Pathological reflexes. Protective reflex of the newborn Name of the reflex, age of manifestation

And the baby is divided into two groups: segmental motor automatisms provided by segments of the brain stem (oral automatisms) and spinal cord (spinal automatisms), and suprasegmental postural tonic automatisms(centers of the medulla oblongata and midbrain).

Spinal motor automatisms[ | ]

Protective reflex of the newborn[ | ]

If the newborn is placed on the stomach, then a reflex turn of the head to the side occurs. This reflex is expressed from the first hours of life. In children with central nervous system involvement, the protective reflex may be absent, and if the child's head is not passively turned to the side, he may suffocate. In children with cerebral palsy, with an increase in extensor tone, a prolonged rise of the head and even tipping it back is observed.

Support reflex and automatic gait in newborns[ | ]

The newborn does not have the readiness to stand, but he is capable of a support reaction. If you hold the child vertically in weight, then he bends his legs in all joints. The child placed on a support straightens the body and stands on half-bent legs on a full foot. The positive support reaction of the lower extremities is a preparation for stepping movements. If the newborn is slightly tilted forward, then he makes stepping movements (automatic gait of newborns). Sometimes, when walking, newborns cross their legs at the level of the lower third of the legs and feet. This is caused by a stronger contraction of the adductors, which is physiological for this age and outwardly resembles the gait in cerebral palsy.

The support reaction and automatic gait are physiological up to 1-1.5 months, then they are inhibited and physiological astasia-abasia develops. Only by the end of 1 year of life does the ability to stand and walk independently appear, which is considered as a conditioned reflex and requires the normal function of the cerebral cortex for its implementation. In newborns with intracranial injury, born in asphyxia, in the first weeks of life, the support reaction and automatic gait are often depressed or absent. In hereditary neuromuscular disorders, ground response and automatic gait are absent due to severe muscular hypotension. In children with lesions of the central nervous system, automatic gait is delayed for a long time.

Crawling reflex (Bauer) and spontaneous crawling[ | ]

The newborn is placed on the stomach (head in the midline). In this position, he makes crawling movements - spontaneous crawling. If you put your palm on the soles, then the child reflexively pushes away from it with his feet and crawling intensifies. In the position on the side and on the back, these movements do not occur. Coordination of movements of arms and legs is not observed. Crawling movements in newborns become pronounced on the 3-4th day of life. The reflex is physiological up to 4 months of life, then it fades away. Independent crawling is a precursor to future locomotor acts. The reflex is depressed or absent in children born in asphyxia, as well as in intracranial hemorrhages, spinal cord injuries. Pay attention to the asymmetry of the reflex. In diseases of the central nervous system, crawling movements persist for up to 6-12 months, like other unconditioned reflexes.

grasp reflex[ | ]

Appears in a newborn with pressure on his palms. Sometimes a newborn wraps his fingers so tightly that he can be lifted up ( Robinson reflex). This reflex is phylogenetically ancient. Newborn monkeys are held on the mother's hairline by gripping the brushes. With paresis of the hands, the reflex is weakened or absent, in inhibited children the reaction is weakened, in excitable children it is strengthened. The reflex is physiological up to 3-4 months, later, on the basis of the grasping reflex, an arbitrary grasp of the object is gradually formed. The presence of a reflex after 4-5 months indicates damage to the nervous system.

The same grasping reflex can also be evoked from the lower extremities. Pressing the ball of the foot with the thumb causes plantar flexion of the toes. If you apply a dashed irritation to the sole of the foot with your finger, then there is a dorsiflexion of the foot and a fan-shaped divergence of the fingers (physiological Babinski reflex).

Reflex Galant [ | ]

When the skin of the back is irritated paravertebral along the spine, the newborn bends the back, an arc is formed that is open towards the stimulus. The leg on the respective side often extends at the hip and knee joints. This reflex is well evoked from the 5-6th day of life. In children with damage to the nervous system, it may be weakened or completely absent during the 1st month of life. When the spinal cord is damaged, the reflex is absent for a long time. The reflex is physiological until the 3-4th month of life. With damage to the nervous system, this reaction can be observed in the second half of the year and later.

Perez reflex [ | ]

If you run your fingers, slightly pressing, along the spinous processes of the spine from the coccyx to the neck, the child screams, raises his head, unbends the torso, bends the upper and lower limbs. This reflex causes a negative emotional reaction in the newborn. The reflex is physiological until the 3-4th month of life. Inhibition of the reflex during the neonatal period and a delay in its reverse development is observed in children with damage to the central nervous system.

