EVOLUTION OF POSTURAL REFLEXES IN NORMAL INFANTS AND IN THE PRESENCE OF CHRONIC BRAIN SYNDROMES

The diving reflex in healthy infants in the first year of life

A cohort study was conducted with a random sample of 33 healthy infants evaluated at birth and at 1, 2, 3, 4, 5, 6, 9, and 12 months to determine the frequency of respiratory rate changes in response to air blown over the face (diving reflex) in the first year of life, and to standardize the description of diving reflex occurrence. All 33 infants remained neurologically normal throughout follow-up. Diving reflex was observed in 95.3% of newborns and in 100% of infants between 2 and 6 months of age. At 6 months, it started to decrease but persisted in 90% of the infants up to 12 months. The diving reflex is highly prevalent in the first year of life and can be easily elicited by applying a flow of air over the infant's face, particularly during crying.

Three-year-old child with meroacrania - neurological signs

Neurological findings in a three-year-old child with meroacrania provide new insights into how the nervous system develops and functions in the absence of superior levels of control from the time of origin. The girl is the first child of a non-consanguineous white Brazilian couple, born at term, weighing 2650 g and measuring 44 cm in length. Upon examination at 43 months, she had quadriplegia, global hypotonia with occasional body hypertonia in a decorticate posture, hyperreflexia, ankle clonus, and extensor plantar response. This case allowed us to verify that, in the absence of upper structures and subcortical nuclei, there are clear signs that suggest corticospinal primacy in motor functions without a substitute pathway. Sound orientation responses suggest the independence of the vestibular-acoustic-ocular system, and manifestations of responsiveness to the environment raise questions about consciousness.

Neural mechanism and clinical significance of the plantar grasp reflex in infants

The plantar grasp reflex can be elicited in all normal infants from 25 weeks of postconceptional age until the end of 6 months of corrected age according to the expected birth date. This reflex in human infants can be regarded as a rudiment of responses that were once essential for ape infants in arboreal life. The spinal center for this reflex is probably located at the L(5)-S(2) levels, which, however, are controlled by higher brain structures. Nonprimary motor areas may exert regulatory control of the spinal reflex mechanism through interneurons. In infants, this reflex can be elicited as the result of insufficient control of the spinal mechanism by the immature brain. In adults, lesions in nonprimary motor areas may cause a release of inhibitory control by spinal interneurons, leading to a reappearance of the reflex. The plantar grasp reflex in infants is of high clinical significance. A negative or diminished reflex during early infancy is often a sensitive indicator of spasticity. Infants with athetoid type cerebral palsy exhibit an extremely strong retention of the reflex, and infants with mental retardation also exhibit a tendency toward prolonged retention of the reflex.

Sensorimotor Therapy: Using Stereotypic Movements and Vestibular Stimulation to Increase Sensorimotor Proficiency of Children with Attentional and Motor Difficulties

The current naturalistic study examined whether sensorimotor therapy utilizing the training program, Retraining for Balance, might be an appropriate technique for sensorimotor proficiency. The 232 children (181 boys, 51 girls), whose mean age was 9.3 yr. ( SD = 2.7), presented attentional and motor difficulties (according to the School Health Care) as indicated by their parents before starting therapy. The children were divided into three groups, i.e., a younger group (7 yr. old or younger, n = 65), a middle group (8 to 10 yr. old, n = 91), and an older group (11 yr. old or older, n = 76). The program has seven parts, including fetal and neonatal movements, vestibular and auditory perceptual stimulation, and gross motor movements, among others. The treatment period was close to 3 yr. on the average. Analyses in a repeated-measures design indicated significant improvement of sensorimotor skills among the three age groups, but the older children performed better than the others on several tests. There were only a few sex differences. Retraining for Balance may be a functional technique for training children and youth with sensorimotor difficulties and might constitute a complement to regular treatment of Developmental Coordination Disorder, Learning Disability, and ADHD, but controlled studies are necessary before more decisive conclusions can be drawn.

