Reflex
Asymmetrical
Tonic Neck
Reflex (ATNR)
Positive Response Looks Like
Position
Supine
“I need you to lie down
on your back so I can see
how you’re moving.”
Assessing Stimulus and Response
Passively or actively turn the head 90
degrees to one side.
Child: “I’m going to turn your head to
the side.”
Sitting; with arms and legs
extended.
Adult: “Can you turn your head to the
“I want you to sit down
right?”
and extend your arms and
“To the left?”
legs.”
* Test both sides
The face side of UE is extended;
skull side is flexed.
Symmetrical
Tonic Neck
Reflex (STNR)
Babies – over lap
Adult – quadruped
“I need you to get down
on your hands and knees
and slightly lean back so I
can see how you’re
moving.”
. 1.
Flex client’s head to bring chin
towards chest.
“Look down.”
2.
Extend the client’s head.
“Now look up.”
Looks like a bunny
hopping
Head flexed, UE flexed, LE
extended.
Head extended, UE extended, LE
flexed
Tonic
Labyrinthine
Reflex
On stomach
“I want you to lie down
on your stomach so I can
see how you’re moving.”
On back
“I want you to lie down
on your back so I can see
how you’re moving.”
Client can’t sit up against gravity;
has muscle tone; extension of
extremities in supine and flexion of
extremities in prone.
Associated
Reactions
See the other hand squeeze too.
Seated
“You can sit down.”
Check to see if client can lift their head
up.
1.
Ask the client: “Can you sit
up?”
2.
Check all sides to feel if the
person is pulling into gravity. Lift above
and below the knee/elbow joint when
lifting arm/legs
Check to see if client can lift their head
up.
1.
Ask the client: “Can you sit
up?”
2.
Check all sides to feel if the
person is pulling into gravity. Lift above
and below the knee/elbow joint when
lifting arm/legs.
Have client squeeze an object with the
unaffected hand.
OR
Standing
“Stand up.”
Seated
“You can sit down. Now
I’m going to check your
grasp.”
Grasp Reflex
*Usually supine for
infants
“I want you to squeeze this ball with
your unaffected hand.”
Press your finger down on ulnar side of
palm.
“Hold out your hand with your palm up.
I’m going to put my finger on the ulnar
side of your palm and press down for a
moment. Now relax your grasp.”
Strong grasp; can’t open hand to
release object.
Righting
Reaction
Sitting on a ball
Move the ball side to side.
“I want to see how you’re
moving by having you sit
on the ball. I’ll stabilize
the ball for you.”
“I’m going to gently rock the ball from
side to side. Try to keep your balance
while I do this.”
Sitting on padded table
“Come and sit on this
padded table so I can see
how you’re moving.”
Push forward, sideways, and
backwards. *OT should extend their
arm across client’s chest.
“I’m going to gently push you in
different directions. Try to keep your
balance while I do this.”
Head orients to midline.
Protective
Extension
Arms extend to protect head.
Equilibrium
Reaction
Head and trunk orient to midline
to maintain balance.
Lie on ball in prone
position
“I want to see how you’re
moving by having you lie
face down on the ball
with your stomach in the
center. Keep your arms
out to help you balance. I
will hold your legs to
balance you.”
Prone (5 months)
Sitting (6 months)
Supine (7 months)
Quadruped
“I need you to get down
Hold the client’s legs while they move
around on the ball.
“I want you to reach out to the floor
using your hands to balance you.”
Push forward, sideways, and
backwards.
“I’m going to gently push you in
different directions. Try to keep your
on your hands and knees
so I can see how you’re
moving.”
balance while I do this.”
Standing on Knees
“I need you to get down
on your knees so I can see
how you’re moving.”
“Try to keep your balance.”
Standing
“Stand up.”
Balance board
“I want to see how you’re
moving by having you
stand and balance on this
board. I’ll be right next to
you.”