Infant Reflexes and Stereotypies

1. Infant Reflexes and Stereotypies Chapter 9 © 2007 McGraw-Hill Higher Education. All rights reserved.

2. Objectives • Explain the importance and the role of the infant reflexes • Pinpoint and explain the number of infant reflexes • Describe the primitive reflexes • Describe the postural reflexes • List and explain some stereotypies © 2007 McGraw-Hill Higher Education. All rights reserved.

3. Infant reflexes and stereotypies are very important in the process of development © 2007 McGraw-Hill Higher Education. All rights reserved.

4. Importance of Infant Reflexes • 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 © 2007 McGraw-Hill Higher Education. All rights reserved.

5. Infant vs. Lifespan Reflexes • Most “infant” reflexes do not last beyond the first year • Reflexes that endure are called “lifespan” reflexes • Knee-jerk reflex • Flexor-withdrawal reflex © 2007 McGraw-Hill Higher Education. All rights reserved.

6. Infant vs. Lifespan Reflexes • 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 © 2007 McGraw-Hill Higher Education. All rights reserved.

7. Infant reflexes are called primitive reflexes Asymmetric tonic neck reflex Symmetric tonic neck reflex Moro reflexes Startle reflex Primitive reflexes are repressed by 6 months of age Primitive reflexes are important for Protection Nutrition Sucking reflex Rooting reflex Survival Labyrinthine reflex Role of the Reflexes in Survival © 2007 McGraw-Hill Higher Education. All rights reserved.

8. Role of Reflexes in Developing Future Movement • 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 © 2007 McGraw-Hill Higher Education. All rights reserved.

9. Role of Reflexes in Developing Future Movement • 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 © 2007 McGraw-Hill Higher Education. All rights reserved.

10. Role of Reflexes in Developing Future Movement © 2007 McGraw-Hill Higher Education. All rights reserved.

11. Reflexes as Diagnostic Tools • 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 © 2007 McGraw-Hill Higher Education. All rights reserved.

12. Reflexes as Diagnostic Tools © 2007 McGraw-Hill Higher Education. All rights reserved.

13. Reflexes as Diagnostic Tools • Milani Comparetti Neuromotor Development Examination • Measures several infant reflexes from birth to 24 months • Purpose: develop profile of child’s movement in relation to what is expected at a specific age • Useful in determining motor delay © 2007 McGraw-Hill Higher Education. All rights reserved.

14. Reflexes as Diagnostic Tools • Primitive Reflex Profile • Quantification of the level of presence or strength of primitive reflexes • Asymmetric tonic neck reflex • Symmetric tonic neck reflex • Moro reflex © 2007 McGraw-Hill Higher Education. All rights reserved.

15. Pinpointing the Number of Infant Reflexes • Different terminologies used for same reflex by experts • Rooting reflex = search reflex; cardinal points reflex • Reflexes are often poorly defined and more complex than once thought • Palmar grasp vs. traction response © 2007 McGraw-Hill Higher Education. All rights reserved.

16. Primitive Reflexes ~ Palmar Grasp • 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 May predict handedness in adulthood © 2007 McGraw-Hill Higher Education. All rights reserved.

17. Primitive Reflexes ~ Sucking • Occurs pre-and postnatally • Babies are born with blisters on lips • Stimulated by touching the lips © 2007 McGraw-Hill Higher Education. All rights reserved.

18. Primitive Reflexes ~ Search • Helps the baby locate nourishment • Baby turns head toward the food • Usually works in conjunctions with sucking reflex • Contributes to head- and body-righting reflexes Stimulus ~ touching the cheek © 2007 McGraw-Hill Higher Education. All rights reserved.

19. Primitive Reflexes ~ Moro Reflex • Palm of hand lifts back of head • Hand is removed suddenly so that head begins to fall • Head is supported • Moro reflex precedes the startle reflex and causes the arms and legs to extend immediately rather than flex • Disappears at 4-6 months © 2007 McGraw-Hill Higher Education. All rights reserved.

