Journal of Neurology

, Volume 240, Issue 8, pp 495–504 | Cite as

Primitive reflexes in healthy, adult volunteers and neurological patients: methodological issues

  • Fred W. Vreeling
  • Jellemer Jolles
  • Frans R. J. Verhey
  • Peter J. Houx
Original Communications


A study was made to determine whether two experienced clinicians elicited and scored primitive reflexes (PR) differently and whether reliability could be improved by standardization. Three studies were carried out, using a protocol for the examination of 14 PR. In the first study with 31 healthy young subjects, two investigators found virtually no difference in the routine neurological examination. However, the interobserver agreement was very poor, indicating the need for a further improvement of the PR protocol. In the second study, 30 neurological patients were examined with an improved, more explicit and standardized protocol, in which the amplitude and the persistence of the reflex were scored separately. Interobserver agreement improved considerably, and was high for amplitude as well as persistence. In the third study, 36 neurological patients were examined twice by one investigator within 2 weeks. Good to excellent intraobserver agreement was found. No pathognomonic or strictly localizing reflex could be distinguished.

Key words

Primitive reflexes Standardization Interand intraobserver reliability Adults 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ajuriaguerra J de, Hécaen H (1960) Le syndrome frontal. In: Ajuriaguerra J de, Hécaen H (eds) Le cortex cérébral. Masson, Paris, pp 27–32Google Scholar
  2. 2.
    Ajuriaguerra J de, Rego A, Tissot R (1963) Le réflexe oral et quelques activités orales dans les syndromes démentiels du grand âge. Encéphale 52:189–219Google Scholar
  3. 3.
    Alberts M (1955) Über das “Mundöffnungs-Fingerspreiz-Phä-nomen”. Nervenarzt 26:228–232Google Scholar
  4. 4.
    Allen MC, Capute AJ (1986) The evolution of primitive reflexes in extremely premature infants. Pediatr Res 20:1284–1289Google Scholar
  5. 5.
    Ansink BJJ (1962) Physiologic and clinical investigation into 4 brainstem reflexes. Neurology 12:320–328Google Scholar
  6. 6.
    Bärtsch-Rochaix W (1952) Der “Finger-Ausweichereflex”, ein vermutlich unbekanntes Symptom bei tiefen Frontalhirnprozessen. Schweiz Arch Neurol 70: 239–244Google Scholar
  7. 7.
    Basavaraju NG, Silverstone FA, Libow LS, Paraskevas K (1981) Primitive reflexes and perceptual sensory tests in the elderly - their usefulness in dementia. J Chron Dis 334:367–377Google Scholar
  8. 8.
    Blake JR, Kunkle EC, Charles E (1951) The palmomental reflex. Arch Neurol Psychiatry 65:337–345Google Scholar
  9. 9.
    Boetz MI, Bogen JE (1976) The grasp reflex of the foot and related phenomena in the absence of other reflex abnormalities following cerebral commissurotomy. Acta Neurol Scand 54: 453–463Google Scholar
  10. 10.
    Brakha S (1958) The clinical value of the pollico-mental reflex in neuropathology. J Nerv Ment Dis 127:91–94Google Scholar
  11. 11.
    Brakha S (1968) Le réflexe profond de l'orbiculaire oral (le phénomène de la bouche d'Escherich) signe précoce et pathognomique des troubles frontaux à prédominance antéro-médiobasale. Rev Neurol (Paris) 124:386–390Google Scholar
  12. 12.
    Brakha S (1978) Le réflexe linguo-mentonnier profond: signe précoce des lésions temporales débutantes. Rev Neurol (Paris) 11:134,707–708Google Scholar
  13. 13.
    Burns A, Jacobi R, Levy R (1991) Neurological signs in Alzheimer's disease. Age Aging 20:45–51Google Scholar
  14. 14.
    Capute AJ, Shapiro BJ, Accardo PJ, Wachtel RC, Ross A, Palmer FB (1982) Motor functions: associated Primitive Reflex Profiles. Develop Med Child Neurol 24:662–669Google Scholar
  15. 15.
    Capute AJ, Palmer FB, Shapiro BK, Wachtel RC, Ross A, Accardo PJ (1984) Primitive reflex profile: a quantitation of primitive reflexes in infancy. Dev Med Child Neurol 26:375–383Google Scholar
