Course:KIN355/2020 Projects/Palmar Grasp Reflex
Palmar Grasp Reflex
Defining the Concept and Its Importance
The Palmar Grasp Reflex
The palmar grasp reflex can be elicited in normal developing infants as soon as 25 weeks post conception and may be observed during the 16 week gestational period via ultrasound (Futagi et al., 2012). The reflex further develops during the first 3 to 6 months of age and begins to phase out between 6 to 12 months of age (Allen & Capute, Pertrikovsky & Kaplan, Jakobovits, Futagi et al., Zafeririou, Touwen, Vojta, Zafeiriou et al., as cited in Futagi et al., 2012). To elicit the palmar reflex, the infant should be placed in a supine position and should be awake. With light pressure one may place a finger on the ulnar side of the child’s palm. This will produce the palmar reflex in two stages: finger closing and clinging, as the infant will wrap their four fingers around the examiner’s finger (Prechtl, Amiel-Tison et al., Halvorson, Pollack, as cited in Futagi et al., 2012).
The Importance of the Palmar Grasp Reflex
This reflex plays a role in early childhood development with respect to acquisition of early forms of voluntary reaching and grasping. It serves to create basic motor movement patterns for future voluntary movements, and is a routine part of a neurological examination (Anekar, Bordoni, 2020). This reflex is significant in infants due to it’s diagnostic abilities with respect to the development of athetoid type cerebral palsy (CP) as well as determining if there is spasticity in the upper limbs (Futagi et al., 2012). A lack of the reflex entirely, or a weak representation of the reflex, can indicate the prevalence of athetoid type cerebral palsy (CP) (Futagi et al., 2012). The contrast of a hyperactive response can relate to spasticity in the upper limbs (Futagi et al., 2012).
It is important to highlight that if the reflex persists it will delay motor skill acquisition, especially in the development of fine motor skills. The presence of this reflex past six months is a large concern in motor skills development because movements such as crawling and creeping become very difficult to do if the child is always grasping objects that touch their palms. If the reflex persists into the early years it makes it very difficult to do daily tasks as an adult such as writing.
Role in Childhood Development and Contemporary Considerations
Role of Palmar Grasp Reflex in Childhood Development
The prevalence of this reflex contributes to the spinal reflex center, and more specifically to the higher brain mechanism (Futagi et al., 2012). As such, this involuntary response, (the palmar grasp reflex) is seen in neonates and infants due to the lack of control of spinal mechanisms (Futagi et al., 2012). If the reflex does not disappear within the correct time frame, it can lead to many delays in motor milestones. For instance an infant who retains the reflex past six months, will have difficulty releasing objects that touch their palms. This plays a role in everyday movements as the infant learns how to creep and crawl, as they will be more sensitive to toys or objects that touch their palm. The infant may then have trouble creeping or crawling while simultaneously holding a toy, due to not establishing the mechanisms for voluntary release. This leads to future problems with hand coordination in daily tasks. An individual with this problem will be able to easily grasp an object, however releasing the object will be very difficult. With the difficulty of releasing objects, infants movement performances will be greatly impacted. For example, writing becomes a very difficult task because the hand can not let go of the pen once it touches the palm of their hand. This leads to very uncoordinated handwriting, making it hard in the future for any tasks involving writing. Thus, it is very crucial for a child’s motor development to elicit the palmar grasp reflex. However, there is equal importance for the reflex to disappear within the first six months of life otherwise there are delays throughout life in regards to motor development.
Contemporary issues to consider include rate limiters such as poor hand strength, an underdeveloped nervous system function, as well as hand coordination. In some cases, adult patients with lesions in their frontal lobes display this reflex, which suggests that this reflex is inhibited after infantile period and not lost (Futagi, Toribe, Suzuki, 2012). If the reflex correctly disappears, as the brain matures the higher motor centres will control spinal circuits and voluntary hand grip will occur (Anekar, Bordoni, 2020).
The Palmar Grasp Reflex and Neurodevelopmental Disorders
With respect to the development of the palmar grasp reflex, it is important to consider neurodevelopmental disorders such as Autism Spectrum Disorders (ASDs) which impacts the abilities of a child. This disorders is recognized in children three years and older (American Psychiatric Association, as cited in Blankenship & Weston, 2012). Some children may exhibit radical sensory over- or under-activity (Martinez-Pedraza & Carter, as cited in Blankenship & Weston, 2012). Notably Children with ASDs have increased rates of seizure disorders but have no notable discrepancies with IQ, motor deficits and a healthy family history (Blankenship & Weston, 2012). This developmental disorders can contribute to the difficulty with respect to the palmar grasp reflex.
Practical Applications
Ready, Set, Rattle
Purpose: To promote the palmar grasp reflex as a neonate learns how to grasp and appropriately release objects.
Target Age: Neonate to Infant
Apparatus: Rattle
Environment and Space setup: A quiet area in which the child can comfortably play on the floor, as they practice the palmar grasp reflex. Introduce one apparatus at a time following the steps indicated in the instruction section below.
Instructions:
Grasping phase: Show the rattle to the child and wait to see if the child will reach for the rattle. If the child has not yet grasped the rattle, place it beside the palm of their hand. If the child does not reach for the rattle once you have placed it beside their palm, you may gently tap the object on the palm of the hand, which will alert their attention to the rattle. If they are able to reach for and grasp the rattle, turn the child onto their side, or onto their stomach and practice again. For this phase it is important to practice this skill with both the left and right hand, and to ensure there is only one apparatus introduced at a time (i.e if you start to use a rattle, do not immediately switch to a new toy if they are unable to grasp it on the first attempt).