20. Primitive Reflexes ~ Startle • Similar to the Moro reflex • May not appear until 2-3 months after Moro disappears • Elicited by a rapid change of head position, by striking the surface that supports the baby, loud noise • Causes the arms and legs to flex immediately © 2007 McGraw-Hill Higher Education. All rights reserved.

21. Primitive Reflexes ~ Asymmetric Tonic Neck Reflex • Causes flexion on one side and extension on the other • Not always seen in newborn • Facilitates the development of bilateral body awareness © 2007 McGraw-Hill Higher Education. All rights reserved.

22. Primitive Reflexes ~ Symmetric Tonic Neck Reflex • Limbs respond symmetrically • Its persistence may impede other motor milestones © 2007 McGraw-Hill Higher Education. All rights reserved.

23. Primitive Reflexes ~ Symmetric Tonic Neck Reflex © 2007 McGraw-Hill Higher Education. All rights reserved.

24. Primitive Reflexes ~ Plantar Grasp • 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 © 2007 McGraw-Hill Higher Education. All rights reserved.

25. Primitive Reflexes ~ Babinski Reflex • Elicited by a stimulus similar to plantar grasp, but response is different • Test of the pyramidal tract activity for later motor movement © 2007 McGraw-Hill Higher Education. All rights reserved.

26. Primitive Reflexes ~ Palmar Mandibular Reflex • Makes the eyes close, the mouth open, and/or neck flexes which tilts the head forward • Also called the Babkin reflex • Stimulus is pressure to both palms © 2007 McGraw-Hill Higher Education. All rights reserved.

27. Primitive Reflexes ~ Palmer Mental Reflex • Elicits a facial response when the base of the palm is scratched • Lower jaw opens and closes © 2007 McGraw-Hill Higher Education. All rights reserved.

28. Postural Reflexes ~ Stepping Stepping reflex is a forerunner to walking © 2007 McGraw-Hill Higher Education. All rights reserved.

29. Postural Reflexes ~ Crawling • Believed to be essential to the voluntary creeping movement • Observed from birth to 3-4 months © 2007 McGraw-Hill Higher Education. All rights reserved.

30. Postural Reflexes ~ Swimming • Characterized by the baby’s swimming-like movements when held in a horizontal position © 2007 McGraw-Hill Higher Education. All rights reserved.

31. Postural Reflexes ~ Head-and-Body Righting • The head “rights” itself with the body when the body is turned to one side • Body follows head • Precursor to rolling movements • Body righting may not be evident before month 5 © 2007 McGraw-Hill Higher Education. All rights reserved.

32. Postural Reflexes ~ Parachuting Reflexes • Propping reflexes • Related to upright posture • This reflex is a conscious attempt to break a potential fall © 2007 McGraw-Hill Higher Education. All rights reserved.

33. Postural Reflexes ~ Labyrinthine • This reflex endures throughout most of the first year • Related to upright posture • Head tilts in the opposite direction of body tilt © 2007 McGraw-Hill Higher Education. All rights reserved.

34. Postural Reflexes ~ Pull-up Reflex When the baby is tipped backward, supporting arms flex in an effort to maintain the upright position © 2007 McGraw-Hill Higher Education. All rights reserved.

35. Stereotypies • Another form of movement observable during infancy • Characterized by patterned, stereotyped, highly intrinsic, and involuntary movements of the body • Believed to precede more complex voluntary movements © 2007 McGraw-Hill Higher Education. All rights reserved.

36. Ester Thelen (1979) studied stereotypies Stereotypies are intrinsic They serve no purpose Not regulated by the nervous system Repetitive, patterned movements Evidence of functional maturation Thelen grouped stereotypies by body region Legs and feet Hands and arms Fingers Torso Head and face Stereotypies © 2007 McGraw-Hill Higher Education. All rights reserved.

37. Stereotypies • Common stereotypies • Single leg kick • Two-leg kick • Alternate leg kick • Arm wave • Arm wave with object • Arm banging against a surface • Finger flexion © 2007 McGraw-Hill Higher Education. All rights reserved.

38. The End © 2007 McGraw-Hill Higher Education. All rights reserved.