'

TABLE 5-4. Neuropbysiologic Reflex Processes and the Influence on Movement and Adaptation
Reflex Age Range
Reflex (See
references below) Position Stimulus Location Responses Adaptation Origin Initiation Inbtbttton

Primitm: Reflexes
__). . Rooting (15, 33) Supine Light tactile Mouth Opens mouth; rotation extension, and flexion Search for breast or bott1e in the direction of Pons 28 weeks' 3 months
of head follow the stimulus \. gestation
'-'): Sucking' {l_2, 33-; Supine Light tactile Oral cavity Close mouth, suck, and swallow Obtain nourishment, develop tongue move- Trigemina! 28 weeks· 2-5 months
37, 39) ment, and, later, produce sound nerve gestation
' MomentafY grasp with total flexion of UE Pons 28 weeks' 2-5 months
3. Traction (46) Supine Propriocep- Forearms Total flexion of upper extremities
tion leading to voluntary reach and grasp gestation
) · Moro (1, 2, 5, 9, Supine Sudden Head and trunk 1st: UEs extend and abduct; hands open and If persists, will interfere with head control, sit- Brainsten,i; 28 weeks' 5-6 months
· 19, 20, 34, 35, change of LEs may extend. 2nd: Flexion and adcwction ting equilibrium, and protective reactions af- me_dulla 1 gestation
36, 37, 39, 41, head position of UEs; hands close; may cry fecting adaptability of child for movement in
46) >30° exten- space
sion (pro-
prioception)
5. Crossed Supine Noxious tactile Ball of foot rst flexion, then extension and adduction of Preparation for reciprocal LE use; persistence Spinal 28 weeks' 1-2 months
J extension (1, 4, opposite LE indicates pathology and interference in recip- gestation
11, 24, 28) rocation and in walking
6. Flexor with- Supine Noxious tactile Sole of foot Withdrawal with flexion of hip and knee; dor- Protection or defense. If persists, will interfere Spinal 28 weeks' 1-2 months
drawal (1, 2, 4, siflexion of foot with toe extension with weight bearing in standing gestation
16, 27, 34, 37,
39, 45)
7. Plantar grasp Supine Firm pressure Ball of foot Grasps with toes (flexion) If persists, interferes with standing and walk- Spinal 28 weeks· 4-9 months
(31, 47) ing; may evoke toe walking gestation
8. Galam (8, 38) Prone Noxious tactile Along paraver- Incurvature of spine to same side Organizes for trunk adaptation. If persists, in- Spinal 32 weeks' 2 months
tebral column terferes with symmetric ,stability of the trunk, gestation
from 12th rib to independent sitting, standing. May -lead to
iliac crest scoliosis
I
i
Supine Propriocep- Neck rotators Log rolling-supine to side Rolling on body axis from back to right and Medulla 34 weeks· 4-5 months
,./2. Neooaral tion to neck left sides. Persistence delays segmented rolling gestation
righting (6, 7,
1
30, 31, 33, 7, rotators and other developmental milestones, espe-
cially bilateral integration
38, 41)
Vertical Proprioceptive LEs; dorsum of Placing of feet; flexion of hips/knees; dorsiflex- Correlates to spontaneous stepping-primitive Spinal 35 weeks' 2 months
J O· Pi,nm pl1og ion at ankle followed by LE extension & sup- form of ambulation and stepping over objects gestation
of legs (21 feet (stretch:
port on surface
Proprioceptive LEs; soles of feet Partial weight bearing with hips & knees Prerequisite for stepping. Preparation for mo- Spinal 35 weeks' 1-2 months
J Neonatal positive Vertical
flexed & ankle plantar flexion in contact with tion; not static. Weight bearing gestation
support (1)
floor surface
Proprioceptive LEs with body Positive support then walking (coordinated & Prerequisite for w\ lking Spinal and 37 weeks' 2 months
12. Spontaneous Vertical
and tactile inclined forward rhythmic with heel touching first) brainstem gestation
stepping (1 , 40)
Head/face Prone; head Increases flexor tone of neck, UEs, & LEs Contributes, when integrated, into a suppor- Inner ear- Birth 6 months
13 Tonic laby- Prone tive framework of nonstressful movement ototitic utri-
/ rinthine (3, 17) down in rela- midline
tion to gravity de maculae

