Normal development & reflex
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1 Normal development & reflex
2 Definition of Development : acquisition & refinement of skills 1 대근육운동발달 2 소근육운동발달 3 대인관계및사회성발달 4 적응능력혹은비언어성발달 5 의사소통및언어발달 6 학습, 청각, 시각의발달 Department of Rehabilitation Medicine, Hanyang University College of Medicine 2
3 Content I. Infant primitive Reflex II. Postural reaction III. Motor development Department of Rehabilitation Medicine, Hanyang University College of Medicine 3
4 I. Infant primitive Reflex
5 Primitive reflex profiles PRP II Moro Neck righting TLR STNR, ATNR Positive supporting Crossed extension Stepping Palmar, plantar grasp L/E placing PRP III Head righting Landau reaction Derotative righting Head on body Body on body Parachute reaction Equilibrium reaction Department of Rehabilitation Medicine, Hanyang University College of Medicine 5
6 Primitive reflex profiles Department of Rehabilitation Medicine, Hanyang University College of Medicine 6
7 Moro reflex Stimulus : sudden neck extension Response : shoulder abduction elbow & finger extension Disappears by 4 6 months Department of Rehabilitation Medicine, Hanyang University College of Medicine 7
8 Moro reflex Head control 이안되어서이용하는것으로 head control 이되면사라짐. Asymmetric Moro reflex : Hemiplegia, brachial plexus injury 의심 Interferes with : balance reactions in sitting protective responses in sitting Eye-head coordination, visual tracking Department of Rehabilitation Medicine, Hanyang University College of Medicine 8
9 Rooting reflex Stimulus : touch around mouth Response : head & mouth move toward stimulus Disappears by 4 months Interferes with oral- motor development development of midline control of head Department of Rehabilitation Medicine, Hanyang University College of Medicine 9
10 Asymmetric tonic neck reflex Stimulus : head turn to side Response : Arm or leg extend on face side, and flex on occipital side Disappears by 6-7 months Fencing like posture Department of Rehabilitation Medicine, Hanyang University College of Medicine 10
11 Asymmetric tonic neck reflex Obligatory abnormal at any age persistent suspicious of CNS pathology Interferes with : Feeding, visual tracking, rolling Midline use of hand, Bilateral hand use Development of crawling Can lead to skeletal deformities : Scoliosis, hip subluxation, hip dislocation Department of Rehabilitation Medicine, Hanyang University College of Medicine 11
12 Symmetric tonic neck reflex Stimulus 1) neck extension 2) neck flexion Response 1) arm extended, leg flexed 2) arm flexed, leg extended Disappears by 6-7 months Department of Rehabilitation Medicine, Hanyang University College of Medicine 12
13 Symmetric tonic neck reflex Obligatory abnormal at any age persistent suspicious of CNS pathology Interferes with : Ability to prop on arms in prone position Crawling reciprocally Sitting balance when looking around Maintaining hand-and knee position Department of Rehabilitation Medicine, Hanyang University College of Medicine 13
14 Palmar grasp reflex Stimulus : pressure or touch on the palm, stretch finger flexors Response : Flexion of fingers Disappears by 5-6 months Department of Rehabilitation Medicine, Hanyang University College of Medicine 14
15 Palmar grasp reflex Diminished in CNS depression Absent in lower motor neuron paralysis persistence suggest spasticity, cerebral palsy Interferes with : Ability grasp and release objects voluntarily Weight bearing on open hand for propping, crawling, protective responses Department of Rehabilitation Medicine, Hanyang University College of Medicine 15
16 Plantar grasp reflex Stimulus : pressure on sole just distal to metatarsal head Response : Flexion of toes Disappears by 8-9 months Department of Rehabilitation Medicine, Hanyang University College of Medicine 16
17 Plantar grasp reflex Absent in lower motor neuron paralysis persist & hyperactive in spasticity, cerebral palsy Interferes with : Ability to stand with feet flat on surface Balance reactions & weight shifting in standing Department of Rehabilitation Medicine, Hanyang University College of Medicine 17
18 Tonic labyrinthine reflex Stimulus position of labyrinth in inner ear Head position in space : strongest at 45 angle Response - supine : body & extremities are held in extension Department of Rehabilitation Medicine, Hanyang University College of Medicine 18
19 Tonic labyrinthine reflex Response - prone : body & extremities are held in flexion Disappears by 6 months Department of Rehabilitation Medicine, Hanyang University College of Medicine 19
20 Tonic labyrinthine reflex Abnormal at any age if hyperactive or if persist - Strong reaction : Suspect of diffuse brain damage Interferes with : Ability to initiating rolling Ability to prop on elbows with extended hips when prone position Ability to flex trunk and hip to come to sitting position from supine position Balance in sitting or standing Department of Rehabilitation Medicine, Hanyang University College of Medicine 20