Moro reflex [ | ]

It is caused by various methods: by hitting the surface on which the child lies, at a distance of 15 cm from his head, by raising the extended legs and pelvis above the bed, by sudden passive extension of the lower extremities. The newborn moves his arms to the sides and opens his fists - the 1st phase of the Moro reflex. After a few seconds, the hands return to their original position - phase II of the Moro reflex. The reflex is expressed immediately after birth, it can be observed during the manipulations of the obstetrician. In children with intracranial trauma, the reflex may be absent in the first days of life. With hemiparesis, as well as with obstetric paresis of the hand, an asymmetry of the Moro reflex is observed.

With pronounced hypertension, there is an incomplete Moro reflex: the newborn only slightly abducts his hands. In each case, the threshold of the Moro reflex should be determined - low or high. In infants with lesions of the central nervous system, the Moro reflex is delayed for a long time, has a low threshold, often occurs spontaneously with anxiety, various manipulations. In healthy children, the reflex is well expressed until the 4-5th month, then it begins to fade; after the 5th month, only some of its components can be observed.

Oral segmental automatisms[ | ]

Sucking reflex[ | ]

With the introduction of the index finger into the mouth by 3-4 cm, the child makes rhythmic sucking movements. The reflex is unconditional and absent in paresis of the facial nerves, severe mental retardation, in severe somatic conditions. The sucking reflex in human children usually fades between three and four years of age, which explains why in many cultures breastfeeding lasts until the age of three or four years, i.e. up to the age at which the child suckles on his own breast. Anthropologist from the USA Professor Katherine A. Dettweiler came to the conclusion that the need for sucking, i.e. the natural duration of suckling at the breast (expected by our children) can last from 2.5 to 7.0 years.

The symptoms of defeat of the pyramidal system include protective reflexes, manifested in central paralysis, protective reflexes are involuntary movements, expressed in flexion or extension of the paralyzed limb when it is irritated.

10. Pathological reflexes (flexion and extension).
Pathological reflexes are called, which are not caused in an adult healthy person, but appear only with lesions of the nervous system associated with a decrease in the inhibitory effect of the brain (pathological reflexes appear when the pyramidal system is damaged).

Pathological reflexes are divided into flexion and extensor (for limbs). These pathological reflexes constitute the syndrome of central (spastic) paralysis that develops when the pyramidal system is damaged. In children under 1 year of age, these reflexes are not signs of pathology.

11. Postural reflexes.

Pozotonic reflexes are congenital unconditionally reflex motor automatisms. With normal development by 3 months. In life, these reflexes are already fading away and do not appear, which will create optimal conditions for the development of voluntary movements. Preservation of postural reflexes is a symptom of CNS damage, a symptom of cerebral palsy. These reflexes can be classified as pathological, since they are not evoked in healthy adults. In children with cerebral palsy, these reflexes persist throughout preschool age, and their influence remains persistent in subsequent years. Higher integrative motor centers do not have an inhibitory effect on the underlying parts of the brain, which carry out primitive motor reflex reactions, which include postural reflexes. On the other hand, the active functioning of the underlying brain structures delays the maturation of the higher integrative centers of the cortex, which regulate voluntary motor skills, speech, and higher cortical functions.

Postural reflexes include:

ü labyrinth tonic reflex;

ü asymmetric tonic neck reflex;

ü symmetrical tonic neck reflex.

labyrinth tonic reflex appears when the position of the head changes.

In the supine position, the tone of the extensor muscles increases. The head is thrown back, legs and arms are tense and unbent. The hands are clenched into fists. The tone in the supine position can be expressed to varying degrees, up to a sharp extension. Then the posture resembles tetanus, the body is arched and the child touches the support only with the back of the head and heels. He cannot raise his head, stretch his arms forward and take an object, bring his hands to the liu, etc. This posture hinders the development of motor skills, self-care skills, and various activities. This reflex often extends to the muscles of the eyes, which narrows the field of view, negatively affects the development of visual-motor coordination, and makes it difficult to perceive the environment. All this affects the development of visual perception and cognitive activity in general. The labyrinth tonic reflex contributes to an increase in muscle tone in the tongue, which makes chewing, articulation of sounds difficult, contributes to salivation and, as a result, affects the development of speech.

