Levels : Spinal reflexes- primitive reflexes 2. Brainstem reflexes- tonic reflexes 3. cortical reflexes- midbrain reflexes 1. Spinal reflexes 1. Flexor withdrawl- pin prick to sole of foot- toes extend, foot dorsiflexes, entire leg flexes Onset- 28wks of gestation Integrated- 1-2 mnths 2. Crossed extension- pain stimulus to ball of foot fixed in extension- opp L/L flexes, then adducts and extends Onset- 28wks of gestation Integrated- 1-2 mnths 3. traction- pull from supine to sitting- grasp and total flexion of U/L Onset- 28wks of gestation Integrated- 2-5 mnths 4. Moro- suddenly drop pt backwards- extension, abduction of U/L, hand opening and crying followed by flexion, adduction of arms across chest Onset- 28wks of gestation Integrated- 5-6 mnths 5. Startle- sudden loud sound- sudden extension/ abduction of arms and crying Onset-birth Integrated-persists 6. Grasp- maintain pressure to palm of hand/ ball of foot- maintained flexion of fingers/toes Onset- palmar: birth, plantar: 28wks of gestation Integrated- palmar 4-6 mnths, plantar: 9 mnths Brainstem reflexes 1. ATNR- rotation of the head to one side- flexion of limbs on occipital side and extension on jaw side Onset-birth Integrated- 4-6 mnths 2. STNR- flexion/ extension of head- with flexion: U/L flexion and L/L extension. With head extension: U/L extension and L/L flexion Onset-4-6 mnths Integrated- 8-12 mnths 3. TLR- prone/ supine position: with prone flexion of all 4 limbs. With supine extension of all 4 limbs Onset-birth Integrated- 6 mnths 5. Positive supporting: contact to the ball of foot in upright- rigid extension of L/L Onset-birth Integrated- 6 mnths 6. Associated reactions: resisted voluntary movt in any part of the body- involuntary movt in the resting extremity. Onset-birth- 3mnths Integrated- 8-9 years Midbrain reflexes 1.NOB: tested in supine. Passively turn head to one side- log rolls to align the body with the head Onset-4-6 mnths Integrated-5 years 2. BOB: tested in supine. Passive rotation of upper/ lower trunk- remaining body rolls to align. Onset-4-6 mnths Integrated- 5 years 3. Labyrinthine head righting. Occlude vision, alter body position by tipping body in all directions- head orients to vertical position with mouth horizontal Onset-birth-2mnths Integrated-persists 4. Optical righting: alter body position by tipping body in all directions- head orients to vertical position with mouth horizontal Onset-birth-2 mnths Integrated-persists 5. Protective extension: displace COG outside the BOSU/L or L/L extend and abduct to support and protect the body against falling Onset-arms: 4-6mnths, legs: 6-9 mnths Integrated-persists 6. Equilibrium reactions- tilting: displace the COG by tilting/ moving the support surface- curvature of the trunk towards the upward side along with extension abduction of limbs on that side and protective extension on the opp side Onset-prone 6mnths. Supine 7-8 mnths. Sitting 7-8 mnths. Quadruped 9-12 mnths. Standing 12-21 mnths Integrated-persists 7. Equilibrium reactions- postural fixation: apply a displacing force to the body, altering its COG in its relation to the BOS- curvature of the trunk towards the external force with extension abduction of limbs on that side to which the force is applied. Onset-prone 6mnths. Supine 7-8 mnths. Sitting 7-8 mnths. Quadruped 9-12 mnths. Standing 12-21 mnths Integrated-persists