Releasing phase: If your child has difficulty holding the rattle and drops it, pick it up, and try again. On the other hand, if your child does not release the rattle gently shake the forearm or rub the back of the hand. Lastly you may gently bend the wrist slightly forward to encourage the fingers to open.
Modifications:
Modifications for Individual Constraints: If the rattle is too heavy for the child to hold, consider using a lighter toy such as a teething ring, or a cloth toy. If the child is not motivated or emotionally engaged in the activity select a rattle or object that is brightly coloured to provide visual stimulation. In addition toys that provide audio stimulation when it is grasped, such as playing music or beads rattling can help to engage the child when participating in this activity. To ensure the child remains motivated, provide positive reinforcement and remain calm if the child does not immediately gain this skill.
Modifications for Environmental Constraints: If one does not have access to such resources you can engage in this activity by simply placing your finger into the palm of an infant, applying gentle pressure. This will yield the same result as seen in the activity but does not require an apparatus. Ensure that the environment in which you are practicing the skill is not over stimulating and if you are using an apparatus, only present one at a time.
Modifications for Task Constraints: If the child has difficulty in the grasping phase try to place try to encourage reaching and progress to the skill of grasping, placing the object beside the child's palm and even onto the surface of the palm to encourage the grasping reflex. With respect the the releasing phase you may gently shake the forearm, rub the back of the hand, or bend the wrist slightly forward to allow the fingers to open and drop the object. Ensure that the apparatus is appropriate to the infant in size, weight and stimulation, by opting for a lighter toy that is brightly coloured such as a cloth book.
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Hand ball
Purpose: To inhibit primitive reflexes in children with Autism Spectrum Disorder (ASDs)
Target Age: 3-10 years old
Apparatus: foam ball
Environment and Space setup: A quiet area in which the child can comfortably play on the floor, as they practice the palmar grasp reflex. Introduce one apparatus at a time following the steps indicated in the instruction section below.
Instructions:
- Holding the foam ball, have the child tightly squeeze the ball, making a fist with their hand, and slowly opening their fist. Repeat this motion for 30 repetitions.
- Next, ask the child to gently hold the ball in the palm of their hand and then press each digit, into the foam ball. Starting with the thumb the child will press their thumb into the ball, next their index finger, followed by their middle finger, and then the ring finger and lastly the pinky finger. This is demonstrated in detail in the video, “Primitive Reflex Palmar Grasp Reflex Ball for Autism, ADD, ADHD, Dyslexia, OCD Exercise 1 of 8”. Repeat this 30 times.
Modifications:
Modifications for Individual Constraints: To support children with autism it is important to first understand the impact of the autism spectrum disorder (ASDs). Autism will limit a child’s physical development and act as a constraint with respect to primitive reflexes such as the palmar grasp. For this reason, the exercise above is designed to help alleviate such individual constraints as children with ASD will be more receptive to repetitive actions, and exercises that are specifically adapted to benefit their motor development.
Modifications for Environmental Constraints: When introducing a new skill to a child with Autism it is important to remove as much external stimuli as possible, limit verbal cues or speak in a soft voice. In addition it can be helpful to introduce a stimulus to centre them and have them relax before engaging in an activity such as a teething ring. More in depth suggestions are provided in the video by Ryan Judd “Easy-to-Use Calming Strategies for Autism” who provides insight into music therapy to help set the stage for when interacting with children who have autism.
Modifications for Task Constraints: When introducing this activity one can slowly increase the number of repetitions as they see fit for the child, over time progressing to 30 repetitions. In addition, one can focus on one step at a time, first teaching the child the activity outlined in step 1 and progressing onto the more complex and detailed activity in step 2. In addition, the size and resistance of the ball can be modified to be larger or smaller in size and softer or more firm to suit the child.
Summary
The palmar grasp reflex is developmentally key for infants up to 6 months of age. This reflex is an important base for acquiring voluntary motor movements such as reaching and grasping. Examining this reflex in infants can also lead to the diagnosis of movement disorders. Equally important to developing this reflex is having it disappear by 12 months. This allows for the next step in development. If persisting through childhood it will inhibit proper fine and gross motor skills. Mastering this reflex through activities is foundational in infancy and key for individuals with disorders impacting this reflex.
References
Anekar, A. A., Bordoni, B., (2020). Palmar Grasp Reflex. Retreived from: https://www.ncbi.nlm.nih.gov/books/NBK553133/
Blankenship, K. M., & Weston, C. (2012). Syndromes of Intellectual Disability. Psychiatry of Intellectual Disability, 338-365. doi:10.1002/9781119945925.ch16
Falkson, S.R., Bordoni, B., Grasp Reflex. (2020) Retrieved from:https://www.ncbi.nlm.nih.gov/books/NBK553125/
Futagi, Y., Toribe, Y., & Suzuki, Y. (2012). The grasp reflex and moro reflex in infants: hierarchy of primitive reflex responses. International journal of pediatrics, 2012.
Judd, Ryan. [Ryan Judd]. (2015, Feb 8). Easy-to-Use Calming Strategies for Autism. [Video]. https://www.youtube.com/watch?v=13DiS7cPgX0&ab_channel=RyanJudd
S. (n.d.). Grasping: Palmar Grasp. Retrieved from https://www.scopeaust.org.au/wp-content/uploads/2015/10/00570-CIRC-One-Day-At-A-Time-2015-_HandSkills_NEW.pdf
[whatif244]. (2011, Dec 31). Primitive Reflex Palmar Grasp Reflex Ball for Autism, ADD, ADHD, Dyslexia, OCD Exercise 1 of 8. [Video]. Streaming Service. https://www.youtube.com/watch?v=ajx2szIE9Vg&t=23s&ab_channel=whatif244