(continued)
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VI
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TABLE 5-4. NeurophysWtog;,: Refled'roces,esawd the lnfluenc, on Movement mid AdaptsUon (conUnu,d) \'
I
Reftex ,=~
references
r (~.,. below) - - - .,,- ------
Refl.ex A2e Range
Position Stimulus Location Responses Adaptation Ot-loin ,_,._______ - -- -- ---
.......&-&. ;,.i,iation Inhibition
Primitm: Rdlexes
14. Supine Head/face up Supine; head Increases extensor tone of neck, UEs, & LEs II persistent, interferes with head control,
in relation to midline lntermedulla
coming to sit, rolling, creeping, and standing
gravity
15. Plantar arms Vertical Proprioceptive UEs; dorsum of Placing of hands: Flexion of shoulder and el- Requisite for supporting body weight on fore-
placing (21 , 34, Spinal or Birth 2 months
(stretch) hands bow, then fingers arid wrist abduct and ex- arms and extended arms
43) brainstem
tend. Followed by extension of elbows &
shoulders for UE support (infants may remain
fisted)
)--61 Asymmetrical Supine Proprioceptive a) Neck muscles a) Extension of UEs and LEs on face side; flex- Contributes to the supportive framework of Atlamo-oc- Birth
tonic neck (3, 6, (stretch) (rotation) ion on skull side nonstressful movement cipital and
8, 17, 22, 23, 25, visual for b) Gaze to in- b) As above, but not obligatory Persistent obligatory presence indicates patho- ixfal joints
28, 42, 44-49) infants duce neck rota- to upper
logic state, inducing lack of symmetrical pos-
tion ture, reach and grasp, normal rolling, cervical
unsupported sitting, and a deficiency in walk- roots,
ing. Globally, a lack of ability to develop mo- integrating
torically. Structural deformity (ie, scoliosis); at medulla
hip subluxation (skull side). Nonobligatory
presence interferes in motor planning, bilat-
eral integration, and reading comprehension.
F Symmetrical Prone Proprioceptive Neck muscles, With neck flexion, UEs flex and LEs extend; Works strongly with asymmetrical tonic and Same as for 4-6 months 8-12 months
../ tonic neck (10, flexion and ex- with neck extension, UEs extend and LEs flex tonic labyrinthine reflexes to influence tonic asvmmetric-
28, 30, 31, 41) tension of neck postural stability. Prolonged influence inter- at' tonic neck
feres with reciprocal creeping, sining, stand- reflex
ing, and walking
Prehension Reactions
18. Palmar grasp Supine Propriocep- Pressure on ul- "Catching phase," quick flexion and adduction Primitive precursor to coordinated voluntary Subcortical Birth 4-6 months
(42, 47) tion (palmar nar surface of of fingers. "Holding phase," sustained finger grasp. If persists, will interfere with releasing
pressure) palm flexion and the development of prehension and hand
skills
19. Avoidance (43) Supine, sit- Light tactile Dorsum or ul- Fingers open; move away from stimulus May cause overpronation of forearms, flexion Subcortical Birth 6-7 years
ting or stroke nar surface of of wrist, abduction extension of fingers. If per-
standing hands sists, will strongly reduce tactile exploration
and hand usage
20. Instinctive grasp Supine, sit- Light tactile Ulnar or radial Orientation of hand and fractionation of total Facilitates radial palmar grasp, thumb-2-3 Subcortical 4-11 months Persists
(19, 28, 30, 31, ting or propriocep- border of hands grasping reflex for voluntary grasping patterns finger grasp, and voluntary pincer grasp
41) standing tion