Extrauterine neuromaturation of low risk preterm infants

The objective of the study was to follow neuromaturation in preterm infants. From serial exams in 90 low risk very low birthweight infants, each infant's Maturity Scores (the sum of tone, reflex, and response items) were plotted against postmenstrual age (PMA) when examined. Each infant's estimated line of best fit provides two descriptors of that infant's neuromaturation: slope (Individual Maturity Slope) and y-value (Predicted Maturity Score at 32-wk PMA). We found that Maturity Scores increased with PMA; 96% had correlation coefficients >0.8. Mean Actual and Predicted Maturity Scores at 32-wk PMA were 60 and 58, respectively, in 65 infants. When stratified by gestational age, Mean Actual Maturity Score at 30-wk PMA were 50 whether infants were 1 or several weeks old when examined. Therefore, low risk preterm infants demonstrated individual variability in rate of neuromaturation. Tone, reflexes, and responses nonetheless emerged in a predictable pattern, whether neuromaturation was intrauterine or extrauterine. This unique tool that measures preterm neuromaturation requires expertise but no technology. It has an exciting potential for providing insight into how emerging central nervous system function and structure influence each other, as well as how the central nervous system recovers from injury.

[Primitive reflex in premature healthy newborns during the first year]

A non-controlled, prognostic cohort study was performed with the aim of establishing markers of neurological development and defining a clinical and epidemiological profile of preterm newborns at 3, 6, 9, and 12 months of gestation-corrected age in terms of primitive reflexes evolution.

RESULTS

At 3 months old of corrected age, all primitive reflexes were present. At 6 months old, all children showed plantar grasp and 2.7% still showed Moro and palmar grasp. Plantar grasp was the unique primitive reflex found at 9 and 12 months of corrected age.

CONCLUSION

It was possible to evaluate the occurence, as well as the disappearing of primitive reflexes in preterm newborns. The results show delay in the disappearing of primitive reflexes even with the use of corrected age.

Assessment of gestational age and neuromaturation

Neuromaturation is the functional development of the central nervous system (CNS). It is by its very nature a dynamic process, a continuous interaction between the genome and first the intrauterine environment, then the extrauterine environment. Understanding neuromaturation and being able to measure it is fundamental to infant neurodevelopmental assessment. Fetal and preterm neuromaturation has become easier to observe with the advent of prenatal ultrasonography and neonatal intensive care units. A number of measures of degree of fetal maturation have been developed and used to estimate gestational age (GA) at birth. The most reliable measures of GA are prenatal measures, especially from the first trimester. Postnatal GA measurements tend to be least accurate at the extremes of gestation, that is, in extremely preterm and post-term infants. Observations of measures of neuromaturation in infants born to mothers with pregnancy complications, including intrauterine growth restriction, multiple gestation, and chronic hypertension, have led to the discovery that stressed pregnancies may accelerate fetal pulmonary and CNS maturation. This acceleration of neuromaturation does not occur before 30 weeks' gestation and has a cost with respect to cognitive limitations manifested in childhood. The ability to measure fetal and preterm neuromaturation provides an assessment of neurodevelopmental progress that can be used to reassure parents or identify at risk infants who would benefit from limited comprehensive follow-up and early intervention services. In addition, measures of neuromaturation have the potential to provide insight into mechanisms of CNS injury and recovery, much-needed early feedback in intervention or treatment trials and a measure of early CNS function for research into the relationships between CNS structure and function.

Babkin reflex and other motor responses to appendicular compression stimulus of the newborn

This cross-sectional study evaluated 106 normal newborns with the aim of determining the prevalence of mouth opening, neck rotation, and limb flexion or extension responses triggered by pressure stimuli applied to the hand, forearm, arm, foot, leg, or thigh. Mouth opening, neck rotation, and lower limb flexion responses were found in the three segments of the lower limb, with mouth opening obtained in 100% of newborns, neck rotation in 88.7%, and flexion of lower limbs in 67.9% with stimuli to the hand. Upper limb extension response was obtained by stimulation of the three segments of the lower limb and was found in 86.7% of the infants with stimuli to the foot. The limb segment more effective in eliciting a response was the hand, followed by the foot, forearm, leg, arm, and thigh. When pressure was applied to the three upper segments, the reflex responses of the head, neck, and limb flexion predominated, whereas when pressure was applied to the three lower segments, extension responses of the upper limbs predominated.