21 Positive support reaction Stimulus : Tactile contact & weight bearing on the sole Response : Leg extension for supporting partial body weight Disappears by 3-7 months Department of Rehabilitation Medicine, Hanyang University College of Medicine 21
22 Positive support reaction Hyperactive : suggest spasticity of the legs Interferes with : standing and walking balance reactions and weight shifting in standing can lead to contractures of ankle into plantar flexion Department of Rehabilitation Medicine, Hanyang University College of Medicine 22
23 Placing reflex Stimulus : Tactile contact on dorsum of foot or hand Response : Flexion to place the leg or arm over the obstacle Present U/E : at 3 month, L/E : at birth Disappears by 12 months Department of Rehabilitation Medicine, Hanyang University College of Medicine 23
24 Placing reflex 3 phase responses : flexion/extension/placing Department of Rehabilitation Medicine, Hanyang University College of Medicine 24
25 Placing reflex Absent responses - suspicious motor dysfunction or extensor spasticity of the leg Asymmetrical response hemiplegia Absence of L/E placing diplegia Department of Rehabilitation Medicine, Hanyang University College of Medicine 25
26 Galant reflex Stimulus : Touch to skin along spine from shoulder to hip Response : lateral flexion of trunk to side of stimulus Disappears by 2 months Interferes with : development of sitting balance Department of Rehabilitation Medicine, Hanyang University College of Medicine 26
27 Startle reflex Stimulus : Loud, sudden noise Response : similar to Moro reflex but elbows remain flexed and hand closed Disappears by 5 months Interferes with : sitting balance, protective responses in sitting Eye-head coordination, visual tracking Department of Rehabilitation Medicine, Hanyang University College of Medicine 27
28 Stepping(Walking) reflex Stimulus : supported upright position with soles of feet on firm surface Response : reciprocal flexion/extension of leg Disappears by 2 months Department of Rehabilitation Medicine, Hanyang University College of Medicine 28
29 Stepping(Walking) reflex Absent in hypotonic children Persist for several months in spastic CP Interferes with : standing & walking balance reactions & weight shifting in standing development of coordinated reciprocal movement of lower extremities Department of Rehabilitation Medicine, Hanyang University College of Medicine 29
30 II. Postural reaction
31 Head righting reaction Stimulus : Vestibular or visual Response : Head & face aligned vertical Mouth aligned horizontal Emerge at birth Prone : 2 months Supine : 3-4 months Department of Rehabilitation Medicine, Hanyang University College of Medicine 31
32 Head righting reaction Suppressed with evolution of voluntary head righting reaction into Landau and derotative righting reaction Delayed or absent in CNS immaturity or damage or motor unit disease Department of Rehabilitation Medicine, Hanyang University College of Medicine 32
33 Protective extension reaction Stimulus : center of gravity displaced outside base of support in sitting Response : Abduction of upper extremity toward displacement to prevent falling anterior : 5-7 months Department of Rehabilitation Medicine, Hanyang University College of Medicine 33
34 Protective extension reaction lateral : 6-8 months posterior : 7-8 months Department of Rehabilitation Medicine, Hanyang University College of Medicine 34
35 Protective extension reaction Emerge at anterior : 5-7 months lateral : 6-8 months posterior : 7-8 months Delayed or absent in CNS immaturity or damage or motor unit disease Department of Rehabilitation Medicine, Hanyang University College of Medicine 35
36 Parachute reaction Stimulus : center of gravity displaced outside base of support in standing Response : extension of upper extremities toward displacement to prevent falling Emerge at standing, months Department of Rehabilitation Medicine, Hanyang University College of Medicine 36
37 Parachute reaction Normal infant Abnormal infant Department of Rehabilitation Medicine, Hanyang University College of Medicine 37
38 Landau reaction Voluntary vertical head extention, then trunk, hip, & leg extention Emerge at 2 months : 50% (+) 3 months : 100%(+) Disappears by 24 months Department of Rehabilitation Medicine, Hanyang University College of Medicine 38
39 Landau reaction Prerequisite for roll over Good marker of vertebral tone Delayed or absent responses in hypotonia Department of Rehabilitation Medicine, Hanyang University College of Medicine 39