  16. 16.
    Cicchetti DV (1976) Assessing inter-rater reliability for rating scales: resolving some basic issues. Br J Psychiatry 129:452–456Google Scholar
  17. 17.
    Cohen J (1960) A coefficient for agreement for nominal scales. Educ Psychol Measure 20:37–46Google Scholar
  18. 18.
    Constantinidis J, Richard J, Ajuriaguerra J de (1978) Dementias with senile plaques and neurofibrillary changes. In: Isaacs AD, Post F (eds) Studies in geriatric psychiatry. Wiley, London, pp 119–152Google Scholar
  19. 19.
    Crevel H van (1986) Clinical approach to dementia. In: Swaab DF, Fliers E, Mirmiran M, Gool WA van, Haaren F van (eds) Progress in brain research, vol 70. Elsevier, Amsterdam, pp 45–51Google Scholar
  20. 20.
    Dalby MA (1970) The diagnostic value of the palmo-mental reflex. Acta Neurol Scand 46:601–608Google Scholar
  21. 21.
    Delwaide PJ, Dijeux L (1980) Réflexes néonataux et dyskinésies bucco-linguo-faciales dans la démence sénile. Actual Gérontol 6:126–133Google Scholar
  22. 22.
    Ekbom KA, Jernelius B, Kugelberg E (1952) Perioral reflexes. Neurology 2:103–111Google Scholar
  23. 23.
    Fleiss JL (1971) Measuring nominal scale agreement among many raters. Psychol Bull 76:378–382Google Scholar
  24. 24.
    Franklin GM, LM Nelson, Filley CM, Heaton K (1989) Cognitive loss in Multiple Sclerosis. Arch Neurol 46:162–167Google Scholar
  25. 25.
    Franssen EH, Reisberg B, Kluger A, Sinaiko E, Boja C (1991) Cognition-independent neurologic symptoms in normal and probable Alzheimer's disease. Arch Neurol 48:148–154Google Scholar
  26. 26.
    Garland HG (1952) Parkinsonism. BMJ 19:153–155Google Scholar
  27. 27.
    Gelmers HJ (1983) Non-paralytic motor disturbances and speech disorders: the role of the supplementary motor area. J Neurol Neurosurg Psychiatry 46:1052–1054Google Scholar
  28. 28.
    Gimenez-Roldan S, Esteban A, Abad YJM (1976) Reflejo palmomentoniano en enfermedad de Parkinson. Arch Neurobiol 39:233–248Google Scholar
  29. 29.
    Gossmann MD, Jacobs L (1980) Three primitive reflexes in parkinsonism patients. Neurology 30:189–192Google Scholar
  30. 30.
    Gött T (1921) Eine wenig bekannte Mitbewegung und ihr Sinn. Z Neurol 66: 93–96Google Scholar
  31. 31.
    Huber SJ, Paulson GW (1986) Relationship between primitive reflexes and severity in Parkinson's disease. J Neurol Neurosurg Psychiatry 49:1298–1300Google Scholar
  32. 32.
    Iriarte LM, Chacon J, Madrazo J, Chaparro P, Vadillo J (1989) Blink reflex in dyskinetic and nondyskinetic patients with Parkinson's disease. Eur Neurol 29: 67–70Google Scholar
  33. 33.
    Jacobs L, Gossman MD (1980) Three primitive reflexes in normal adults. Neurology 30:184–188Google Scholar
  34. 34.
    Janischewski A (1914) Le réflexe de préhension dans les affections organiques de l'encéphale. Rev Neurol (Paris) 27:678–681Google Scholar
  35. 35.
    Jenkyn LR, Reeves AG (1983) Evaluating cortical disinhibition signs (letter). Neurology 33:957Google Scholar
  36. 36.
    Jenkyn LR, Walsh DB, Walsh BT, Culver CM, Reeves AG (1975) The nuchocephalic reflex. J Neurol Neurosurg Psychiatry 38:561–566Google Scholar
  37. 37.
    Jenkyn LR, Reeves AG, Warren T, Whiting K, Clayton RJ, Moore WW, Rizzo A, Tuzun M, Bonnet JC, Culpepper BW (1985) Neurological signs in senescence. Arch Neurol 42: 1154–1157Google Scholar
  38. 38.
    Klawans HL Jr, Goodwin JA (1969) Reversal of the glabellar reflex in Parkinsonism byl-Dopa. J Neurol Neurosurg Psychiatry 32:423–427Google Scholar
  39. 39.
    Koller WC (1982) Primitive reflexes and cognitive function in the elderly. Ann Neurol 12:302–304Google Scholar
  40. 40.
    Koller WC (1984) Primitive reflexes in the evaluation of the aging patient. Clin Gerontol 3:19–22Google Scholar
  41. 41.
    Landis RJ, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174Google Scholar
  42. 42.
