A seven-month-old infant is able to initiate rolling from supine to prone when playing on a level floor surface. Which scenario would MOST likely be associated with this developmental milestone?

1. Integration of the tonic labyrinthine reflex
2. Persistence of the asymmetrical tonic neck reflex
3. Integration of the rooting reflex
4. Persistence of the Galant reflex

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A seven-month-old infant is able to initiate rolling from supine to prone when playing on a level floor surface. Which scenario would MOST likely be associated with this developmental milestone?

1. Integration of the tonic labyrinthine reflex
2. Persistence of the asymmetrical tonic neck reflex
3. Integration of the rooting reflex
4. Persistence of the Galant reflex

Pediatric primitive reflexes typically follow a pattern of onset and integration. Infants are able to attain certain developmental milestones in coordination with the integration of specific reflexes. If a reflex persists after the period of integration, there is typically an associated delay with motor skills.

To answer this question, it’s going to be critical to understand the terms persistence and integration and of course to be familiar with each of the four presented primitive reflexes.

Reflex Terminology
Persistence – when presented with the appropriate stimulus, the reflex is present.

Integration – when presented with the appropriate stimulus, the reflex is no longer present.

Armed with this information, let’s take a deeper dive into the specific reflexes.

Option 1 - Integration of the tonic labyrinthine reflex
The tonic labyrinthine reflex is stimulated through the labyrinth in the inner ear. If the infant is in a supine position, the body and extremities are held in extension. If the infant is in a prone position, the body and extremities are held in flexion.

This reflex not only interferes with the ability to roll, but also the ability to prop on elbows, balance in sitting, and attain an upright posture from a supine position. As a result, integration (i.e., the reflex is no longer present) of the tonic labyrinthine reflex is often associated with the ability to roll from supine to prone.

Option 2 - Persistence of the asymmetrical tonic neck reflex
The asymmetrical tonic neck reflex is stimulated through head position, specifically turning to one side. When the infant turns the head to one side, the arm and leg on the face side are extended, while the arm and leg on the scalp side are flexed.

I call this reflex the Saturday Night Fever reflex. Do you feel me? Ok, maybe it’s not exact but I always think of this when I encounter this reflex.

The persistence of this reflex will interfere with rolling as well as visual tracking, midline use of the hands, and feeding.

Option 3 - Integration of the rooting reflex
The rooting reflex is stimulated by a touch of the cheek. When the infant is stimulated, the infant will turn the head toward the side of stimulation. As a result, integration (i.e., the reflex is no longer present) of the rooting reflex would not have an effect on the ability to roll.

Option 4 - Persistence of the Galant reflex
The Galant reflex is stimulated by touching the skin along the spine from the shoulder to the hip. The infant’s response is lateral flexion of the trunk towards the side of the stimulus. Persistence of this reflex interferes with the development of sitting balance, but would not affect the ability to roll.

The correct answer is Option 1

Let’s explore the all student data:

53% of students selected Option 1, Integration of the tonic labyrinthine reflex, the correct response
28% of students selected Option 2, Persistence of the asymmetrical tonic neck reflex
10% of students selected Option 3, Integration of the rooting reflex
9% of students selected Option 4, Persistence of the Galant reflex

System Classification
This question is a Neuromuscular and Nervous Systems question which represents approximately 24% of all exam items.

Content Outline Classification
This question is an Interventions question which represents approximately 29% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Check out pages 315-316 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!

Watch the video version of this Q&A episode on YouTube - https://youtu.be/b1Bm_mFF03U