Primitive Reflex Integration Case Studies

Help for anxiety, motor skills, sensory issues, and more.

The use of innate rhythmic movements and primitive reflex integration from the Brain and Sensory Foundations First Level course results in huge improvement for anxiety, motor skills, focus, and much more! 

Submitted by Alison Randolph, OTD, OTR/L, ATP

Bo is a 6-year-old male who excels academically in the general education setting though his teacher and mother were primarily concerned with the way he held his pencil, the legibility of his written work, and his poor attention span. When writing, he would often grasp the pencil with his fist with his arm elevated off the writing surface. He was recently diagnosed with ADHD. Additional concerns reported by Bo’s mother are as follows:

   - Poor balance and coordination
   - Allergies
   - Dislike of change/ difficulty with transitions
   - Anxiety and nervousness
   - Mood swings
   - Poor endurance/ easily fatigued
   - Poor muscle tone/ weakness
   - Difficulty judging distance, depth, space, and speed
   - Headaches from muscle tension in the neck
   - Difficulty sitting still/ fidgeting/ hyperactivity
   - Difficulty staying on task
   - Poor concentration
   - Poor short-term memory
   - Insecurities/ low self-esteem; self-conscious
   - Extreme fear of failure, perfectionism
   - Obsessive compulsive tendencies
   - Fear of separation from a loved one
   - Sleep difficulties
   - Self-restricted diet
   - Poor eye contact
   - Sensitivity to sound

On December 17, 2019, Bo and his mother were guided through the rhythmic movements [from the Brain and Sensory Foundations course] and instructed to complete them for about 10-20 minutes per day for two weeks. This plan was established so Bo and his mother could familiarize themselves with the movements and grow accustomed to incorporating new activities into their daily schedule. 

Since Bo’s pencil grasp and handwriting were of the utmost concern to his mother and teacher, hand reflex integration activities [from the Brain and Sensory Foundations course]  — including isometrics activities — were introduced first following the initial two weeks of rhythmic movements. Next, Moro [Reflex]/FPR [Fear Paralysis Reflex] and TLR [Tonic Labyrinthine Reflex] integration activities were incorporated — two weeks after introducing the hand reflex integration activities — since anxiety and balance issues had been identified. After about six total weeks, we incorporated reflex integration activities for ATNR [Asymmetrical Tonic Neck Reflex], STNR [Symmetrical Tonic Neck Reflex], and Spinal Galant [Reflex] into his routine. I made Popsicle sticks (color-coded for each reflex) for all of the age-appropriate, play-based activities associated with each targeted reflex. 

Bo participated in up to 20 minutes each day of RMs and reflex integration activities combined. He enjoyed having the opportunity to draw a Popsicle stick of each color and reading the activity aloud because it provided him with a sense of control over what activities were coming next, and he was more eager to participate than when the adults instructed him on what to do next. Due to the rapid and continued success with Bo’s home program, there was no need to modify or change it. 

Between the second and fourth weeks of completing the rhythmic movements and assigned reflex integration activities up to that point, Bo’s mother reported the following:

   - Bo was no longer as picky of an eater and had begun to try more things
   - Bo was able to calm down at night and lie down in a restful state before bed
   - Bo was demonstrating more patience
   - Bo’s anger was half of what it used to be
   - Bo’s pencil grasp was maturing and his arm was resting on the surface when writing
   - Bo’s gait and posture changed; he previously assumed a slumped posture but now walks upright

After continued engagement in the rhythmic movements and all of the targeted reflex integration activities, [from the Brain and Sensory Foundations course] Bo’s mother reported the following changes:

   - Bo seems to be sleeping a lot better. He is no longer groggy when he wakes in the morning and does not seem as exhausted as he used to. He has been sleeping through the night with no issues. 
   - Bo no longer experiences leg cramps. 
   - Bo’s grip strength has improved significantly. 
   - Extreme improvements with Bo’s balance and coordination have been noted.
   - For the first time in his life, Bo’s allergies are not affecting him.
   - Bo now looks others in the eyes when they are speaking 
   - Bo recently underwent a surgery and a huge move, and he adapted to those changes very well.
   - Bo’s anxiety and nervousness have become less severe. He is calmer in situations that may have previously caused anxiety.
   - Bo’s mood swings are about a quarter of what they used to be.
   - Sound no longer bothers Bo unless it is extremely loud. 
   - As of 3/1/20, Bo has not experienced fatigue in the last three weeks. 
   - Bo’s strength and muscle tone have improved. His mother reports he can lift heavier things. 
   - Bo’s grip has noticeably improved (he now functionally utilizes a monk grip). His handwriting has “changed for the better tremendously.”
   - His ability to judge distance, depth, and speed has dramatically improved. 
   - Bo’s balance is “100% better.”
   - The frequency at which Bo experiences headaches has decreased. 
   - Bo’s ability to sit still has improved both at home and at school. He has been focusing as well as starting and finishing tasks on his own. Now he rarely has issues with paying attention. 
   - Bo’s short-term memory has notably improved. 
   - In the last three weeks, Bo has experienced fear of separating from familiar people only once. 
   - Bo no longer seems to be afraid to fail anymore. He is taking chances without fear. 
   - Bo’s obsessive-compulsive tendencies have completely resolved. 
   - Bo seems calm, happy, and stress-free. He is smiling a lot more☺ 

 On my most recent visit with Bo, we completed the 5-Step Balance [from the Brain and Sensory Foundations course]. It took maximum encouragement, use of a visual schedule and token board, and increased time to get Bo to engage. Immediately prior to my visit, Bo had been given access to a tablet, and it was taken away by his mother upon my arrival. It had also been a while since I had last worked with Bo due to his surgery and a move to a new home. Needless to say, he was not very willing to participate in activities with me at first. His mother identified that Bo has a fear of having an audience, especially in respect to singing in front of others. I helped him to generate the goal of, “I am singing in front of a group with confidence.” His stuffed animals were placed in a recliner to simulate an audience. Eventually he agreed to act out the goal by singing Jingle Bells, but he wrapped himself up in a blanket on the floor and hid his face from view while doing so. He then stimulated the Moro reflex by falling backwards and correcting his balance before falling down. Bo drew three Popsicle sticks and completed five repetitions of each reflex integration activity (somersaults, donkey kicks, and Roly Polys). It took quite a bit of encouragement, prompting, tactile/verbal/visual cueing, and occasional physical assist for him to complete the Support Re-patterning Sequence. 

Ultimately he completed five rounds of the puppet crawl and cross crawl (we did not focus on directing eye movement because it took so much effort to get him to participate), and he held the Hook-Up position for ten deep breaths. Bo refused water, so we moved directly into acting out the goal again. He was aware that this was the last thing he was being asked to do so he was less resistant to beginning this step, but I still expected to see him hide or avoid singing to his stuffed animal friends again. Instead, Bo grabbed his favorite stuffed animal, spun around in circles and belted “Jingle Bells” while laughing and smiling. His mother was amazed and acknowledged that all of the activities must have “prepared his body and mind” for singing in front of others without fear. It was astonishing to see how quickly and successfully the 5-Step Balance Process helped Bo to overcome the anxiety associated with singing in front of others.

Through working with Bo, I learned firsthand how powerful the rhythmic movements and reflex integration activities are to children with immature neuro-sensory-motor systems. Without the knowledge from this [Brain and Sensory Foundations] course, I would have first approached improving his grasp and handwriting by focusing on increasing shoulder/upper body strength since he was not resting his arm on the table when writing and movement was initiating from the shoulder and elbow. Witnessing so many profound improvements across multiple functional areas - including his grasp and arm position when writing – after less than two months of rhythmic movements and reflex integration activities was incredibly eye opening and encouraging as a therapist. I have never witnessed results like these even after many months of intervention with my patients, and to see these extreme improvements within just weeks was incredible.

[Edited for length and clarity, emphasis added]