    Maertens de Noordhout A, Delwaide PJ (1988) The palmomental reflex in Parkinson's disease. Arch Neurol 45: 425–427Google Scholar
  43. 43.
    Magnus R, Kleijn A de (1912) Die Abhängigkeit des Tonus der Extremitäten-Muskeln von der Kopfstellung. Arch Physiol 45:455–548Google Scholar
  44. 44.
    Marinesco G, Radovici A (1920) Sur un réflexe cutané nouveau, réflexe palmo-mentonnier. Rev Neurol (Paris) 27:237–240Google Scholar
  45. 45.
    Marti-Vilalta JL, Graus F (1984) The palmomental reflex. Eur Neurol 23:12–16Google Scholar
  46. 46.
    Mayer C, Reisch O (1928) Über die Widerstandsbereitschaft des Bewegungsapparates (Gegenhalten Kleists) und über krankhafte Greifsphdnomene. Dtsch Z Nervenheilkd 102:28–80Google Scholar
  47. 47.
    McDonald JK, Kelley JJ, Brock LD, Bartunek EJ (1963) Variability of the palmomental reflex. J Nerv Merit Dis 136:207–215Google Scholar
  48. 48.
    Morgan AM, Koch V, Aldag J (1988) Neonatal neurobehavioral examination. Phys Ther 68:1352–1358Google Scholar
  49. 49.
    Nemlicher L, Schetzer M, Schmelkin D (1931) Über ein neues Symptom bei doppelseitigen Affektionen des Hirnstammes. Dtsch Z Nervenheilkd 120:184–190Google Scholar
  50. 50.
    Otomo E (1965) The palmomental reflex in the aged. Geriatrics 11:901–905Google Scholar
  51. 51.
    Paulson GW (1977) The neurological examination in dementia. In: Wells CE (ed) Dementia, 2nd edn. Davis, Philadelphia, pp 169–188Google Scholar
  52. 52.
    Paulson G, Gottlieb G (1986) Development reflexes: the reappearance of foetal and neonatel reflexes in aged patients. Brain 91:37–52Google Scholar
  53. 53.
    Pearce J, Aziz H, Callagher JC (1968) Primitive reflex activity in primary and symptomatic Parkinsonism. J Neurol Neurosurg Psychiatry 31:501–508Google Scholar
  54. 54.
    Pfeiffer J (1964) Zum lokalisatorischen Wert pathologischer Greifphänomene. Arch Psychiatry 206: 406–418Google Scholar
  55. 55.
    Reis DJ (1961) The palmomental reflex. Arch Neurol 4:486–498Google Scholar
  56. 56.
    Richard J, Constantinidis J (1970) Les démences de la vieillesse. Notion acquises et problèmes cliniques actuels. Confront Psychiatr 5:39–61Google Scholar
  57. 57.
    Sandyck R, Fleming J, Brennan MJW (1982) The head retraction reflex — its specificity in Parkinson's disease. Clin Neurol Neurosurg 84:159–162Google Scholar
  58. 58.
    Schuster P, Pinéas H (1926) Weitere Beobachtungen über Zwanggreifen und Nachgreifen und deren Beziehungen zu ähnlichen Bewegungsstörungen. Dtsch Z Nervenheilkd 9:1656Google Scholar
  59. 59.
    Tavy DLJ, Woerkom TCAM van, Morre HHE, Slaets JPJ (1985) Alteration of the visual blink reflex in patients with dementia (letter). J Neurol Neurosurg Psychiatry 48:718Google Scholar
  60. 60.
    Touwen BLC, Prechtl HFR (1970) Examination of reflexes. In: Touwen BLC, Prechtl HFR (eds) The neurological examination of the child with minor nervous dysfunction. Spastics International Medical Publications. Heinemann, London, pp 21–42Google Scholar
  61. 61.
    Tweedy J, Reding M, Garcia C, Schulman P, Deutsch G, Antin S (1982) Significance of cortical disinhibition signs. Neurology 32:169–173Google Scholar
  62. 62.
    Vreeling FW, Verhey FRJ, Houx PJ, Jolles J (1993) Primitive reflexes in Parkinson's disease. J Neurol Neurosurg Psychiatry (in press)Google Scholar
  63. 63.
    Wartenberg R (1941) Head retraction reflex. Am J Med Soc 201:553–561Google Scholar
  64. 64.
    Zametkin AJ, Stevens JR, Pittman R (1979) Ontogeny of spontaneous blinking and habituation of the blink reflex. Ann Neurol 5:453–457Google Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • Fred W. Vreeling
    • 1
  • Jellemer Jolles
    • 2
  • Frans R. J. Verhey
    • 2
  • Peter J. Houx
    • 2
  1. 1.Department of NeurologyUniversity of LimburgMD MaastrichtThe Netherlands
  2. 2.Department of Psychiatry, Division of Neuropsychology and PsychobiologyUniversity of LimburgMD MaastrichtThe Netherlands

Personalised recommendations