In the position of the child on the stomach, the neck and back are bent - an increase in the tone of the flexor muscles is manifested. The shoulders are extended forward and down, the arms are bent under the body, and the hands are clenched into fists, the hips and shins are adducted and bent, the pelvis is raised (Fig. 2). Such a posture inhibits the development of voluntary movements, since the child cannot raise his head, turn it to the side, straighten his arms, stand up, etc. A constantly bent back contributes to the curvature of the spine.

Thus, the labyrinth tonic reflex has a negative impact on the development of voluntary motor skills, delays the formation of basic motor functions. The pathogenic influence of the reflex on the formation of mental components is also obvious: spatial perception, perceptual, cognitive activity, visual-motor coordination, subject, game, educational, speech activity, etc.

Asymmetric tonic neck reflex manifests itself in a change in the position of the limbs when the head is turned to the side: in the side of the body where the child's face is turned, muscle tone increases in the extensors of the arms and legs, in the opposite side of the body - in the flexors of the arms and legs. Thus, turning the head to the side causes a change in the position of the limbs and the child assumes the “swordsman” position. The reflex has a particularly detrimental effect on visual-motor coordination, visual perception and objective activity. When turning the head to the side of the object, the arm on the side of the turn involuntarily unbends and the child cannot take this object. If, nevertheless, the child bends his arm with effort, then the head automatically turns to the other side and it is no longer possible to examine the object. This reflex negatively affects both the elementary process of creating a holistic image and the mastery of educational and labor skills and abilities.

Symmetrical tonic neck reflex manifests itself in an increase in extensor tone in the arms and flexion in the legs when the head is raised, and when the head is tilted forward, it increases

Twenty-eight days - this is exactly how long the neonatal period lasts, during which the child's body is going through adaptation to completely new conditions for it now extrauterine life, so the reflexes of a newborn child play a major role here.

This is explained by the fact that a recently born baby is still deprived of many useful skills - nature takes care of it.

Basic reflexes

In this period, the baby has developed only unconditioned reflexes - that is, those that are laid down as if by default. Gradually, some of them disappear, giving way to conventional ones.

Conditioned reflexes can also be called the "personal experience" of the child, since they are acquired in the process of further development and maturation of the brain.

What are unconditioned (innate) reflexes for?

There are as many as fifteen clinically significant unconditioned reflexes in a baby - and their “fate” is very different: some are needed only in order to survive the difficult process of birth (therefore, they quickly disappear after birth), others - to give impetus to the development of new ones, and others remain for life.

Pediatric neonatologists divide the congenital reflexes of newborns into several groups:

1. Providing general normal vital activity (respiratory, sucking, swallowing, as well as spinal reflexes)
2. Aimed at protecting the child's body from external influences of bright light, cold, heat and other irritants
3. "Temporary" reflexes - for example, the breath holding reflex necessary to move through the mother's birth canal.

oral reflexes

The ability to suckle a mother's breast or nipple on a bottle of artificial nutrition is called sucking reflex, and the ability to swallow food eaten - swallowable.

Swallowing reflex remains for life.

proboscis reflex - another kind of oral reflexes. If you lightly touch the baby's lips, they bulge funny into a tube - just like an elephant's trunk, because at this moment the circular muscle of the mouth involuntarily contracts. The proboscis reflex disappears by two to three months.

Babkin's reflex (palmar-mouth) - a mixed version of the child's reaction, in which he opens his mouth slightly, if you gently press both thumbs at the same time with your thumbs. It is best expressed in the first two months of life, in the third it begins to fade and then disappears completely.

Kussmaul reflex (search) - an attempt to find food: if you touch the corner of the child's mouth, he turns his head to the irritant. It disappears quite quickly - three to four months after birth. In the future, the search for food occurs visually - the baby sees the breast or bottle.

spinal reflexes. Examining the baby immediately after birth and throughout the entire neonatal period, the pediatrician also pays attention to spinal reflexes - a set of reactions responsible for the state of the muscular apparatus.

Upper defensive reflex. One of the most important unconditioned reflexes that starts already in the first hours of life is the upper protective reflex. It manifests itself if the newborn baby is placed on the stomach: the head immediately turns to the side, and the baby tries to raise it. This is a protection against possible respiratory failure: the child thus restores air access to the respiratory tract. The reflex disappears a month and a half after birth.

Grasping reflexes

Reflexes Yanishevsky and Robinson in a newborn child, they manifest when he firmly grabs the fingers of his mother (doctor) with both hands and is able to hold them so strongly that he can even be lifted in this way. They are expressed up to three or four months, then weaken. The persistence of these reflexes at a later age is evidence of existing neurological problems.

