Infant Reflexes and Stereotypies · 09.01.2011 · •Milani Comparetti Neuromotor Development...
Transcript of Infant Reflexes and Stereotypies · 09.01.2011 · •Milani Comparetti Neuromotor Development...
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Infant Reflexes and Stereotypies
Chapter 9
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Infant reflexes and
stereotypies are very
important in the process
of development
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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
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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
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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
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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
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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
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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
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Role of Reflexes in
Developing Future
Movement
Infant Reflex Future Voluntary
Movement
Crawling Crawling
Labyrinthine Upright posture
Palmar grasp Grasping
Stepping Walking
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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
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Reflexes as Diagnostic
Tools
Reflex Concern when lacking, weak,
asymmetrical or persisting
Moro Cerebral birth injury
Asymmetric
tonic reflex
Cerebral palsy; other neural
damage
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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
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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
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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
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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
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Primitive Reflexes ~
Sucking
• Occurs pre-and
postnatally
– Babies are born with
blisters on lips
• Stimulated by
touching the lips
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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
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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
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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
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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
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Primitive Reflexes ~
Symmetric
Tonic Neck Reflex
• Limbs respond
symmetrically
• Its persistence may
impede other motor
milestones
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Primitive Reflexes ~
Symmetric
Tonic Neck Reflex
Place baby in a sitting
position ~ tip forward
Neck
flexes
Arms
flex
Legs
extend
Place baby in a sitting
position ~ tip
backward
Neck
extends
Arms
extend
Legs
flex
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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
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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
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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
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Primitive Reflexes ~
Palmer Mental Reflex
• Elicits a facial response
when the base of the
palm is scratched
• Lower jaw opens and
closes
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Postural Reflexes ~
Stepping
Stepping reflex is a forerunner to walking
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Postural Reflexes ~
Crawling
• Believed to be essential to the voluntary creeping
movement
• Observed from birth to 3-4 months
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Postural Reflexes ~
Swimming
• Characterized by the baby’s swimming-like
movements when held in a horizontal position
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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
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Postural Reflexes ~
Parachuting Reflexes
• Propping reflexes
• Related to upright
posture
• This reflex is a
conscious attempt to
break a potential fall
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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
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Postural Reflexes ~
Pull-up Reflex
When the baby is tipped backward,
supporting arms flex in an effort to
maintain the upright position
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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
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Stereotypies
• 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
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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