Primitive Reflex Integration Case Studies

Submitted by Melody Edwards, PT 

At the initial evaluation this child was 20 months of age and used scooting on her bottom as her means of mobility. She kept her chin tucked at all times. She held her eyes locked straight forward or downwards. She was neglecting her upper visual field. When she looked upwards at all, her hips and knees extended and her toes pointed. Obviously, her TLR-extensor was profoundly active. She was unable to commando crawl, creep, pull to stand or walk. Her only word was “dada”. She scored -2.13 standard deviations below the mean on the gross motor sub-tests of the Peabody Developmental Motor Scales.

• I used the Rhythmic Movements [from the Brain and Sensory Foundations course] as my initial treatment strategy.
• I also taught the parents how to work together to do facilitated isometric activities to address the TLR.
• I also used the 5 step process [from the Brain and Sensory Foundations course] in my initial session so the family could incorporate this process into the child’s daily routine.
  
  Goal: since the child was so young, the parents set the goal of having her be able to look upwards at least one inch higher without her feet pointing downwards.
  
  Activate Reflexes: I used a flashlight in a dimly light room to elicit the child’s interest in playing “follow the light”. The child was sitting on her mom’s lap. I started the light down by the baseboard and slowly moved the light up the wall until her TLR-extensor reflex was activated. The reflex was activated as soon as her eyes moved even slightly above the horizontal. The location of the light just before the TLR [Tonic Labyrinthine Reflex] was triggered was marked on the wall to use as a baseline to assess progress.
  
  Play: I moved the light slowly up and down to activate/integrate the reflex while mom was holding the child:
         - First with her knees flexed and her ankles into near full dorsiflexion
         - Then with her knees fully extended and her ankles at 0° of dorsiflexion (at right angles)
         - Mom moved her legs into and out of these positions as we played follow the light.
         - The child really enjoyed this activity and participated in this game for 23 repetitions before getting distracted. By the 7th repetition, with her legs bent, she was able to go follow the light 13 inches higher before her knees began to extend. By the 12th repetition, with her legs straight and her ankles bent, she no longer pushed against her mom’s hands that were holding her feet when the light went 4 inches higher than originally.
  
  Support repatterning: Child was placed in supine and the activities [from the Brain and Sensory Foundations course]Brain and Sensory Foundations course] were passively done with her by her father while I coached him through the process and while mom stood at her head to elicit an upward gaze.
  
  Post-activity: the parents were pleased with her progress and expressed that they were confident that they could play this game each night at bedtime right after they did the rhythmic movements.
  
  I choose the rhythmic movements for global facilitation of reflex maturation/integration. I choose the game to focus on a fun way to promote integration of the TLR-extensor in a toddler. I choose the facilitated isometric activities [from the Brain and Sensory Foundations course] to selectively focus on the TLR-extensor since it was negatively impacting her developmental progress.
  
  Client Response
• In two weeks child was able to look upwards while prop sitting on the floor without her hips, knees, and toes extending. She enjoyed the “follow the light game”. She also was able to walk up to 10 feet by herself.
• At four weeks she was creeping typically. Head movements were much more separated from her body movements. I added crawling games that involved the child following the light with her eyes as she crawled. Dad would move the light in a multitude of directions, slowly. She was beginning to walk short distances between two people.
• At the two month follow-up visit, the child was walking throughout the house with a near-typical gait pattern of a new walker. I added easel activities.
• At the 6-month follow-up visit, the child was 26 months of age. She was walking independently indoors and outside on uneven surfaces. She was going up/down a flight of stairs with handrail support. She was able to kick a stationary ball with either foot. I added both throwing and kicking activities to her routine.
• Child was discharged from Physical Therapy at 28 months of age due to resolution of concerns about her development.
  
  

A global evaluation at 28 months (8 months after starting the movements) revealed she was functioning at age level in all domains.

What did I learn as a result of this case? To address the primitive reflexes rather than putting the child into a crawling or standing position. This allows the child to develop naturally rather than being “taught” each skill.

Did I change my client’s program based on their response? Yes, I introduced other games for the parents to play with their child to promote the integration of the TLR-extensor. These games included scribbling at an easel (the child LOVED to scribble); tossing balloons in the air and watching where they went; hitting balloons that dad tossed to her; during crawling she would follow the laser light in a multitude of directions; catching bubbles; and in prone, added the activity of having the child following a rolling pin (wrapped with an interesting mylar paper) as the parent started away from her and slowly rolled it towards her until her gaze was about to avert and then rolled it away.

[Edited for length and clarity; emphasis added]