Eshkol-Wachman movement notation in diagnosis: the early detection of Asperger's syndrome

The diagnostic criteria of Asperger's syndrome (AS), considered a part of the autistic spectrum disorder, are still unclear. A critical marker, which distinguishes AS from autism, is the presence of language. The ability of a child with AS to acquire and use language early results in the fact that AS usually is diagnosed much later than autism. Autism is not usually diagnosed until around the age of 3, whereas AS usually is not diagnosed until the child is 6 or 7 years of age. In the present article, using Eshkol-Wachman movement notation, we present evidence that abnormal movement patterns can be detected in AS in infancy. This finding suggests that AS can be diagnosed very early, independent of the presence of language. As shown earlier by us, almost all of the movement disturbances in autism can be interpreted as infantile reflexes "gone astray"; i.e., some reflexes are not inhibited at the appropriate age in development, whereas others fail to appear when they should. This phenomenon appears to apply to AS as well. Based on preliminary results, a simple test using one such reflex is proposed for the early detection of a subgroup of children with AS or autism.

Parachute and lateral propping reactions in preterm children

A non-controlled, prognostic cohort study was performed with the aim of establishing markers of neurological development and defining a clinical and epidemiological profile of preterm newborns at 3, 6, 9, and 12 months of gestation-corrected age in terms of parachute and lateral propping reactions. Newborns with gestational age of up to 36 weeks and 6 days, weighing 2,000 g or less at birth, were included in the study At 6 months of age, parachute and lateral propping reactions were present in 8.1% of the patients. At 9 months, the parachute reaction was present in 87.5%, and the lateral propping reaction was present in 90% of the children. It was possible to assess parachute and lateral propping reactions in preterm children in the first year of life. Alterations in trunk-limb coordination may be evidenced in the 1st year of life through postural reactions, which are maintained as prematurity markers until school age.

Clinical significance of plantar grasp response in infants

The present study was undertaken to delineate the clinical significance of the plantar grasp response in infants. All 834 normal control infants had a positive response within the first 6 months of age, and most of them had a marked response at 1-4 months of age. The authors attempted to evaluate the neurologic outcomes of infants who had negative or diminished responses in these respective periods. Ninety-three infants examined from 1982 to 1992 fulfilled these criteria, and their prognoses were reviewed. The outcomes consisted of cerebral palsy in 75 (69 spastic, four athetoid with spasticity, one athetoid, and one ataxic); mental retardation in seven; borderline intelligence in two; motor delay in one; and eight were considered normal. These outcomes indicate that the negative or diminished response of this primitive reflex during early infancy is highly suggestive of neurologic abnormalities, especially for spasticity. Infants with such findings should be carefully observed for possible development of neurologic abnormalities.

Using postural reactions as a screening test to identify high-risk infants for cerebral palsy: a prospective study

To clarify the predictive value of the seven more commonly used postural reactions (PR) in the 1st year of life regarding the diagnosis of cerebral palsy (CP), we prospectively examined 204 high-risk infants of whom 58 developed CP, 22 had developmental retardation (DR) and 124 were normal at follow-up at 3 years of age. Abnormalities of five or more PR from the 1st month of life were correlated with spastic CP, while five or six abnormal PR were also correlated with athetoid CP. Three or less abnormal PR correlated with a normal outcome. All seven PR tested were significantly abnormal in children with spastic CP from the 1st month compared to normal children. Athetoid children demonstrated abnormalities of the Peiper-Isbert (P-I) reaction and Vojta reaction from the 1st month and of the vertical, horizontal and Collis vertical suspension from the 3rd month. Children with DR had significantly abnormal Collis horizontal and Collis vertical suspension, Vojta reaction and traction response from the 1st month and Peiper-Isbert reaction from the 3rd month. Ataxic children demonstrated significantly abnormal traction response from the 1st month, Collis horizontal reaction from the 7th month and Peiper-Isbert reaction from the 11th month. We conclude that the examination of PR is a useful quantitative and qualitative diagnostic screening tool for high-risk infants from the 1st month of life.

