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NEUROPEDIATRIC EXAMINATION. PRIMITIVE REFLEXES. Why is the study of infant reflexes important?. Dominant form of movement for last 4 months prenatally and first 4 months postnatally. Primitive reflexes critical for human survival .
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NEUROPEDIATRIC EXAMINATION PRIMITIVE REFLEXES
Why is the study of infant reflexes important? • 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.
INTRODUCTION • 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.
PRIMITIVE REFLEXES - 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.
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
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
Role of the Reflexes in Survival 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 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
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
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
Reflexes as Diagnostic Tools 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
PRIMITIVE REFLEXES • Galant • Palmar Grasp • Sucking • Search • Moro • Startle • Asymmetric Tonic Neck • Symmetric Tonic Neck • Plantar Grasp • Babinski • Palmar Madibular • Palmar Mental POSTURAL REFLEXES • Stepping • Crawling • Swimming • Head and Body Righting • Parachuting • Labyrinthine • Pull Up
GALANT REACTION • 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
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 • 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
ASYMMETRIC TONIC NECK REFLEX • 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
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
PLANTAR GRASP • The toes appear to be grasping • Stimulus is touching the ball of the foot • This reflex must disappear before the baby can standor walk • Duration: birth-1 years • Patologic: negative medula spinalis lesion, perifer nervous system lesion (must disappear before the baby can stand or walk)
POSTURAL REFLEXES: Parachuting Reflexes • 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
