Submitted by Tzipora Abaev, OT
| Before | After |
|---|---|
| Not toilet trained | Toilet trained |
| Poor motor planning | Can follow multi-step directions |
| Unable to walk down stairs with alternating feet | Able to walk down stairs with alternating feet, unassisted |
| Poor motor skills | Able to manage scissors and catch a ball |
| Shy | More verbal with teachers and classmates |
Noy is a 4 year old girl with developmental delays. She presented with delayed processing skills, motor planning skills and overall executive functioning. Her receptive and expressive language was very limited. She presented with sensitivity to different textures and would not tolerate light touch on her body and face. Noy was not toilet trained and required moderate assistance with ADLs. On the reflex integration assessments she showed retained Moro, Tonic Labyrinthine [Reflex], ATNR [Asymmetrical Tonic Neck Reflex] and STNR [Symmetrical Tonic Neck Reflex] and the spinal galant reflexes. Noy has been receiving occupational therapy twice a week for 30 minutes in school.
I chose to provide Noy with rhythmic movements to improve the integration of her primitive reflexes and to integrate her tonic labyrinthine reflex. Noy enjoyed receiving the first and the third rhythmic movement [from the Brain and Sensory Foundations course]. She participated in TLR integration activities to improve balance and coordination problems, muscle tone and strength, spatial awareness, speech difficulties, motor planning, and walking up and down the stairs with alternating feet. She also engaged in Moro integration activities to improve balance and coordination, shyness, hypersensitivity to sound and touch, attention span, ability to catch a ball, and visual perceptual skills.
After 2 weeks of activities Noy has shown improved processing skills when asked to follow a 2-step directions; she was able to alternate feet with some cues for reminders when walking down the stairs; her vocabulary has improved and she was able to answer questions with 1-3 words; and she was able to maneuver herself through obstacle courses with smoother movements and improved spatial awareness. Noy seemed happier.
After 4 weeks of therapy with continued rhythmic movements, Noy has shown improved bilateral coordination skills evidenced by her ability to alternate feet when walking down the stairs independently and manipulating scissors and paper with both hands with minimal assistance. She has also shown improved social skills and has become more verbal when engaging with classmates and teachers. She still shows some shyness when seen in the hallways and a familiar adult or classmate says hello to her. She has also shown ability to catch and throw a ball with minimal verbal prompts for redirection to the task. Noy is now toilet trained and requires minimal assist in ADLs, which also shows how the rhythmic movements and integration of the primitive reflexes have assisted in this progress.
Working with Noy and helping her integrate some of her reflexes has helped me understand the importance of rhythmic movements and integration of primitive reflexes. Noy is a girl with developmental delays and she is slowly catching up to her appropriate age level as she continues working on integrating her reflexes.
[Edited for length and clarity, emphasis added]