j
 Righting Reactions
Prone Otoliths of the Neck, without Orients head (in space and to ground) in an In general, automatic reactions that allow for Red nucleus Birth-2 Persists
y. Labyrinthine normal standing position and preserve bal- midbrain months
head righting labyrinthine vision upward position by neck extension
prone (&,..28,,29, ance in the process of changing from prone
37, 41) or supine to fully upright position. Prerequi-
site for head control in the normal upright
position. Initially, infant uses this reaction to
clear the head in the prone position. In gen-
eral, suppresses primitive abnormal reflexes
and facilitates normal movement for sining,
creeping, standing, and walking
22. Labyrinthine Supine Otoliths of the Neck, without Orients head (in space and to ground) in an
J head righting su- labyrinthine vision upward position by neck flexion
pine ('s, 28, 29,
37, 41)
23. Labyrinthine Vertical Otiliths of the Neck, without Orients head (in space.and to ground) in an
head righting labyrinthine vision upward position by tilting of head
tilting (8, 28, 29,
37, 41) ,
/ .Optical righting Prone Vision versus Neck, with vi- Orient head in space in an upright position in As in labyrinthine head righting, need the Cerebral 2 months Persists
prone (8, 26, 37, labyrinthine sual receptors extension subsequent motor development requiring cortex,
39, 43) head control in the normal upright position especially
occipital
Jfl. Optical righting Supine Vision Neck, with vi- Orients head in space in an upright position
supine (8, 26, 37, sual receptors inflexion
39, 43)
26. Optical righting Vertical Vision Neck, with vi- Orients head in space in an upright position
tilting (8, 26, 37, sual receptors in lateral tilting
39, 43)
f Neck righting Supine Proprioceptive Neck-lumbar Body alignment in rotation on axis with seg- Facilitates rolling for pursuits and for proceed- Midbrain 4-6 months 5 1·ears
(11, 30, 31, 34, (stretch) rotation mentation. Shoulder-thorax rotation followed ing with head control to sining, creeping,
41) by trunk-pelvic rolling standing, and walking. Deficiency may indicate
poor bilateral integration
j Body righting Supine Proprioceptive Pelvis rotation Trunk (thoracic rotation) on body axis with Facilitates rolling for pursuits and for proceed- Red nucleus 4-6 months 5 rears
(11, 30, 31, 37, (stretch) and with hip flexion segmentation; pelvic-trunk rotation followed ing to sining, creeping, standing and walking. of the mid-
40) tactile by shoulder-thoracic rotation on body axis Deficiency indicates diminished bilateral inte- brain
gration
Prone Proprioceptive Neck extensors Increases prone extension tone Dissociates flexor posture and·assists neck ex- Diffuse 3-4 months 12-24
Landau (3, 8, 13,
(stretch) tension in prone (especially pivot prone) com-
1· 18, 30, 31, 34,
37) ing to sit, and standing. Absence is associated
months
with motor weakness and mental retardation.
Early or exaggerated LandJu is associated with
-spasticity or increased muscle tone. Dela1· in
Landau will retard the development of prone
extension, sitting and standing, and related de-
velopmental adaptations