Babinski's reflex - it is also called the plantar reflex: a slight stroking of the edges of the soles from the outside causes the fingers to open in the form of a fan, while the feet bend from the back. Evaluation criteria are energy and especially the symmetry of movements. One of the longest-lived congenital reflexes - it lasts up to two years.

Other motor reflexes

Moro reflex - a biphasic reaction in which the child responds to a fairly loud knock on the changing table or any other sharp sound.

• The first phase - the baby spreads his arms to the sides and opens his fingers, while straightening his legs.
• The second phase is the return to the previous position. Sometimes a child can even hug himself, as it were - therefore the Moro reflex has another name - the “hug reflex”.

It is pronounced up to the age of five months of the baby.

Kernig's reflex - the reaction of the hip and knee joints to an attempt to unclench them by force after bending. Normally, this cannot be done. Disappears completely after four months.

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Automatic gait reflex , which is a very funny sight, consists in the attempts of the newborn to walk in the most real way, if he is raised and tilted forward a little. The evaluation criterion is the degree of completeness of support when “walking” on the entire foot. Reliance on the fingers and clinging of the feet to each other is a sign of disorders that require the supervision of a pediatric neurologist.

Support reflex - an attempt by the baby to stand on his feet, when, carefully holding him, they put him on a flat surface (on a table, for example). This is a two-phase reflex: first, the baby, having felt the touch of the support, sharply bends his knees, and then he becomes both feet and firmly presses the soles to the table. Well-defined support reflexes and "automatic" gait persist for one and a half months.

Bauer reflex (spontaneous crawling) can be observed by placing the baby on his stomach and placing his palms on his soles: he begins to crawl, while starting from the created support and helping himself with his hands. Appearing on 3-4 days, this reflex disappears after 3-4 months.

Reflex Galant - the reaction of the spine to an external stimulus. If you run your finger along the entire length of the ridge, then the child arches his back, while straightening his leg from the side of the stimulus.

There are also postural reflexes newborns - attempts to redistribute muscle tone when the body posture changes in the absence of the ability to hold the head, sit and walk.

Magnus-Klein reflex - the reaction of the extensor and flexor muscles of the shoulder, forearm and hand, in which the child assumes a "swordsman's pose". This happens when the baby's head is turned to the side. You can observe how the arm and leg are straightened from the side where the child's face is. On the opposite side, they, on the contrary, bend. This reflex lasts up to two months.

Weak reflexes or when to sound the alarm

It happens that some reflexes in a baby turn on late or do not appear very clearly. This may be due to trauma during childbirth, illness, and may also be an individual reaction to certain medications.

Also, weakness of oral and spinal reactions is commonly noted in preterm infants and in those born with mild asphyxia.

Interestingly, the weak reflexes in a newborn child associated with the search for food and its absorption (sucking and swallowing) can be explained simply by the fact that the baby is simply not hungry. Most clearly they appear before feeding.

The most frightening situation is when there are no reflexes at all. The complete absence of reflexes in a newborn child is a reason for immediate resuscitation, which should be carried out only by specialists.

Pathological reflexes arise as a result of damage to the pyramidal tract, which conducts impulses from the cerebral cortex to the spinal cord. passes from the anterior central gyrus of the cerebral cortex through the subcortical regions of the brain, the brain stem and ends in the cells of the anterior horns.

Pathological reflexes are observed not only in cases of damage to the pyramidal tract, but also in the norm in children 1-1.5 years old (see above). There are pathological reflexes: a) carpal; b) foot (flexion and extensor); c) oral automatism.

hand reflexes are characterized by the fact that with various methods of evoking them, a reflex flexion of the fingers of the hand occurs - they “bow”.

Rossolimo's carpal symptom - the examiner applies a short jerky blow to the tips of the II-V fingers of the patient's hand with his fingertips (the hand is in the palm down position). In response, rhythmic flexion of the fingertips occurs.

Zhukovsky's symptom - the researcher strikes with a hammer on the palm at the base of the fingers. In response, rhythmic flexion of the fingertips occurs.

foot reflexes divided into extensor and flexion. The extensor foot reflexes are characterized by the fact that with various methods of evoking them, a reflex extension (extension) of the thumb occurs.

Babinsky's symptom is caused by holding the handle of the neurological hammer, the blunt end of the needle along the outer edge of the sole (Fig. 9). In response, there is an extension of the thumb or a fan-shaped divergence of the toes. In children under 1.5 years of age, Babinski's symptom is physiological and is normally caused.