From the foot-mouth reflex to the hand-mouth reflex. A continuum of responses to appendicular compression

We studied the mouth opening response to appendicular compression in two groups of children. This study was performed with the intention of testing the semiologic role of the act of mouth opening following stimulation of various regions, based on the hand mouth reflex of Babkin. Group I was formed by 33 normal children who underwent monthly follow up assessments since birth; and group II consisted of 50 children older than 6 months of age, known to have a neurologic deficit and a neuro-psychomotor development equivalent to that of a child in the first trimester of life. We observed that the normal mouth opening response in group I was more pronounced following compression of the hand and forearm when compared to compression of the arm (p < 0.001). This response could persist for as long as the first 6 months of life. We were not able to elicit a mouth opening response following compression of the lower limb in this group. Among children from group II, we observed mouth opening responses to stimulation of all limb segments. Within the upper limb, the response was more pronounced following compression of the hand in comparison to the forearm (p < 0.01), and forearm in comparison to the proximal arm (p < 0.01). Stimulation of the foot was more effective in eliciting a mouth opening response when compared to equivalent stimulation of the lower leg (p < 0.05). However, there was no statistical difference when responses to stimulation of the lower leg and thigh were compared. The presence of the previously unreported foot-mouth response may serve as an indicator of central nervous system compromise and could be associated with a poorer prognosis. We believe that our observations of the specific foot-mouth response patterns may serve as a marker of early neuro-psychomotor development dysfunction during childhood.

The influence of head position and head position change on spontaneous body posture and motility in full-term AGA and SGA newborn infants

No consensus exists concerning the influence of head position and head position change on body posture and motility. Especially the existence of an asymmetric tonic neck reflex (ATNR) in full-term newborns is an issue of discussion. Three-hour video recordings were made of 15 full-term appropriate for gestational age (AGA) and 15 full-term small for gestational age (SGA) infants between the third and eight postnatal day. During a playback of the video recording head position, head position change and several movement patterns of the four limbs were fed into a computer using an event-detecting program. Furthermore, spontaneous head turnings were selected and body posture just before, immediately at and 1 min after the head turning were sketched. The data were analyzed concerning: (1) influence of head position on symmetry of movement of the four limbs; (2) the existence of an ATNR and ATNR-related patterns. In both AGA and SGA infants all movement patterns except hand-face and hand-mouth contact showed a symmetrical distribution, independent of head position. Furthermore, the occurrence of an ATNR following a spontaneous head turning in both AGA and SGA infants was rare. From our results it may be concluded that the ATNR is rare in full-term AGA and SGA newborns. Furthermore, this study demonstrates that head position is not a major factor influencing quantitative aspects of spontaneous motor behaviour. The results are of clinical importance as they imply that in the examination of the neurological condition of the full-term newborn infant by means of observation of spontaneous posture and motility, head position is not of major importance.

Prognosis of infants with ankle clonus within the first year of life

The present study was undertaken to clarify how we should assess the necessity of close follow-up in each case, when we first examine an infant with ankle clonus within the first year of life. The neurologic prognoses of 169 infants who had exhibited ankle clonus at least once during the first year of life were reviewed in relation to the age at examination for positive response, degree of response, and coexisting neurologic signs other than ankle clonus. Ninety-seven of them (57.4%) were normal, while the rest had diverse pathologic outcomes: cerebral palsy in 49, mental retardation in 12, borderline intelligence in 9, and motor delay in 2. The neurologic prognoses in infants whose ankle clonus was more than ten beats at any age within the first year of life, and ten or less beats over 8 months of age were always abnormal. In the subjects whose neurologic signs other than ankle clonus appeared within 4 months of age and persisted after 5 months of age, prognoses were generally poor. In infants with such findings, their clinical courses should be closely observed for the possible development of neurologic abnormalities.

Prospective follow-up of primitive reflex profiles in high-risk infants: clues to an early diagnosis of cerebral palsy

To clarify reflex profiles in the first year of life in connection with categories of neurologic abnormality, eight primitive reflexes (i.e., the palmar grasp reflex, the plantar grasp reflex, the Galant response, the asymmetric tonic neck reflex, the suprapubic extensor reflex, the crossed extensor reflex, the Rossolimo reflex, and the heel reflex) were prospectively examined in 204 high-risk infants, of whom 58 developed cerebral palsy, 22 had developmental retardation, and 124 were normal at follow-up examination at 2 years of age. The change in the retention time of reflex activity for each of these reflexes was characteristic for each category or type of neurologic abnormality: retention of palmar grasp reflex, suprapubic extensor reflex, crossed extensor reflex, Rossolimo reflex, and heel reflex in spastic cerebral palsy, as well as retention of plantar grasp reflex, Galant reflex, and asymmetric tonic neck reflex in athetoid cerebral palsy and somewhat weaker retention of these reflexes in developmental retardation (statistical significance P < .001 compared with normally developed patients). These characteristic changes imply that a presumptive diagnosis can be made in neurologically high-risk infants by examination of the primitive reflexes, which are of specific significance among the other neurologic criteria within the first year of life.

