PRIMITIVE REFLEXES

AGE OF
REFLEX STIMULUS RESPONSE CLINICAL SIGNIFICANCE
SUPPRESSION
Baby will begin to suck Premature babies may have a weak
Sucking Roof of the baby’s mouth is 3 months
or immature sucking ability
touched

Crawl Reflex Pulling their legs under their

Place baby on their stomach body and kick them out in 3-4 months
crawling motion
Rooting Diminished in CNS pathology, may
Stroking lips/around mouth Moving mouth or head 4 months
present in CNS pathology.
forward stimulus in search
(Birth to 2-4 months) May ensure successful breastfeeding
of nipple
Symmetrically fling the arms
Moro Sudden neck extension 4-6 months Persists in CNS pathology static
(Shoulder abd, elbow &
encephalopathy
finger extension)  Reverse
Startle Sudden noise flexion
(Arm flexion and adduction)

Obligatory or hyperactive abnormal

3-5 months replaced
Positive Light pressure or WB on Legs extend for partial at any age, early sign of lower
by volitional weight
Supporting plantar surface support of body weight extremity spasticity, may be
bearing with support
associated with scissoring
Asymmetric Tonic Extremities extend on face
Head turning to side 6-7 months
Neck side, flex on occiput side Obligatory response abnormal at
(5-6 months)
any age, persists in static
Symmetric Tonic Neck flexion Arms flex, legs extended
6-7 months encephalopathy
Neck Neck extension Arms extend, legs flex
Touch or pressure on palm or Flexion of all fingers/ Grasp
Palmar Grasp 5-6 months Diminished in CNS suppression,
stretching finger flexors Removal of Stimuli: tighter
absent in LMN paralysis; persists
grip (3-4 months)
hyper-active in spasticity
Pressure on sole distal to MT 12-14 months when
Plantar Grasp Flexion of all toes
heads walking is achieved
On vertical support plantar
Automatic Alternating automatic Variable activity in normal
contact and passive tilting of 3-4 months
Neonatal Waking/ steps with support infants, absent in LMN
body forward and side-to-
Step/ Dance paralysis
side
Tactile contact on dorsum of Extremity flexion to place Absent in LMN paralysis or with LE
Placement or Before end of first year
foot or hand hand spasticity
Placing
or foot over an obstacle
Sequential body rotation
Neck Righting or 4 months replaced Nonsequential leg rolling
Neck rotation in supine from shoulder to pelvis
Body Denotational by volitional rolling suggests increased tone
towards
direction of face
Supine Predominant extensor tone Hyperactivity/obligatory abnormal
Tonic Labyrinthine 4-6 months at any age persists in CNS
Prone Predominant flexor tone (2-4 months) damage static encephalopathy

PHYSIOLOGIC POSTURAL REFLEX RESPONSES

AGE OF
REFLEX STIMULUS RESPONSE CLINICAL SIGNIFICANCE
EMERGENCE
Align face/head vertical, Prone – 2 months
Head Righting Visual and vestibular
mouth horizontal Supine – 3-4 months
Align body parts in
Head and Tactile,
anatomic position relative to 4-6 months
Body Vestibular,
each other and gravity
Righting Proprioceptive
Protective Displacement of center of Extension/abduction of Anterior 5-7 Delays or absent in
Extension or gravity outside supporting lateral extremity toward Lateral 6-8 CNS Immaturity or
Parachute base in sitting, standing displacement to prevent Posterior 7-8 damage
Reactions falling Standing 12 - 14
Adjustment of tone and Sitting – 6-8
Displacement of center
Equilibrium or posture of trunk to maintain months Standing
of gravity
Tilting balance – 12-14
months

Primitive/ Spatial Tonic/ Brainstem Midbrain/ Cortical

Flexor Withdrawal Positive Support Equilibrium
Crossed Extension ATNR NOB
Traction STNR BOB
Moro TLR BOH
Startle Associated Reaction Optic Righting with Vision
Palmar Grasp Optic Righting without Vision
Plantar Grasp Protective Extension
 Classification of
Afferent Nerve Center Efferent Nerve Response
Reflex Reflex

Corneal Polysynaptic Contraction of the orbicularis oculi

Ophthalmic Branch of
        Right Superficial Pons CN VII (blinking of both eyes)
CN V
        Left Visceral

Pupillary Direct: constriction of stimulated

Polysynaptic Edinger Westphal
    Right eye ipsilateral/stimulated eye
Superficial CN II nucleus at CN III
    Left eye Consensual: Constriction of contralateral
Visceral Midbrain
eye

Gag or Polysynaptic Gagging: vomiting as response; Soft

Vomiting Superficial CN IX Spinal Cord CN X palate elevation
Visceral

Jaw Jerk Monosynaptic Mandibular branch (v3) of Contraction of temporal muscles

Pons CN V
Deep Trigeminal Nerve (CN V)

Biceps Jerk Monosynaptic Flexion of elbow

C5-6 Spinal cord CV - VI
Deep

Triceps Jerk Monosynaptic Extension of elbow

C7-8 Spinal cord CN VII - VIII
Deep

Abdominal Polysynaptic Upper: T8-10 Upper: T8-10 Contraction of ipsilateral abdominal

Spinal cord
Superficial Lower: T10-12 Lower: T10-12 muscles on the stroked side

Knee Jerk Monosynaptic Knee extension

L2-4 Spinal cord L2-4
Deep

Ankle Jerk Monosynaptic Plantarflexion

S1-2 Spinal cord S1-2
Deep

Plantar Polysynaptic N: Toe curling or no reaction

S1-2 Spinal cord S1-2
Superficial (+)/Abn: Extension of big toe or fanning