Oppenheim's symptom is caused by holding the back surface of the middle phalanx of the II and III fingers along the anterior surface of the lower leg of the subject. In response, there is a reflex extension of the big toe (Fig. 10).

Gordon's symptom is caused by compression of the gastrocnemius muscle of the subject's leg (Fig. 11). In response, there is a reflex extension of the big toe.

Schaeffer's symptom is caused by contraction of the Achilles (Fig. 12). In response, there is a reflex extension of the big toe.

Flexion foot reflexes are characterized by the fact that the fingers, with various methods of irritation, “nod”, “bow”.

Symptom of Rossolimo - the examiner with his fingertips delivers a short blow to the tips of the II-V fingers from the plantar side of the foot of the examinee. In response, there is a reflex flexion of the fingers.

Zhukovsky's symptom - caused by a hammer blow in the middle of the sole at the base of the fingers. In response, there is a reflex flexion of the fingers.

Ankylosing spondylitis I - is caused by a blow of the hammer on the back of the foot in the region of the IV-V metatarsal bones. In response, there is a reflex flexion of the fingers.

Symptoms of oral automatism occur with bilateral damage to the cortico-nuclear pathways (paths from the cortex to the nuclei).

The palmo-chin reflex is caused by irritation of the palm. In response, there is a contraction of the muscles of the chin.

The labial proboscis reflex is caused by either a stroke irritation of the lips. In response, there is a protrusion of the lips.

Grasping reflexes occur when the frontal lobe is affected, along with symptoms of oral automatism, mental and speech disorders. There are several grasping reflexes.

The symptom of automated grasping occurs with stroke irritation of the palm. In response, there is a flexion of the fingers of the hand (the patient grabs the object).

A symptom of obsessive grasping - the patient grabs all the surrounding objects.

Along with pathological reflexes in paralyzed or paretic limbs, an increase in tendon and periosteal reflexes, muscle reflexes, and protective reflexes occur.

defensive reflexes- involuntary shortening or lengthening of a paralyzed limb (flexion or extension of it), which occurs in response to pain, temperature, cold irritation. For example, in response to a needle prick, the paretic limb bends into,. With a sharp painful flexion of the toes, flexion of the leg occurs in the hip, knee and joints.

Protective reflexes manifest themselves in different ways. If the paretic limb was bent, then after an injection, a sharp cooling - it unbends, if it is unbent - it bends. Similar phenomena are noted on the hands.

They are an involuntary withdrawal of a paralyzed limb in response to irritation.

protective (shortening) Bekhterev-Marie-Foy reflex caused by repeated stroke irritation, a pinch, a touch of something cold on the skin of the sole, or a sharp plantar flexion of the toes. In response, there is a "triple shortening" - flexion of the paralyzed leg in the hip, knee and ankle joint;

protective shortening (lengthening) reflex of the upper limb- in response to irritation of the upper half of the body, the upper limb is brought to the body and bent at the elbow and wrist joints (shortening reflex) or the upper limb is extended in these joints (extension reflex).

Pathological synkinesis

Synkinesias (friendly movements) are involuntary movements that occur against the background of arbitrary ones. Various physiological synkinesis can be noted in healthy individuals. For example, when walking, there are additional hand movements such as "go-ahead".

Pathological synkinesis- these are involuntary movements in a paralyzed limb that occur when performing voluntary movements in non-paralyzed muscle groups. The formation of pathological synkinesis is based on the tendency to irradiate excitation to a number of neighboring segments of its own and opposite side, which is normally inhibited by the cortex. With the defeat of the pyramidal pathways, this tendency to spread excitation ceases to be inhibited. There are three types of pathological synkinesis: global, imitation, coordinating.

Global synkinesis- involuntary movements of paralyzed limbs that occur with strong muscle tension in healthy limbs. For example, patients are asked to strongly clench a healthy hand into a fist, in response, an involuntary “shortening” movement occurs in a paralyzed limb, which the patient cannot voluntarily perform.

Imitative synkinesis consist in the fact that the paralyzed limb involuntarily "repeats" the movements of the healthy one, although the same movement cannot be voluntarily performed.

Coordinator synkinesis- involuntary contractions of paretic muscles when trying to voluntarily contract other muscles that are functionally related to them. This includes Strümpel's tibial phenomenon the patient in the supine position cannot produce dorsiflexion of the foot on the side of the paresis, but when he flexes the lower limb at the knee joint, especially with resistance, extension in the ankle joint involuntarily occurs at the same time.

Table number 2. Differential diagnosis of central and peripheral paralysis