The neurological development of prehension: a developmental neurologist's view

From the developmental neurological point of view prehension is an important function as it involves the total sensorimotor nervous system. In order to make efficient performance possible both postural activity and motility of arms and hands must be coordinated, implying an intricate interplay between tonic and phasic activities. The analysis of the development of the different contributors suggests that they are based on independently developing brain mechanisms. This independency guarantees the variability which is required for adequately adaptive and purposeful functioning. A lack of this ability to vary, i.e. monotonous and stereotyped function resulting from deficient or deficiently coupled brain mechanisms leads to maladaptive and impaired motor function. Identification of the dysfunctioning brain mechanisms may inform treatment strategies.

Primitive reflex profiles in infants: differences based on categories of neurological abnormality

In order to clarify reflex profiles in the first year of life in connection with categories of neurological abnormality, six primitive reflexes, i.e., the crossed extensor reflex, suprapubic extensor reflex, heel reflex, Galant response, asymmetric tonic neck reflex and plantar grasp response, were examined in 458 normal infants, 78 infants with cerebral palsy (CP) and 81 infants with mental retardation (MR), whose diagnoses were confirmed at a later follow-up examination. The change in the mean score for each of these reflexes with age was characteristic for each category or type of neurological abnormality. This implies that a presumptive diagnosis can be made in neurologically high-risk infants by examination of the primitive reflexes. Such reflexes are therefore of specific significance, among other neurological criteria, in infants within the first year of life.

Early prognosis for ambulation of neonatal intensive care survivors with cerebral palsy

The ambulatory status of 74 neonatal intensive care unit survivors with cerebral palsy, excluding those with central nervous system malformations and syndromes, was assessed at eight years of age. Detailed examinations were completed at two and eight years of age; of the 47 who were sitting by two years, 46 became ambulatory, and a total of 47 of the 74 children became ambulatory. The clinical type of cerebral palsy at two years of age related significantly to eight-year ambulation. However, between two and eight years the diagnosis was changed for 18 children. At two years of age the tonic labyrinthine, asymmetrical and symmetrical tonic neck and Moro reflexes related significantly to ambulation; in five of 27 children not walking, these reflexes were absent by two years of age. Foot placement and/or parachute reactions at two years were found in more than one-third of children not walking. Multivariate analysis determined that age at sitting explained 91 per cent of the variance in ambulation. No other variables, combined with sitting, increased this prediction.

Early identification of cerebral palsy in high risk infants

This study of high risk infants aimed to identify which signs at the corrected ages of 1, 4 and 8 months were important for distinguishing those infants who later developed hypertonic cerebral palsy (CP). From a total cohort of 450 infants (350 of birthweight less than 1500 g and 100 of birthweight greater than 1500 g), 26 infants were later diagnosed as having CP and formed the study group. A control group of 26 infants from the same initial cohort who did not develop CP was matched to the study group. Both groups were followed for a minimum of 2 years. At each assessment (1, 4, 8, 24 months corrected age), all children were assessed using a standard medical examination and a detailed neurosensorimotor developmental scale that evaluated neurological signs, motor attainments, primitive reflexes and postural reactions. Each test response was graded as normal, suspect or abnormal and the results for the two groups were compared. Assessment at 1 month failed to identify a number of the CP infants whereas at 4 months there was some overidentification. At 8 months, assessment was highly predictive of cerebral palsy. Individual signs of abnormality were found to be of limited value but the presence of three or more abnormal signs at 8 months was highly predictive of CP.

