The Moro Reflex - a Startling Test

The Moro reflex is an important tool for any pediatric osteopath. The Moro reflex allows the pediatric osteopath to assess the neurological status of the infant and also to assess torticollis.

In the Moro reflex video we will learn the following:
a) The exact definition of the Moro Reflex
b) How to execute the Moro Reflex
c) What the Moro Reflex tells us about the patient

d) When and to whom to refer the infant
d) Differential diagnosis of the Moro Reflex findings

What is the Moro Reflex?

The Moro reflex is an involuntary motor response or natural reflex of the baby to a threatening stimulus such as a noise or sudden movement. It is a two-step process and develops shortly after birth.  

The Moro reflex is one whereby the infant throws back its head, splays its arms at the shoulder and extends its legs. This is then followed by the baby curling its legs and arms back to its body followed occasionally by the baby letting out a cry. 

The practitioner can test the Moro reflex by gently cupping the baby's head in his hands and releasing it suddenly allowing it to fall back for a short moment and then supporting it again.

3 outcomes of the Moro Reflex:

There are 3 possible outcomes of the Moro reflex. 

1) A normal symmetrical Moro reflex

2) An absent Moro Reflex

3) An asymmetrical response of the Moro reflex

Both an asymmetrical Moro reflex or an absent Moro reflex require further investigation for the following reasons: both an absent and an asymmetrical Moro reflex are as a result of birth trauma:

Absent Moro Reflex

An absent Moro reflex is normally as a result of trauma to the higher centers such as in the case of cerebral palsy.  For this reason, an infant that exhibits an absent Moro reflex requires a thorough neurological examination. 

An asymmetrical Moro Reflex

An asymmetrical Moro reflex on the other hand is normally as a result of a local trauma either to a peripheral nerve such as the brachial plexus or as a result of fracture to the clavicle.  For this reason an infant that presents with an asymmetrical Moro reflex requires further examination in the form of neurological examination, local palpation and X-ray.

Fractures of the clavicle in the infant:

Fractures of the clavicle in the newborn are the most common fracture to occur during delivery even in natural, spontaneous deliveries. Clavicular fractures often go unnoticed which is why it is so important for the osteopath to consider fractures of the clavicle even when there has not been a previous diagnosis made in the hospital. 

The Moro Reflex and Torticollis:

From an osteopathic points of view, the Moro reflex can also be used to assess torticollis.  The osteopath will note that the side on which the torticollis is suspected will maintain a more flexed position than the contralateral arm.

How long does the Moro Reflex last?

The Moro reflex typically lasts between 2 to 4 months and disappears by the sixth month once the baby's neck can support its head.  A continuation of the Moro reflex beyond the six-month mark could be a sign of a more serious problem and requires further neurological investigation.

Cranial Osteopathy - The five fundamental principles of the cranio sacral mechanism

The cranial concept is a system of therapy that is being used widely throughout the world and I will try to explain the fundamental principles that apply to it. The cranial concept was first developed by an osteopath called William Garner Sutherland in the early 20th century and he was the first to coin the phrase cranial-osteopathy. Since Sutherland, there have been practitioners like Upledger who have further developed the theory and other branches have developed such as cranio-sacral therapy (craniosacral). The system of cranial osteopathy and cranio-sacral therapy is becoming more and more popular in Israel and in Jerusalem specifically patients are beginning to benefit from it due to greater awareness.

Whether an osteopath uses cranial osteopathy, structural osteopathy, classical, visceral or functional osteopathy, the same principles of diagnosis are used which are based on a system that applies anatomy and physiology in order to prevent disease. The osteopath considers the whole body as a unit all of whose parts need to be properly nourished by its internal fluid environment in order to function, heal itself and thus combat disease.

When the osteopath considers the body as a whole, inevitably this includes the cranium and all of it components; it's bone, cartilage, membranes and internal environment that is nourished by blood-vessels and nerves.

5 fundamental principles exist in cranial osteopathy:

1) That an inherent mobility exists within the brain and spinal cord.
The neural tube develops in the embryo with 2 anterior sections that invaginate and curl up like a ram's horn to form the cerebral cortex. Since it is believed that there is inherent motility within the brain, the pulsating motility responds by curling and uncurling in the way it was developed.

2) Fluctuation of the cerebro-spinal fluid.
There are a number of theories as to how the CSF fluctuates and what the basis of its movement is. For the osteopath however, the important factor is that changes in pressure can be palpated along the route of the CSF and any existing restrictions may alter the CSF fluctuation and have consequences on the body.

3) Motility of intracranial and spinal membranes.
The spinal membranes that form the structures of the intracranial membranes are the falx cerebri and the 2 tentorium cerebelli. These sickle-shaped structures arise from a common origin at the straight sinus known as "The Sutherland fulcrum". The insertions of these membranes are along various points around the cranium. The falx cerebri originates at the internal occipital protuberance, travels upward and forward and eventually insert into the crista galli of the ethmoid bone. The 2 tentoria cerebelli pass along the transverse ridges and the two converge on the body of the sphenoid and insert onto the anterior clinoid process. Together, these membranes constitute the reciprocal tension membranes linking the cranium to the sacrum, functioning as a unit around a common fulcum - the Sutherland fulcrum.

4) Mobility of the bones of the skull.
Whilst the skull may appear to be a solid structure in fact it has zigzag edges which grow together to form movable sutures. These joints evolve from smooth-edged plates of membrane in the newborn and eventually evolve into articulations with slight movement according to the contours of the two surfaces.

5) The involuntary mobility of the sacrum between the ilia.
Not to be confused with movement of nutation and counter-nutation of the sacrum between the ilia, the cranial-osteopathic concept considers the sacrum having an involuntary, respiratory mobility. We have already mentioned the mobility of the intracranial and spinal membranes and it is the lower attachment of these membranes to the sacrum that results in the direction and containment of the sacrum's movement. The movement is a physical extension of the primary respiratory mechanism and allows the sacrum to flex an extend at the level of the second sacral vertebra.

It is with the comprehension of these five fundamental concepts that the cranial osteopath starts to understand the craniosacral mechanism. With a knowledge of the anatomy of the cranium, the physiology of the respiratory mechanism and the cranio-sacral rhythm the osteopath embarks upon a path of therapeutics that are applicable to all kinds of ailments experienced by patients.

Click, for more information on cranio-sacral therapy in Jerusalem