FIGURE 41.1 Tonic neck reflexes in a patient with a suprasellar cyst. A. Turning of the head to the right produces increased extensor tonus on that side and flexion of the opposite arm. B. Characteristic attitude of patient with legs in full extension and arms in semiflexion (decorticate). C. Turning of the head to the left produces increased extensor tonus on that side and flexion of the right arm. (Modified from Davis LE. Decerebrate rigidity in man. Arch Neurol Psychiatry 1925;13:569–579.)
The Neck Righting Response
This is a variation of the tonic neck reflex. With the infant supine, its head is turned toward one side. A positive response results in rotation of the shoulder, trunk, and pelvis toward that side, occasionally followed by a turn of the entire body. The response should be approximately equal on each side. The reflex appears at about the time the tonic neck reflexes disappear and can be obtained in nearly all infants by the age of10 months; it disappears at about the time the child can arise directly without first turning on its abdomen.
The Parachute Response
The parachute response appears at the age of 8 to 9 months and persists. To elicit it, the infant is held prone in the air and then suddenly thrust headfirst toward the examining table or floor. When the response is present, the arms immediately extend and adduct slightly, and the fingers spread as if to attempt to break the fall. Asymmetry of the response indicates unilateral upper-extremity weakness or spasticity. Absence of the response is seen in severe motor disorders and dementia. The response does not depend upon vision and may be obtained in blindfolded children.
The Hand-Mouth Reflex of Babkin
Pressure on the palm of the hand in premature and newborn infants is followed by opening of the mouth, flexion of the neck, and sometimes closing of the eyes and flexion of the forearm. The response is easier to elicit and more pronounced if the stimulus is bilateral. Except in infants with retarded development, this reflex disappears by the third or fourth month of life.
The Placing Reaction