Reflexes

1. Reflexes Definition ; Stereotype movement which can be elicited by application of stimulus to the periphery Importance of reflexes: 1- Diagnostic role: More reflex ------more hypertonia ------No Movement 2- Therapeutic role Iniate elbow flexion-------ASTNR 3- Serve process of motor development Putting toy on the side of the child-----------turn head --------------extension of head--------------- eye hand coordination

2. Classification of Reflexes • According to level of CNS maturation • According to type of stimulus

3. According to level of CNS maturation • Spinal Level (Spinal reflexes) • Brain Stem Level(Brain Stem reflexes) • Midbrain Level(Midbrain reflexes) • Cortical Level (Cortical reflexes) a- (Spinal reflexes) Primitive reflexes , phasic reflexes Movement reflexes A- beta reflexes: • Flexor with drawl (nociceptive reflex)

4. Starting position : Supine lying position, head in midline position, • upper , lower limb extended • Stimulus : Painful Scratching on sole of foot • Response : Mass Flexion or uncontrolled flexion • Age positive : from birth to 2 month • b- extensor thrust : • Starting position : Supine lying position, head in midline position, • upper extended, lower ,one is flexed, other extended • Stimulus ; painful stimulus on the sole foot of flexed • Response: Uncontrolled extension of leg • Age: From birth to 2 Month

5. Crossed extension: • Starting position : Supine lying position, head in midline position, • upper , lower limb extended • Stimulus ; Tapping on medial aspect of thigh • Response: Extension , adduction, internal rotation of opposite scissor • Age: birth to 2 months

6. B)Brain stem reflexes(static postural reflexes)(tonic reflexes)(primitive reflexes) • Changing position of the body or head in the space will change distribution of the tone. 1- asymmetrical tonic neck reflex (ATNR): • Starting position : Supine lying position, head in midline position, • upper , lower limb extended • Stimulus ; Turning the head to one side • Response: Face head : extension of upper and lower limb • occipital side: flexion in upper and lower limb • Age: birth to 4- 6 months • ASTNR interfere with ( ROLLING, FEEDING, both hand use)

7. 2- symmetrical tonic neck reflex (STNR): • Starting position : Quadriped or prone on my leg • Stimulus ; Flexion of head • Response: Flexion of upper limb and extension in lower limb • Or vice versa • Age: birth to 4- 6 months 3- Tonic labyrinthine supine (TLS): • Starting position : head in midline position, • Stimulus ; Supine lying position, • Response: increase of extension tone in all over the body • Age: birth to 4 months

8. 3- Tonic labyrinthine prone (TLP): • Starting position : head in midline position, • Stimulus ; Prone lying position, • Response: increase of flexor tone in all over the body • Age: birth to 4 months 4- +ve Supporting reaction: Starting position :Standing with his back on my face Stimulus ; Hold the child from pelvic or axilla and bounce him on sole of foot. Response: Lower limb extension, adduction, internal rotation plantar flexion (scissors). Age: from 3 to 8 Months

9. 5 -VeSupporting reaction: Stimulus : Child in weight bearing with leaning forward Response: Semi flexion of lower limb with few steps forward Age: From 8 to continue throughout life

10. Midbrain reflexesrighting reaction • A) Neck Righting; • Starting position : Supine lying position, head in midline position, upper , lower limb extended • Stimulus ; Rotation of the head to one side • Response: Rotation of the body as a whole following head • Age: birth to 6 months • B) Body righting acting on body: • Starting position : Supine lying position, head in midline position, upper , lower limb extended • Stimulus ; Turning the head to one side • Response: Segmental rotation of the body • Age: from 6-18 months

11. C) Labyrinthine righting on head: • First: Starting position: prone in space with blind folded • Stimulus: prone in space on my hand with blind folded • Response: raising head to normal position age from 1-2 month then continue • Second: Starting position: supine lying • Stimulus: Supine in space on my hand with blind folded • Response: raising head to normal position age from 6 month s then continue

12. Third: Starting position: Holding child from pelvis blind folded • Stimulus: tilting the body to right side • Response: raising head to normal position age from 6-8 month then continue • Fourth: Third: Starting position: catching the child from trunk • Stimulus: tilting the body to Left side • Response: raising head to normal position age from 6-8 month then continue

13. D) Optical righting acting on head: • THE SAME LIKE LABRYINTHINE (POSITIONS , RESPONSES) WITHOUT EYE BLIND FOLDED • Amphibian Reaction :Starting position: Prone head in midline ,legs extended , arm extended overhead • Stimulus: lift pelvis on one side • Response: Automatic flexion of hip ,knee ankle on the same side Age from 6 month then continue

14. Automatic Movement Reactions: • Moro Reflex • Starting position: Semi recline • Stimulus: Drop head backward • Response: Extension, abduction, external rotation of arms, extension, adduction fingers • Age: Normal from birth to 4 months • Landau Reflex : Starting position: prone in space with holding under thorax • Stimulus: raise head active or passively • Response: Spine and leg extend • Age: Normal from 6 months to 2or 2.5 years

15. Protective extensor Thrust( Parachute reaction) • Starting position: Prone , arms extended over head • Stimulus: Suspend the child from ankle or pelvis suddenly move child to floor • Response: Immediate Extension , of arms,, fingers to protect head • Age: Normal from 6 months continue through out life

16. CORTICAL REFLEXES OR EQUILBRIUM REACTION • SUPINE • Starting position: supine on tail board • Stimulus: Tilt board to one side • Response: Righting head, thorax extension, abduction of arms, legs on raised side • Age: Normal from 6 months continue through out life

17. Prone: Starting position: Prone on tail board • Stimulus: Tilt board to one side • Response: Righting head, thorax extension, abduction of arms, legs on raised side • Age: Normal from 8 months continue through out life • Sitting: Starting position: Sitting on chair • Stimulus: pull child to one side • Response: Righting head, thorax extension, abduction of arms, legs on raised side • Age: Normal from 12 months continue through out life

18. Kneel Standing : Starting position: Kneel standing • Stimulus: pull child to one side • Response: Righting head, thorax extension, abduction of arms, legs on raised side • Age: Normal from 15 months continue through out life • Hopping 1, 2and 3:Starting position: Standing holding from upper arms • Stimulus: Move to lift or right, forward, backward • Response: Righting head, thorax extension, hopping steps to sideway, forward, backward to maintain equilibrium • Age: Normal from 15 to 18 months continue through out life

19. Dorsiflexion: Starting position : Standing holding from axilla • Stimulus: Tilt child backward • Response: Righting head, dorsiflexion of feet • Age: Normal from 15 to 18 months continue through out life • See- saw: • Starting position: Standing holding hand , foot with flex hip knee • Stimulus: pull arm gently forward and to lateral side • Response: Righting head, thorax extension, slightly abduction of flexed knee • Age: Normal from 15 months continue through out life

20. Simian position Starting position: Squatting sitting • Stimulus: Tilt child to one side • Response: Righting head, thorax extension, abduction of arms, legs on raised side • Age: Normal from 15 to 18 months continue through out life