TONIC LABYRINTH REFLEX

Tonic Labyrinthine Reflex: A Review of Its Clinical Significance

Dorothy E. Smith, MD1 and Edward P. D’Angelo, MD2

1Department of Neurology, University of California San Francisco, San Francisco, CA, USA
2Department of Neurology, University of California Davis, Sacramento, CA, USA

Abstract

The tonic labyrinthine reflex (TLR) is an important component of the neurological exam and is often used to assess the degree of spasticity and balance in patients. The TLR is a primitive reflex that is present in neonates and is typically suppressed in adults. An exaggerated TLR has been associated with a variety of neurological conditions including cerebral palsy, traumatic brain injury, and stroke. This review article discusses the clinical relevance of the TLR in the evaluation of spasticity and balance. Additionally, the review explores the utility of the TLR in the differential diagnosis of various neurologic conditions.

Keywords: Tonic labyrinthine reflex, Spasticity, Balance, Neurologic conditions

Introduction

The tonic labyrinthine reflex (TLR) is a primitive reflex that is present in neonates and is typically suppressed in adults. The TLR is a postural reflex that is elicited in response to stimulation of the labyrinthine structures in the inner ear. It is believed to be an important part of the vestibular system and is involved in the maintenance of balance and coordination. An exaggerated TLR has been associated with a variety of neurological conditions including cerebral palsy, traumatic brain injury, and stroke. The purpose of this review is to discuss the clinical relevance of the TLR in the evaluation of spasticity and balance. Additionally, the review will explore the utility of the TLR in the differential diagnosis of various neurologic conditions.

Neurologic Exam

The TLR is an important component of the neurological examination and is often used to assess the degree of spasticity and balance in patients. It is elicited by stimulating the labyrinthine structures in the inner ear. The most common method of eliciting the TLR is by stimulating the labyrinthine structures with a vibrating tuning fork, commonly referred to as the Weber test. The Weber test is performed by placing the vibrating tuning fork over the mastoid bone behind the ear. Normal responses to the Weber test include a contralateral flexion of the neck and ipsilateral flexion of the upper extremity. Abnormal responses, such as an exaggerated TLR, can suggest the presence of spasticity or balance deficits.

Clinical Significance

An exaggerated TLR has been associated with a variety of neurologic conditions. Exaggerated responses to the Weber test have been reported in patients with cerebral palsy, traumatic brain injury, and stroke. The exaggerated TLR can be used to diagnose spasticity and balance deficits in these patients. Additionally, the TLR can be used to monitor the effectiveness of treatments for spasticity and balance deficits. A decrease in the response to the Weber test is indicative of a decrease in spasticity and balance deficits.

Differential Diagnosis

The TLR can also be used to differentiate between various neurologic conditions. An exaggerated TLR is often seen in patients with cerebral palsy and traumatic brain injury. In contrast, patients with stroke typically show a decreased response or no response to the Weber test. This can help clinicians differentiate between these conditions and guide further diagnostic workup and treatment.

Conclusion

The TLR is a primitive reflex that is present in neonates and is typically suppressed in adults. It is an important component of the neurological examination and is often used to assess the degree of spasticity and balance in patients. An exaggerated TLR has been associated with a variety of neurologic conditions including cerebral palsy, traumatic brain injury, and stroke. This review article discussed the clinical relevance of the TLR in the evaluation of spasticity and balance. Additionally, the review explored the utility of the TLR in the differential diagnosis of various neurologic conditions.

References

1. Koman, L.A., & Reed, K.F. (2004). The tonic labyrinthine reflex in normal and pathological conditions. Physical and Occupational Therapy in Pediatrics, 24(3-4), 39-62.

2. Baum, C., & Koman, L.A. (2006). The tonic labyrinthine reflex: Clinical aspects. Physical and Occupational Therapy in Pediatrics, 26(1-2), 3-21.

3. Sinha, S., & Shetty, B. (2013). Tonic labyrinthine reflex: A review. Indian Journal of Physiotherapy and Occupational Therapy, 7(3), 21-24.

4. Jain, N., & Chhabra, D. (2012). Tonic Labyrinthine Reflex: A review. Malaysian Journal of Medical Sciences, 19(4), 59-63.

5. Koman, L.A., & Fong, C. (2007). The tonic labyrinthine reflex: Clinical implications. Physical and Occupational Therapy in Pediatrics, 27(3-4), 3-17.

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