40 Vojta s postural reaction : 7 가지자세반응을통해발달정도를평가 Traction reaction Vojta reaction Peiper 의거꾸로매달기반응 Collis 의거꾸로매달기반응 Collis 의수평반응 Landau reaction 겨드랑이걸치기반응 Department of Rehabilitation Medicine, Hanyang University College of Medicine 40
41 Traction reaction newborn 3 month 6 month Department of Rehabilitation Medicine, Hanyang University College of Medicine 41
42 Landau reaction 1~ 6 wk 7wk ~ 3mon 13wk ~ 6mon Department of Rehabilitation Medicine, Hanyang University College of Medicine 42
43 Collis horizontal reaction newborn 3 month 6 month 8-10 month Department of Rehabilitation Medicine, Hanyang University College of Medicine 43
44 Normal acquisition and regression of primitive reflex behavior Reflex Onset Disappears Moro Birth 6 months Palmar grasp Birth 6 months Plantar grasp Birth 9-10 months Tonic neck 2 months 5 months Landau 3 months 24 months Parachute 8-9 months Persists Department of Rehabilitation Medicine, Hanyang University College of Medicine 44
45 III. Motor development
46 Newborn to 1 month Prone Supine Physiologic flexion Lift head briefly Head to side Physiologic flexion Roll partly to side Department of Rehabilitation Medicine, Hanyang University College of Medicine 46
47 Newborn to 1 month Sitting Standing Head lag in pull to sit Reflex standing & walking Department of Rehabilitation Medicine, Hanyang University College of Medicine 47
48 2 to 3 months Prone Supine Lift head 90 briefly Chest up with some Wt. through forearm Roll prone to spine ATNR influence strong Leg kick reciprocally Prefer head to side Department of Rehabilitation Medicine, Hanyang University College of Medicine 48
49 2 to 3 months sitting standing Variable head lag Need full support to sit Head upright but bobbing Poor weight bearing Hip in flexion, behind shoulder Department of Rehabilitation Medicine, Hanyang University College of Medicine 49
50 4 to 5 months Prone Supine Lift head 90 Bear wt. on extended arms Pivot in prone to reach toy Roll from supine to side position Play with feet to mouth Department of Rehabilitation Medicine, Hanyang University College of Medicine 50
51 4 to 5 months sitting standing Sit alone for brief period Turns head in sitting Head upright but bobbing Bear all wt. through legs in supported stand Department of Rehabilitation Medicine, Hanyang University College of Medicine 51
52 6 to 7 months Prone Supine : Lift head Mobility Rolls from supine to prone Hold wt. on one hand to reach for toy : May crawl backward Department of Rehabilitation Medicine, Hanyang University College of Medicine 52
53 6 to 7 months sitting standing Sit independently Lift head when pulled to sitting position Stand holding Bounce in standing Department of Rehabilitation Medicine, Hanyang University College of Medicine 53
54 8 to 9 months Prone sitting Get into Hand-and-Knee position Move from sitting to prone position Pivots in sitting position Department of Rehabilitation Medicine, Hanyang University College of Medicine 54
55 8 to 9 months standing Mobility Stands at furniture Pull to stand at furniture Crawls forward Walks along furniture (crusing) Department of Rehabilitation Medicine, Hanyang University College of Medicine 55
56 10 to 11 months Standing Stands without support briefly Pull to stand using half-kneel intermediated position Pick up object from floor from standing with support Department of Rehabilitation Medicine, Hanyang University College of Medicine 56
57 10 to 11 months Mobility Creeps on hand & feet (bear walk) Walks with one or both hand held Department of Rehabilitation Medicine, Hanyang University College of Medicine 57
58 12 to 15 months Mobility Walks without support Fast walking Walks backward Walks sideways Creeps upstairs Throw ball in sitting position Department of Rehabilitation Medicine, Hanyang University College of Medicine 58
59 16 to 24 months Mobility Squats in play Walk upstairs & downstairs with one hand held Propels ride-on toy Kick ball Throw ball forward Department of Rehabilitation Medicine, Hanyang University College of Medicine 59
60 2 years Mobility Ride trycycle Walks backward Walks on tiptoe Runs on toe Walks downstairs alternating feet Catch large ball Department of Rehabilitation Medicine, Hanyang University College of Medicine 60
61 Gross motor milestone Department of Rehabilitation Medicine, Hanyang University College of Medicine 61
62 Reference 1. Physical Medicine & Rehabilitation 3 rd - Randall L. Braddom 2. Physical Medicine & Rehabilitation 4 rd - Joel A. Delisa 3. Child and Adolescent Neurology 2 nd - Roland B David 4. Clinical Pediatric Physical Therapy - Katherine T. Ratliffe 5. Pediatric Rehabilitation 2 nd - Gabriella E. Molnar 6. 소아재활의학 - 소아재활의학회 7. 소아과학 - 홍창의 Department of Rehabilitation Medicine, Hanyang University College of Medicine 62
63 The end 감사합니다
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