Residual developmental disabilities in children with transient hypertonicity in infancy

Developmental disabilities occurred in children who manifested transient neurologic abnormalities in early infancy. In an attempt to identify associated problems at an earlier age, the neuromotor and developmental progress of 33 children who had transient hypertonicity during early infancy was analyzed. At 2-3 years of age, various developmental abnormalities were identified in more than two-thirds of these children. Delays in speech and language development and also in fine motor/adaptive and behavioral difficulties were most frequently present. Over time, these problems persisted and other disorders also became apparent. At 5 years of age or older, learning disabilities were frequent and associated with language and perceptual problems. None of the patients had epilepsy; mental retardation was present in only 2 children. Our study demonstrates that children with transient hypertonicity in early infancy are at risk for various developmental problems which can be identified as early as 2 years of age. It also indicates that although their severity lessens over time, these developmental abnormalities tend to persist.

A case for long-term treatment with anticonvulsants

Seizures occurring in the neonatal period are one of the most significant discriminating factors in predicting childhood neurologic mortality and morbidity (epilepsy, cerebral palsy and mental retardation). Data derived from retrospective and prospective studies indicate that different variables, such as cause and severity of seizure activity, birth weight, neurologic examination and electroencephalogram, help predict which of these children will be severely affected. Most physicians treat such children with an anticonvulsant (phenobarbital) for the first year of life on the supposition that this therapy will minimize mortality and long-term morbidity. There are no controlled studies to indicate whether anticonvulsant therapy affects the outcome in children with neonatal seizures. It may now be possible to select those who are at significantly higher risk for neurologic morbidity, and these infants may benefit from anticonvulsant prophylaxis with phenobarbital.

The Landau reaction in fullterm and preterm infants at four months of age

Twelve normal fullterm infants and 11 low-risk preterm infants were assessed at four months of age. Assessments included a Three-Component-Scale for the Landau reaction, the Touwen Scale for the Landau reaction, the Bayley Scales of Infant Development Motor Scale, and the Movement Assessment of Infants Muscle Tone Scale. A statistically significant relationship was found between gestational age (preterm vs. fullterm birth) and scores on the hip and kicking subcomponents on the Three-Component-Scale for the Landau reaction, and also between gestational age at birth and scores on the summary of tone-extremities and total risk score items on the Movement Assessment of Infants. Although preterm and fullterm infants may not show differences in scores on motor developmental level assessments, variations in postural reactions and muscle tone may be present at four months of age.

Primitive reflex profile: a quantitation of primitive reflexes in infancy

This report describes quantitative standardization data on nine primitive reflexes for a cohort of 381 normal infants evaluated longitudinally at each visit between birth and two years of age. Normality was confirmed by the use of the Bayley Scales of Infant Development at one year of age. The standardization of this new examination technique complements the traditional infant neurological examination and may allow primitive reflexes to become a useful adjunct to the prediction of motor disability in early infancy.

Neuromotor Synergies as a Basis for Coordinated Intentional Action

Although neurally based units of action (neuromotor synergies) have often been proposed as a possible basis for coordinated intentional as well as automatic actions, the idea has rarely been translated into sets of testable hypotheses. This essay examines four issues which should facilitate the development of such hypotheses: (a) definitions of neuromotor synergies, (b) criteria for recognizing and comparing synergies in automatic and intentional actions, (c) problems in representing systems of synergies, and (d) models for generating intentional actions from sets of neuromotor synergies. Limitations of, and support for the neuromotor synergy hypothesis are discussed, both in general and for the specific cases of postural synergies and cervico-spinal reflexes. Although current data do not provide conclusive support for or against the neuromotor synergy hypothesis, the problem can be formulated in ways open to experimental investigation.

The asymmetric tonic neck reflex. Its presence and significance in the newborn

Asymmetric tonic neck reflex (ATNR) is an easily elicited reflex in the immediate newborn period and should not be considered pathologic unless it is obligatory. Although bidirectional responses are normally encountered, unidirectional responses are not uncommon. The majority of infants display the complete reflex, however, the lower extremities are the most consistent participants.

Motor functions: associated primitive reflex profiles

The results of reflex/motor activity interactions in 177 normal infants are evaluated. The asymmetrical tonic neck reflex, tonic labyrinthine reflex-supine, and Moro reflexes were assessed for each child at birth and at intervals up to 12 months. Ages of rolling prone to supine, rolling supine to prone, and sitting alone were elicited from parents. The effects of the primitive reflexes on early motor activity were assessed, and statistically significant correlations were demonstrated between decreased reflex activity and the emergence of motor milestones. The distinctive association of reflex activity with motor function suggests the interaction of several reflexes (a primitive reflex profile) rather than the influence of isolated reflex activity. Such patterns support the hypothesis that decreasing primitive reflex activity is associated with the onset of volitional motor activity in normal infants.