...
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i
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TABLE 5-4. Neuropbysiologic Reflex Processes and the Influence on Movement and Adaptation (continued)
Reflex (See
references below) Position Stimulus Location Re.ftex Age Range
Responses Adaptation Origin Initiation Inhibition
Equilibrium Reactions
30. Visual placing Vertical Visual (ad- Hands
arms (34, 43) Flexion of shoulder/elbow followed bv exten- Needed for weight bearing on forearms and
vance UEs/ Cortical 3-4 months Persists
sion of elbow/wrist/fingers for support extended arms; also for accurate placing of
hands toward
hands, creeping, and visual reaching and
supporting
grasping
surface)
31. Visual placing Vertical Visual (ad- Feet Hip and knee flexion followed by dorsiflexion Needed for LE weight bearing on knees and Cortical -
legs (8, 34, 43) vance LEs/feet 3-5 months Persists
of the ankle and LE extension for support on feet and for accurate placing of LEs in creep-
toward surface ing, knee activity, and standing/walking
supporting
surface)
32. Protective exten- Sitting Vestibular and Displace body Flexion of shoulder with elbow, wrist, and In general, protects body from harm when Midbrain,
sionforward proprioceptive forward 6-9 months Persists
finger extension center of gravity of the body is displaced. Fa- basal gan-
cilitates support with extended arms in sitting glia, brain-
and is used to attain weight-bearing activities stem with
with UEs cortical
input
33. Protective exten- Sitting Vestibular and Displace body Abduction of shoulder with elbow extension Sitting with arm support and protection 7 months Persists
sion sideways proprioceptive sideways and extension and abduction of the fingers against falling sideways. Needed for rotation in
(I , 8, 14, 29, 30, sitting
31, 34)
34. Protective exten- Sitting Vestibular, Displace body Total extension of shoulder, elbow, wrist, and Sitting with arm support, rotating body on its
sion UEs back- 9-10 months Persists
propriocep- backward fingers with finger abduction axis, and protection from falling backward.
ward tive, and Prolonged Moro may interfere with this
visual development
35. Positive support Vertical Propriocep- Ball of feet Hip abduction with external rotation, knee ex- Facilitates weight bearing/standing and pro- Midbrain or 6-9 months Persists
(6, 7, 28, 34, 43) tive, vestibular tension with dorsiflexion of ankles (cocontrac- vides generalized support (not rigid) for activ- thalamus
tion) ity and movement. Increased obligatorv
extensor tone with hip abduction and plantar ...
flexion of ankle indicates pathologic influence
and prevents normal gait, sitting, and stair
'-
walking. Structured deformity may occur sec-
ondarily to increased extensor tone
36 Equilibrium Prone Vestibular, Displace the Curvature of the spine, concave to the side In general, equilibrium reactions are auto- Cortical 5 months Persists
prone (6, 29, 30, propriocep- body, in prone being stressed or upward side, with abduction matic reactions which preserve body's center
3\ , 32) tive, and laterally & extension of the extremities. Head turns to- of balance when the supponing base is unsta-
visual ward upward side ble. Also, equilibrium facilitates movement
and postural adaptation ro different gravita-
-:°), tional changes
;;
/••·.
 " --
.:
37. Equilibrium Supine Vestibular, Displace 7-8 months \lers\sts
supine (3 1) propriocep- the body,
tive, and laterally in
visual supine
38. Equilibrium sit- 1 Sitting Vestibular, Displace the Curvature of the spine, concave to the side Stable, prone, and supine with beginning sit- 7-8 months Persists
ting (31) ,, propriocep- body in sitting, being stressed or upward side, with abduction ting equilibrium are necessary for sitting with-
tive, and to the right and and extension of the UEs out support
visual left, forward and
backward
39. Equilibrium qua- Quadruped Vestibular, Displace the Curvature of the spine, concave to the side Stable prone, supine, and sitting equilibrium Cortical 9-12 months Persists
druped (31) propriocep- body on all being stressed with increased UE and LE ex- with beginning equilibrium in quadruped are
tive, and fours tension on stressed side needed for creeping
visual
40. Equilibrium Biped Vestibular, Displace the Curvature of the spine, concave to side being Stable equilibrium in quadruped and begin- Cortical 12-21 Persists
standing (31) propriocep- body in standing stressed with abduction and extension of UEs ning biped standing reactions are needed for months
tive, and and LEs standing and walking. Delayed or deficient
visual equilibrium reactions will interfere with all
forms of volitional movement and restrict mo-
bility and adaptability.
41. Staggering reac- Biped Vestibular, Displace the One or more steps in direction of displace- Perfected staggering ensures safe independent Brainstem, 15-18 Persists
tion (protective) propriocep- body in biped ment to maintain balance walking and recovery from loss of balance in midbrain, months
(14, 16, 29, 42} tive, and position for- concert with protective reactions of UEs. basal gan-
visual ward, backward, glia with
and sideways cortical
input
Development of Prebenslon

(1) ITraction reflex 1--~ initiates brief holding

(2) IPalmar grasp reflex I elicits sustained holding }

as traction is integrated, I - - ~ Swiping occurs
embalanced reaching occurs f with palmar
grasping
(3) IAvoidance reflex 1--~ initiates releasing
affects orientation to supination with
·d · · t d t f ·1·t t ( )-l_t_· - .- ~ radial palmar grasp
As pa/mar grasp _ _ _ avo, ance 1s orien e o ac1 1a e _ _ _ 4 ns 1nct1ve
is integrated pronation with ulnar palmar grasp grasp reaction
a~ects fractionation of grasp for
pincer and opposition
Throughout the first 6-7 years of life, avoidance and instinctive grasp reactions occur and affect prehension. Csually, these reactions are integrated by 7 years, and
smooth voluntary reach grasp and release are achieved. ·

(continued)
...
a