Plantar Grasp Reflex

Original Editor - Ahmed Essam Top Contributors - Muskan Rastogi, Ahmed Essam and Chelsea Mclene

Introduction[edit | edit source]

Plantar Grasp Reflex.jpg

This reflex in human infants can be regarded as a foundation of responses that were once essential for ape infants in arboreal life. The spinal center for this reflex is most probably located at the L5-S2 levels, which are controlled by higher brain structures. Nonprimary motor areas may exert regulatory control of the spinal reflex mechanism through interneurons. In infants, this reflex can be provoked due to insufficient control of the spinal mechanism by the immature brain. In adults, lesions in nonprimary motor areas may cause a release of inhibitory control by spinal interneurons, leading to a reappearance of the reflex.[1] [2]

Incidence and Prevalence[edit | edit source]

Age incidence-According to research done by Brain and Curran in fifty participants this reflex was evident in all young ones aged equal to or less than 9 months ,while it had disintegrated in all participants over the age of 2 years.[3]

In an experimental study done by Gentry and Aldrich all the participants lesser than 6 months showed signs of the reflex and also in the same research during the time of 8-9 months of the age, maximum loss of this reflex was noted.[4]

Prevalence-According to Stirnimann (1940), 984 out of 1,000 normal newborns gave response to the tonic plantar grasp reflex. The plantar grasp was more noticeable in newborns when compared to the Babinski sign.[5]

In healthy adults aged 65 and older it is approximated to be 0.1% and in adults 65 and older with mild cognitive impairment is estimated to be 1.7%, and in adults 65 and older with dementia it is evaluated to be 18.4%.[6]

Position[edit | edit source]

Infant lying on a flat surface in the supine position while awake, head and arms at the neutral position. [7][8][9][10][1]

Care should be taken to keep the subject’s head facing the midline, to avoid the influence of the asymmetric tonic neck reflex.[1]

Stimulus[edit | edit source]

The plantar grasp reflex is elicited:-

  1. By pressing a thumb against the sole of the foot just behind the toes.[1][7][8][9][10] OR
  2. By stroking gently the plantar surface medially with a blunt object such as the handle of a reflex hammer.[11]

Response[edit | edit source]

Normal Response[edit | edit source]

In Infants-The lateral surfaces of the foot bend as if to make a cup out of the plantar surface.[11] It consists of the flexion and adduction of all toes as if the toes were firmly grasping the stimulating object[3]; there is hollowing of the sole with some wrinkling of the skin. If the toes also flex, this is called the tonic foot response.[11] It is tonic in character, because the posture is often maintained for 15 or 30 seconds, or longer during early infancy[3]

In adults- no response - as it diminishes in later life.

Abnormal Response[edit | edit source]

In Infants- No response means there is underlying pathology.

In adults- If flexion or adduction of toes occurs it means there is underlying pathology.

Duration[edit | edit source]

The plantar grasp reflex can be elicited in all normal infants from 25 weeks of postconceptional age until the end of 6 months of corrected age according to the expected birth date.[1]

[12]

The therapist presses her finger on the ball of the foot at the base of the toes.

Clinical Significance[edit | edit source]

  • The plantar grasp reflex in infants is of high clinical significance. A negative or diminished reflex during early infancy is often a sensitive indicator of spasticity. Infants with athetoid type cerebral palsy exhibit extremely strong retention of the reflex, and infants with mental retardation also exhibit a tendency toward prolonged retention of the reflex.[1]
  • A reduced or negative plantar grasp reflex during early infancy can be a sensitive indicator of later development of spasticity.[1]
  • Reappearance in adults- More recent studies have implicated lesions of the medial frontal cortex anterior to the primary motor cortex, i.e., the supplementary motor area and cingulate motor cortex, as the etiology of the palmar (or plantar) grasp reflex.[10][13][14][15]
  • The plantar grasp reflex is usually present at or soon after birth; it is remarkably constant and active during early infancy, and usually disappears between 6 and 12 months of age. The disappearance of the plantar grasp reflex appears to be related to the age of standing.[16]

Reference[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Futagi Y, Suzuki Y. Neural mechanism and clinical significance of the plantar grasp reflex in infants. Pediatric neurology. 2010 Aug 1;43(2):81-6.
  2. Plantar Reflex. Contributed from Ashley Arbuckle, Flickr under Creative Commons License (CC By 2.0 https://creativecommons.org/licenses/by/2.0/)
  3. 3.0 3.1 3.2 Brain Wr, Curran Rd. The grasp-reflex of the foot. Brain. 1932 Sep 1;55(3):347-56.
  4. Gentry EF, Aldrich CA. Toe reflexes in infancy and the development of voluntary control. American Journal of Diseases of Children. 1948 Oct 1;76(4):389-400.
  5. Zafeiriou DI. Primitive reflexes and postural reactions in the neurodevelopmental examination. Pediatric neurology. 2004 Jul 1;31(1):1-8.
  6. Hogan DB, Ebly EM. Primitive reflexes and dementia: results from the Canadian Study of Health and Aging. Age and ageing. 1995 Sep 1;24(5):375-81.
  7. 7.0 7.1 Futagi Y, Suzuki Y, Goto M. Clinical significance of plantar grasp response in infants. Pediatric Neurology. 1999 Feb 1;20(2):111-5.
  8. 8.0 8.1 Prechtl H, Beinthema D. Reflexes and responses: The neurological examination of the full-term newborn infant. Clin Dev Med. 1977;63:40-2.
  9. 9.0 9.1 Touwen B. Reactions and responses: neurological development in infancy. Clinics in Developmental Medicine. 1976;58:83-98.
  10. 10.0 10.1 10.2 Schott JM, Rossor MN. The grasp and other primitive reflexes. Journal of Neurology, Neurosurgery & Psychiatry. 2003 May 1;74(5):558-60.
  11. 11.0 11.1 11.2 Walker HK. The suck, snout, palmomental, and grasp reflexes. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. 1990.
  12. Nicole Edmonds. Plantar Grasp Reflex. Available from:https://www.youtube.com/watch?v=Vy18c5oGLSk
  13. Hashimoto R, Tanaka Y. Contribution of the supplementary motor area and anterior cingulate gyrus to pathological grasping phenomena. Eur Neurol 1998;40:151-8
  14. Goldberger ME. Restitution of function in the CNS: The pathologic grasp in Macaca mulatta. Exp Brain Res 1972;15:79-96
  15. Smith AM, Bourbonnais D, Blanchette G. Interaction between forced grasping and a learned precision grip after ablation of the supplementary motor area. Brain Res 1981;222:395-400
  16. Dietrich HF. A longitudinal study of the Babinski and plantar grasp reflexes in infancy. AMA journal of diseases of children. 1957 Sep 1;94(3):265-71.