1. Primitive Reflexes
Dr. Vivek H. Ramanandi (PT)
MPT (Neuro), Ph.D. Scholar
Assistant Professor,
SPB Physiotherapy College, Surat.
2. What are Reflexes?
• A reflex, or reflex action, is an
involuntary & nearly instantaneous
response to a stimulus.
• Examples:
– Constriction of pupils when
exposed to light
– Sneezing or coughing when
exposed to irritant
– Jerky withdrawal of leg when
pricked
3. What are Primitive Reflexes?
• Reflex actions originating in
the CNS and are exhibited by
normal infants, but not
neurologically intact adults, in
response to particular stimuli.
• Suppressed by the development
of the frontal lobes during
process of normal development
4. What are Primitive Reflexes?
• Represent neurological
maturation of the newborn and
most develop before birth
• Also called infantile, infant or
newborn reflexes
• Absence of response &
abnormal persistence of reflex
both may suggest neurological
abnormality
5. Adaptive Value of Primitive Reflexes
• Assisted in the survival of babies
during human evolution (e.g.,
The Moro Reflex)
• Reflexes such as sucking and
grasping help establish
interaction between parents and
infants
8. • Noxious stimulus (pinprick) to sole of foot.
Tested in supine or sitting position.
Stimulus
• Toes extend, foot dorsiflexes, entire LE
flexes uncontrollably
Response
• 28 weeks of gestation
Onset
• 1–2 months
Integrated
Flexor
withdrawal
9. • One leg extended and the other flexed; sole
of flexed leg is given stroking
Stimulus
• Immediate extension adduction and internal
rotation of flexed leg with plantar flexion of
foot
Response
• Birth
Onset
• 4 months
Integrated
Extensor
thrust
10. • Noxious stimulus to ball of foot of LE fixed
in extension; tested in supine position.
Stimulus
• Opposite LE flexes, then adducts and
extends.
Response
• 28 weeks of gestation
Onset
• 1–2 months
Integrated
Crossed
Extension
11. • Stroking cheek or mouth
Stimulus
• Turn its head towards stimulus, searching
object
Response
• Birth
Onset
• 4 months (3-6 months)
Integrated
Rooting
13. • Maintained pressure to palm of hand
(palmar grasp) or to ball of foot under toes
(plantar grasp)
Stimulus
• Maintained flexion of fingers or toes
Response
• Palmar: Birth
• Plantar: 28 weeks of gestation
Onset
• Palmer: 4–6 month
• Plantar: 9 months
Integrated
Grasp
14. • Grasp forearm and pull up from supine into
sitting position
Stimulus
• Grasp and total flexion of the UE
Response
• 28 weeks of gestation
Onset
• 2–5 months
Integrated
Traction
16. • Rotation of the head to one side
Stimulus
• Flexion of skull limbs, extension of the jaw
limbs, “bow and arrow” or “fencing” posture
Response
• Birth
Onset
• 4–6 months
Integrated
Asymmetrical Tonic
Neck Reflex (ATNR)
17. • Flexion or extension of the head
Stimulus
• With head flexion: flexion of UEs, extension
of LEs; with head extension: extension of
UEs, flexion of LEs
Response
• 4–6 months
Onset
• 8–12 months
Integrated
Symmetrical Tonic
Neck Reflex (STNR)
18. • Prone or supine position
Stimulus
• With prone position: increased flexor
tone/flexion of all limbs; with supine:
increased extensor tone/extension of all
limbs
Response
• Birth
Onset
• 4–6 months
Integrated
Symmetrical Tonic
Labyrinthine Reflex
(STLR/TLR)
19. • Contact to the ball of the foot in upright
standing position
Stimulus
• Rigid extension (co-contraction) of the LEs
Response
• Birth
Onset
• 6 months
Integrated
Positive supporting/
Walking/ Stepping
21. • Supine blind folded: Rotate head to one
side
Stimulus
• Body rotates to that side as a whole
Response
• Birth
Onset
• 3 months
Integrated
Neck Righting Reflex
22. • Hold child from armpit in a suspended
position then change position of his head
from side to side
Stimulus
• Eyes will always move to same side as
head
Response
• 1-2 Years
Onset
• Persists
Integrated
Optical Righting
Reflex
23. • Same as Optical righting
Stimulus
• Same as Optical righting
Response
• 2-3 months, reaches peak 5-6 months
Onset
• Persists
Integrated
Labyrinthine
Righting Reflex
24. Cortical Level
Equilibrium Reflexes
• Movement of tilt board or rocking board
Stimulus
• Extension of upper and lower extremities on
the side of tilt
Response
• Sitting: 10-12 months
• Standing: 18 months
Onset
• Persists
Integrated
26. • Sudden change in position of head in
relation to trunk; drop patient backward
from sitting position.
Stimulus
• Extension, abduction of UEs, hand
opening, and crying followed by flexion,
adduction of arms across chest.
Response
• 28 weeks of gestation
Onset
• 5–6 months
Integrated
Moro Reflex
27. • Sudden loud or harsh noise
Stimulus
• Sudden extension or abduction of UEs,
crying
Response
• Birth
Onset
• Persists
Integrated
Startle Reflex
28. • Either active or passive flexion of neck in
ventral suspension
Stimulus
• Flexion of both upper and lower limbs
Response
• 3 months (Reaches at peak at 8 months)
Onset
• 10 months
Integrated
Landau Reflex
29. • Light tapping over glabellar region
Stimulus
• Blinking of both eyelids
Response
• 2-3 months
Onset
• Persists
Integrated
Glabellar Tap Reflex
30. • Stroke child’s side of back
Stimulus
• Swing towards side of stroke
Response
• Birth
Onset
• 4-6 months
Integrated
Galant Reflex
31. • Child is held upright and the baby's body is
rotated quickly to face forward
Stimulus
• Extension of arms forward as if to break a
fall
Response
• 6-12 months
Onset
• Persists
Integrated
Parachute Reaction
32. • Resisted voluntary movement in any part of
the body
Stimulus
• Involuntary movement in a resting extremity
Response
• Birth–3 months
Onset
• 8–9 years
Integrated
Associated
Reactions
33. References
Pediatric Physical therapy (4th Ed.) – J. Tecklin
Nelson Essentials of Pediatrics (2nd Ed.)
Physical Rehabilitation (6th Ed.)- Sullivan
Physiotherapy in Neuro-Conditions- Glady S. Raj
