari tangan
menutup dengan posisi menggenggam

lahir

6 bulan

Neurologic disorder

Refleks genggam
plantar

Sentuh bagian proximal plantar dengan jari


pemeriksa, menyebabkan fleksi plantar jari-jari
kaki seolah menggenggam

lahir

8-12 bulan

Lesi saraf tepi dan medulla


spinalis

Refleks parasut

Pertahankan bayi dalalm posisi telungkup,


kemudian seolah-olah menjatuhkan bayi
kedepan dan kebawah secara mendadak,
sehingga timbul respon berupa ekstensi lengan,
seperti seakan menopang badan

4 bulan

1 tahun

Menghilang pada CP,


asimetris pada gangguan
ortopaedia atau
neuromuskuler

Stimulus /
Response

S: touch of lips
R: sucking action

Duration

In utero - 3 months postpartum

Concerns
Other

No reflex problematic for nutrition


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 nutrition


No 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
Concerns

After birth 3 months


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
Other

Birth 3 months
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
Other

Essential forerunner to walking


Sometimes called walking reflex
Developmental 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