Reflexes

Asymmetrical Tonic Neck Reflex [ATNR]

• Stimulus: neck position


• Can be tested in supine or sitting


• Response: Neck turns right followed by extension of right arm and flexion of left arm (and vice versa)


• Same pattern seen in the LE, where the right leg extends and left leg flexes (and vice versa)


• Age range: 0-4-6 months


• Functional implications: not able to crawl or roll over; hand-eye coordination

Symmetrical Tonic Neck Reflex [STNR]

• Stimulus: neck flexion or extension


• Can be tested in sitting or quadruped


• Response: When neck is extended, the arms will extend and LE will flex


• When neck is flexed, the arms will flex and the LE will extend


• Age range: 4-6 months


• Functional implications: inability to reach for objects, difficulty writing & reading, poor posture

Tonic Labyrinth Reflex [TLR]

• Stimulus: position of the body


• Can be tested in prone or supine with head midposition, ask client to stand from the position


• Response: identification of flexion and extension of extremities; identify tone of muscle (increase); look for gravity balance & head control (negative result = reflex is not present)


• Age range: 4-6 months


• Functional implications: difficulty with balance & coordination; weak muscle tone; toe walking

Grasp Reflex

• Stimulus: pressure in palm of hand (medial border)


• Can be tested in supine


• Response: flexing of fingers; grasping the stimulus object


• Age range: 3, 4 months


• Functional implications: immature pencil grip, difficulty with cup handles


• Associated Reactions


• Stimulus: any movement or position (e.g. squeezing an object)


• Can be tested in any position


• Response: opposite hand will mimic the other hand


• Age range: mostly in small children (with time the reflex will be integrated in the CNS); adults that suffered a brain injury (e.g. hemiplegia due to stroke)


• Functional implications: difficulty performing ADL’S, IADL’S, etc

Neck Righting

• Stimulus: moving of the head


• Can be tested supine; ask client to face up and turn head right and left while UE & LE are extended


• Response: positive (+) indicates that the body is following the head movement


• Age range: 0-6 months


• Functional implications: difficulty with balance, safety issues

Protective Extensions

• Stimulus: displacing body forward, sideways and backwards


• Can be tested in sitting position, kneeling, or sitting on a medicine ball


• Response: client will use hands to stabilize


• Age range: 6 months - death


• Functional implications: safety issues, injury from falls

Equilibrium Reactions

• Stimulus: rocking client


• Can be tested in sitting, kneeling, or standing


• Response: automatic movements to maintain balance, position of head and body; protective reactions


• Functional implications: injury from falls, safety issues