A prospective study of three postural reactions

In order to assess the evolution of postural reactions in the prone position, a group of 149 normal infants were followed from birth to two years of age. The Landau reflex was present in 44 per cent of two-month-old infants, and in 95 per cent at four months. The tonic labyrinthine response (grades 2 to 4) was seen in 80 per cent of infants at two weeks, with a marked diminution by the age of 24 months. In contrast, the symmetrical tonic neck reflex was detected in fewer than 30 per cent of the infants: the maximum prevalence was at four to six months of age. These findings are consistent with the hypothesis that the Landau is an early righting reflex which emerges after, and is independent of, the tonic labyrinthine response in prone and the symmetrical tonic neck reflex.

Right-hand preference facilitated by rightward turning biases during infancy

A rightward turning bias is the earliest human asymmetry and may be a precursor of handedness. Head-turning affects arm position as part of the Asymmetric Tonic Neck Reflex (ATNR). The hypothesis was tested that turning biases operate in coordination with the ATNR to promote handedness by measuring reflex behavior during turns in the preferred vs nonpreferred direction. Twenty infants were filmed during spontaneous movement and during the following factorial design: head turned left vs right; voluntarily vs passively; 30 degrees vs 70 degrees. The incidence, strength, and duration of the ATNR were least when the child turned toward his/her preferred side. When right-preference children turned rightward, the occurrence of the ATNR was no better than chance. Thus, a child can orient toward the right hand with minimal intrusion of the ATNR upon limb position, perhaps promoting right-handedness.

Cognitive assessment of the handicapped infant: the need for an alternative approach

Traditional developmental protocols based on neurological or sensorimotor models frequently underestimate the cognitive status of physically handicapped infants. A critical review of current clinical practices in the area of infant assessment is followed by a discussion of an alternative approach and the presentation of an illustrative case.

The Landau reaction: a clinical and electromyographic analysis

Thirty normal infants aged two months (N=10), five months (N=11) and eight months (N=9) participated in a three-month longitudinal study of the Landau reaction. Each infant's response to horizontal suspension was filmed and electromyographically recorded. Thoraco-lumbar extension and head elevation 90 degrees above the horizontal (face vertical to the horizontal) were present in 45 per cent of infants at four months and in 90 per cent of infants between five and 10 months. The postural response changed little between five and ten months of age. Less than 10 per cent of the infants regressed in postural response between monthly examinations. No infant hung limply over the examiner's hand, and electromyographic activity of the neck extensors never decreased to zero. All infants were able to reassume neck and spinal extension following active and passive flexion of the neck. Kicking activity was observed in 80 per cent of infants over four months of age. A pattern of motor responses for the normal infant was noted and variations from this pattern which have been observed in infants with motor dysfunction are discussed. The EMG recordings correlated well with the visual observations and provided an accurate written record of the responses. They proved to be a reliable research tool in the study of infants' gross motor responses.

Methods of assessing and recording motor skills and movement patterns

The literature in different fields of assessment and recording motor skills and movement patterns in children is reviewed and various methods of movement analysis are discussed from a clinical and instrumental point of view. Their advantages and disadvantages in the study of motor development and in neuropaediatric diagnosis and research are considered. The methods chosen for a special purpose, whether a motoscopic, motometric or motographic technique, depend on what the investigator wants to study and on the available facilities, and is also influenced by the degree of co-operation of the patient. Whatever technique is used, the results obtained must enable comparisons to be made with later assessments as that valid statements about the child's progress become possible.

Locomotor prognosis in cerebral palsy

A study of the prognosis for walking of 73 pre-school children who had cerebral palsy or delayed motor development is reported. The importance of prognostic signs, based upon the presence or absence of postural reflex activity, was confirmed. The prognosis was accurate in 94-5 per cent of the 73 children studied. The method of scoring a child's reflex responses and relating this to the prognosis seems to be a simple procedure, easy to understand and to apply. It is suggested that the assessment of treatment methods should include an analysis of the child's walking potential, based upon the methods delineated in this study, before treatment is started.