Primitive Reflex Integration Case Studies

2-year-old meets all OT goals within 3 months

This young toddler demonstrated severe motor delays, hypotonia, and poor balance, and he had difficulty feeding himself. After receiving rhythmic movements and reflex integration from the Brain and Sensory Foundations course, he met all of his original occupational therapy goals!

Submitted by Jaime Carlson, MSEd, OTR/L

Sam (age 2 years) was born full-term with a C-section delivery, weighing 7lbs, 10oz. He has an enlarged head circumference with concern for increased cerebral spinal fluid (CAT scan looked OK and he did not require a shunt). He was in the NICU on oxygen for 5 days at birth and presented on evaluation with generalized hypotonia impacting overall development. He was also head banging during self soothing.

Sam’s goals were to improve transitional movements (tummy to sit, sit to tummy, sit to short/tall kneel/stand, tummy to all 4s to crawl, crawl to controlled sit, cruising, walking), be more independent with feeding (self feeding, achieving a pincer grasp, drinking from a straw), communicate or imitate with gestures/signs or words and to follow simple 1-step directions.

When I started seeing Sam in OT he could only commando crawl, could not complete most transitional movements with any sort of motor planning/control without significant physical assistance, was not feeding himself and only had a few words/gestures/signs. He avoided sensory input on his palms or soles of his feet and when placed in a standing position to bear weight, he would stand only on his tip toes.

After experiencing the rhythmic movements, Brain Tune Up, Heart Connection, and reflex integration [from the Brain and Sensory Foundations course] in my own body, I encouraged Sam’s parents to participate and model this process in their home including involving Sam’s sisters (ages 4 and 6). I see Sam once a week for one hour sessions. For 4 weeks, I focused on implementing all 4 innate rhythmic movements with Sam and teaching his parents how to incorporate these movements into their normal daily routines.

With rhythmic movements alone, Sam started to become more vocal, increasing his vocabulary/gestures to 1 and 2 word phrases through imitation and even showing some spontaneity. He started gaining core strength, neck strength and was able to achieve all 4s crawling. He began pulling to stand on furniture without assistance.

After rhythmic movement was becoming second nature, I started working on hand and feet reflexes so that the musculature of Sam’s hands and feet could start taking shape and to reduce his defensiveness. His hands and feet were soft and squishy to the touch. Other symptoms included biting fingers, fisting hands when concentrating for movement, drooling during sensory/fine motor play, hypersensitive palms and soles, poor movement sense (vestibular) development, standing with left foot turned out, delayed transitional movements and loose wrists and ankles. Hand and feet reflexes were the main focus for 4 weeks with activities to stimulate and integrate these reflexes including lots of sensory play with a variety of textures applied. Sam can now feed himself using a pincer grasp on small foods, hold his cup successfully, and drink from his straw. His heels are coming down in standing, so he is not going to require orthoses. He is also beginning to be able to touch damp textures without upset.

Next, for another 4 weeks, I introduced stimulation and integration games/activities [from the Brain and Sensory Foundations course] for Tonic Labyrinthine Reflex, Moro Reflex, Asymmetrical Tonic Neck Reflex, and Symmetrical Tonic Neck Reflex, because Sam exhibited symptoms of retaining each of these such as muscle tone imbalances, toe standing, speech delays, poor core strength/balance/coordination/gross motor skills/posture/endurance, hypersensitivity to tipping head back, muscle weakness and fatigue. I incorporated songs throughout these sessions because Sam responds well to music in any form. Sam can now tilt his chin up and down without losing his balance or becoming upset. He can cross midline in play and is taking independent steps about his house. He can stoop to pick up toys and return to standing without falling over. Sam now likes to play in a prone position either on his own achieving a plank or over a therapy ball/cushion. He can tolerate bouncing, rocking and swaying while seated on a therapy ball, reaching in all planes. Now that he can feel where his body is in space, his head banging is decreasing as well.

Sam’s development has taken off in every category since introducing Brain Tune Up, Heart Connection, and reflex integration in both passive and active forms. His parents are good about understanding the rationale for this type of intervention and they follow through with incorporating it into their daily lives, which is another reason why he is experiencing such progress and meeting all of his goals. Our team recently met to write new goals for Sam. I have learned to go slow and to repeat any teaching that isn’t at first completely understood, which is hard because I want the families I serve to have all of this information ASAP. I understand the importance of not giving them information through a fire hose and see that this is best practice.

I have been working with Sam incorporating these techniques and strategies for 12 weeks (one hour per week) and will continue to include these interventions moving forward with him and his family. His parents are quite pleased with his progress.

(Edited, emphasis added)