Primitive Reflex Integration Case Studies

Life-Changing Results for Teen with Cerebral Palsy and Trauma History

This 13-year-old with cerebral palsy and an extensive trauma background would constantly attempt to bang his head on any surface he could find. Even with intervention and wearing a helmet he regularly experienced bruising and swelling. After receiving rhythmic movements and reflex integration from the Brain and Sensory Foundations, First Level course, his head banging was nearly eliminated and he could use his gait trainer far more easily.

Submitted by Ashley Kahila MOT, OTR/L, c/NDT

Junior is a 13-year-old boy diagnosed with cerebral palsy. Birth history is unknown as he was abandoned at 2 years old. He initially resided in a typical orphanage setting until the model of care transitioned to simulate a more stable, consistent home setting. He still has experienced a lot of difficult transitions of house parents, kids transitioning to forever homes, and many child deaths. He has a significant history of trauma. His functional presentation: He sits independently and is able to pull himself into chairs; however, he does not stand or walk independently. He shows weakness and instability at the hips, knees, and ankles. He requires constant supervision due to banging his head on any surface he can find and if not supervised, he will bang his head 24/7. Even though he wears a soft helmet, he frequently experiences swelling in the face and head at times due to the head banging. When standing/walking with assistance, he constantly moves his head in all directions and often displays forward flexion of the waist to attempt to locate a surface to bang his head on or to attempt to drop to the floor. His head movements will increase in speed and the banging will become more aggressive when it appears he is under stress or overwhelmed; however, he bangs his head even when appearing to be in a calm state. In addition, he constantly has a hand in his mouth. He thoroughly enjoys attention and hugs from others. His caregivers expressed the following as priority goals: stop banging his head, stand independently, walk using a gait trainer or walker.

Tools from the [Brain and Sensory Foundations] course used while working with this child included:
Rhythmic movements–I feel given his history along with seemingly being “stuck” in a high stressed state with difficulty calming the nervous system and showing delays in motor skills that going to these foundational, core movements were vital prior to implementing other techniques. Rhythmic Movements were completed passively.

He showed great toleration for the majority of the rhythmic movements with the exception of rhythmic movement #2a, he tolerated 2-3 repetitions prior to sitting up and not wanting to return to the position. Due to his response, we skipped it for a few sessions and then slowly reintroduced the movement, and over a week later, he was able to complete 30 seconds of the movement prior to sitting up. With the other positions, he was always smiling and excited to complete once we found the right speed and rhythm.

The reflex work was completed slowly as he often pulled away from the stimulus as well as the integration activities. Another sign of poor toleration the first week was increase vigorous shaking of the head, more vocal noises and frequent attempts to hit head. By week 2, these behaviors had significantly decreased and by the third week, the behaviors had stopped.

After 1 week, he showed progress and after 2 weeks, he tolerated all reflex activities completed. I had started with Moro and Fear Paralysis [from the Brain and Sensory Foundations course]. I also did some Babkin due to always putting his hand in his mouth as well as releasing some stress hormones stored in the palms, and some of the foot reflexes were used as well. All reflexes are conducted passively as well as the rhythmic movements. When attempting to get some active movements, it is difficult. Carryover in the home is not consistent—the home is set up with 1 house parent and a rotation of 5 nannies. There are 3 other total care kids in the home as well. I do limit what I hand the nannies as it is hard to determine if they will recognize/understand signs of distress. Regardless, he responds very well to the rhythmic movements and reflex integration.

A big take away from working with this child was always to ensure to stay aware with the child’s whole body and being able to notice the small reactions and the small changes. Another was to ensure work was being done at the pace the child was controlling. I feel I tended to try to go through activities too quickly which was too much for his system. Once I slowed down and really focused in on his reactions, I was able to adjust to meet his needs in the moment.

We also did a 5-Step Balance, with the goal for him to take 10 steps while in gait trainer providing without attempting to bang his head on the gait trainer. When he acted out the goal the first time, he took 1 step and then showed forward flexion attempting to hit his head and then trying to drop to the floor. After the balance when he acted out the goal he pushed through his feet independently to stand in the gait trainer and took 5-6 steps prior to displaying forward flexion of the trunk.

Significant progress was observed using the tools from this [Brain and Sensory Foundations] course. The first day his lips, nose and around his eyes had swelling. His forehead had visible discoloration from bruising. When we attempted to walk in the gait trainer, he would not push through his feet to hold his body weight and once he did, he immediately leaned forward and starting hitting his head on the gait trainer. Within a week, the swelling in his face had visibly reduced and he was able to stand in the gait training for a longer period of time. His caregivers reported a significant decrease in head banging. By the end of the 3rd week he had stopped banging his head almost completely and was able to spend time out of his helmet, he had minimal swelling and he was able to stand upright in the gait trainer with improved eye contact, engagement, and no attempts to hit his head [while in the gait trainer]. He was also able to walk significant distances in the gait trainer with only assistance to start the movement forward.

I was able to work with him for 3 weeks, 5 days a week for 1.5-2 hours a day.

(Edited, emphasis added)