Primitive reflexes and postural reactions in the neurodevelopmental examination

Abstract 

The primitive reflexes and the postural reactions comprise one of the earliest, simplest, and most frequently used tools among child neurologists to assess the central nervous system integrity of infants and young children. Infants with cerebral palsy have been known to manifest persistence or delay in the disappearance of primitive reflexes and pathologic or absent postural reactions. The clinical significance of asymmetric tonic neck reflex, Moro, palmar grasp, plantar grasp, Galant, Babinski, Rossolimo, crossed extensor, suprapubic extensor, and heel reflex, alone or in combination, as well as their contribution to the early diagnosis and differential diagnosis of cerebral palsy, have been demonstrated in a number of studies. Moreover, infants with 5 or more abnormal postural reactions have developed either cerebral palsy or developmental retardation as reported in a number of studies. Although a comprehensive neurologic examination in the context of a motor assessment instrument is preferable to an informal list of items, the combined examination of primitive reflexes and postural reactions should be considered by the child neurologist, as a simple but predictive screening test for the early identification of infants at risk for cerebral palsy. It is quick and easy to perform, both in nonhospital environments and in underdeveloped countries, where time and specific recourses are limited. The combined examination is also useful in developed countries because many developmental disorders such as cerebral palsy appear in nonrisk groups whereas others are not detected by metabolic screening programs.