- Primitive reflexes become integrated

- Come under the control of higher centers

- Are 'inhibited' so that they no longer manifest themselves when the stimulus is presented

- They may once again manifest themselves, presence of primitive reflex after time it should have been integrated indicates injury to CNS

- Remnants of primitive reflexes may manifest when intact CNS is placed under stressful conditions

- Onset:  28 wks GA

- Integration:  3 months

- Position:  Supine with head in midline

- Procedure:  Stroke from corner of mouth laterally

- Response:  Head turning to side stimulated, mouth opens in preparation to suck

- Onset:  28 weeks GA

- Integration:  2-5 months

- Position:  Supine

- Procedure:  Place finger or nipple into infant's mouth

- Response:  Effective rhythmical sucking movements

- Onset:  28 weeks GA

- Integration:  5-6 months

- Position:  Supine, head in midline

- Procedure:  Allow head to drop about 30º

- Response:  Abduction of shoulders with extension of elbows, wrists and fingers; then adduction, elbow flexion and head flexion

- Reaction to startle reflex is identical to Moro though stimulus is loud noise

- Startle reflex easily elicited in childre with CP even when older

- Onset:  28 weeks GA

- Integration:  2-5 months

- Position:  Supine with head in midline

- Procedure:  Grasp child's wrists and pull up as if to pull into sitting, passively stretch shoulder adductors and arm flexors

- Response:  Flexion of UE

- Onset:  28 weeks GA

- Integration:  9 months

- Position:  Supine with head in midline and toes relaxed

- Procedure:  Press thumb or finger against ball of infant's foot directly below toes

- Response:  Plantar flexion of all toes

- Onset:  32 weeks GA

- Integration:  2 months

- Position:  Prone

- Procedure:  Stimulate along paravertebrals about 3 cm from midline from shoulder to buttock, test both sides

- Response:  Brief lateral incurving of the stimulated side (concavity to stimulated side)

- Onset:  35 weeks GA

- Integration:  2 months

- Position:  Hold child vertical with hands around chest

- Procedure:  Life child so dorsum of one foot presses lightly against a surface

- Response:  Flexion of knee and hip to place foot above table, leg then extends and foot is placed on surface

- Onset:  35 weeks GA

- Integration:  2 months

- Position:  Hold child vertical

- Procedure:  Lift child so dorsum of one hand is brought up against a protruding edge

- Response:  Arm flexes to bring hands up, then elbow and wrist extend to place hand on surface

- Onset:  35 weeks GA

- Integration:  1-2 months

- Position:  Support infant in vertical position

- Procedure:  Allow feet to make firm contact wiht firm, flat surface

- Response:  Coactivation of flexors and extensors of LE, child bears portion of weight, hips and knees may be slightly flexed

- Onset:  37 weeks GA

- Integration:  2 months

- Position:  Hold child upright

- Procedure:  With trunk supported and feet touching table, incline child forward slightly

- Response:  Child begins to take reciprocal steps, but does not help support his body weight

- Onset:  Birth

- Integration:  6 months

- Procedure:  Position in prone

- Response:  Flexor tone is increased

- Significance:  Strong reflex will prevent a child from lifting head while prone

- Procedure:  Position in supine

- Response:  Extensor tone is increased

- Significance:  Strong reflex will prevent a child from reaching up, bringing hands to midline or lifting legs in supine

- Onset:  0-2 months

- Integration:  4-6 months

- Position:  Supine with head in midline

- Procedure:  Display object to encourage child to turn head to side or turn head with hands

- Response:  Chin side arm and leg extend, skull side arm and leg flex

- Significance:  Must be integrated before child can roll over

- Onset:  4-6 months

- Integration:  8-12 months

- Position:  Child prone supported by trunk

- Procedure:  Flex head, extend head

- Response:  After flexion-UE flex, LE extend; after extension-UE extend, LE flex

- Onset:  Birth

- Integration:  3-5 months

- Position:  Supine with head in midline

- Procedure:  Place finger in palm of hand from ulnar side

- Response:  Flexion fo all fingers and grsp of stimulating object