Primitive Reflex Integration Case Studies

Submitted by Rebecca Quinn, OTR/L, SIPT-C

On October 3, 2022, my 12 y.o. daughter suffered a serious concussion (mTBI) during a volleyball game. Another player collided with her head to head and the force of the collision knocked her backwards where she also hit the back of her head on the gym floor. Initially, Michaela complained of not being able to see very well out of her Right eye – the other player’s glasses had hit her under her orbital ridge – although her eyeball looked to be free of physical injury. By the next day, she was experiencing a severe headache, dizziness, blurred vision and vomited at school. She was seen by her pediatrician that afternoon and diagnosed with a significant concussion. She had poor balance, light sensitivity, sound sensitivity, blurred vision, nausea with vomiting, a marked nystagmus and difficulty coordinating her eyes. Her pediatrician recommended some school accommodations and rest along with OTC pain relievers.  OTC pain medications did little to help with her severe headache and she continued to vomit if she got out of bed. She also had memory issues and could not concentrate. I brought her to the ER the next day and she received a CT scan which was normal. She was treated and released with a referral to see a Concussion Specialist.  A week after her accident, she saw the Concussion Specialist who recommended ½ days of school and many accommodations for her school work.

• During her absence from school, Michaela developed significant anxiety about returning to her daily school routine and being able to meet her teacher’s expectations for her schoolwork. Prior to her accident she had a 100% average in all of her classes (advanced math and science and was a year ahead in ELA) and was a very organized and driven student. 
• Initiated Rhythmic Movements (RM) [from the Brain and Sensory Foundations course] with her
  • I facilitated RM 1, 2b and 3 while she did #4 independently. She was pretty much in bed or on the couch most of the time. Michaela reported a decrease in the intensity of her headache while we were performing the movements although it did return once the movements stopped.
  • Since she found it to be helpful, we did the movements 2-3x day.
  • She stayed home for 2 ½ weeks before she could tolerate a ½ day of school.
    • • During that time, her headache slowly decreased in intensity however remained significant.
      • She continued to report relief from the RM so we continued to perform them at least twice a day.
      • We also pursued a vision assessment with a Neuro-Optometry doctor and light therapy was started with
      • Michaela reporting significant relief from her headache after using the light.
      • Special prism glasses with a blue tint were recommended
      • Recommended by the Concussion Specialist to receive vestibular PT intervention.
• Her headache stayed severe and was between a 7-8 daily with little relief from pain medications.
• • She now was having difficulty concentrating, retrieving thoughts, reading text and was experiencing foggy thinking. 
  • Began incorporating 5 Step Balance with Support Repatterning Sequence [from the Brain and Sensory Foundations course] embedded at least 2x week sometimes 3x.
• Began vestibular PT 1x/week with daily exercises for head righting and equilibrium responses – these made her very nauseous and dizzy almost to the point that she did not want to do them
  • Performed Brain Tune up activities before PT exercises to help prepare and ground her body and after PT exercises, performed RM to soothe brain irritation and promote organization as well as overall well being
  • She reported this helped with her dizziness, nausea
• Began vision therapy 1x/week for convergence insufficiency with exercises 4-6x week which also included reflex integration work with the ATNR. Began wearing prescription glasses during the day (never needed glasses prior to injury)
  • Activities sparked headaches
  • After vison therapy, would experience rebound headaches that could be very severe and occasionally prevented attendance at school the next day
  • Followed procedure we used for PT – Brain tune up prior to exercises and RM after exercises along with light therapy
    • She reported this helped with the intensity of her headaches
• Given interventions, Michaela symptoms improved significantly over 2 months
  • Less intensity of headaches
  • Less sensitivity to light/sound
  • Improved concentration
  • Less mental fogginess
  • Able to tolerate full day of school
  • Continued to excel academically
  • Able to return to playing her instrument (saxophone) and participate again in school band
• As of this writing (1/3/23), Michaela is scheduled to be discharged from vestibular PT this week
  • She no longer has a headache! Headache finally subsided 2.5 months after injury Able to exercise without symptoms
  • Vision issues with clarity and tracking have resolved
  • No longer has reading difficulties
  • She feels 99% back to her regular self
• Appointment this week with the Concussion Specialist and hopefully will be cleared to participate in physical activities again including PE
• Continues with vision therapy 1x/week however we expect this to be discontinued soon

I am very thankful I was taking this [Brain and Sensory Foundations course] when her injury occurred! It was terrible feeling so helpless when her symptoms were severe. Seeing her in significant pain and struggling to perform everyday activities was almost more than I could bear at times however I had to keep a positive outlook, support and encourage her through it. Using the Rhythmic Movements and 5-Step Balance Process allowed me to help her feel better and it made me feel useful in contributing to her recovery – especially in those first few weeks before her therapies began. 

Thank you, Sonia, for developing this course and sharing it with everyone! I sincerely believe these interventions, along with her therapies, helped my daughter to endure and overcome her injury. 

Also, in my school-based practice, I see the improvements and gains my students are making and I am so glad to be providing them with something that will truly address their needs! I had always seen retained primitive reflexes in my students however before now, I had little resources to rectify them. Thank you again!

Respectfully Submitted

Rebecca Quinn, OTR/L, SIPT-C

Edited, emphasis added