Primitive Reflex Integration Case Studies

Submitted by AT, OTR/L

AP is a bright 13-year-old male with no history of surgery or major illness. He was born via vaginal birth with no known complications. He is reportedly independent in all ADLs [activities of daily living] but is reported to have difficulty with completion of IADLs [instrumental activities of daily living] in respect to initiation and awareness and is reported to frequently engage in his ADLs with clumsiness, messiness, and poor attention. Client reports that he has difficulty with engaging in non-preferred activities, sitting still, and with balance based activities. He reports that he contributes much of his balance concerns to weakness and an injury to the left lower extremity at the ankle which ‘never fully healed’. He was observed to have difficulty with maintaining balance on one foot using both lower extremities and often assumed a slouched posture. He was observed to utilize a variety of pencil grasps including a thumb tuck grasp and 5 finger grasp with ulnar side pointing down. 

Upon checking AP’s reflex stimulus responses he appeared to have an unintegrated asymmetrical tonic neck reflex (ATNR) as his arms slightly followed his head with stimulation as well as changed vertical height. He also had a very strong reaction to the Babinski reflex check, becoming very unsettled and demonstrating the classic big to dorsiflexion with other toes fanning out. At first his head righting seemed typical, however, during observation during IADLs and when ‘swirling’ the patient during the check, he did not appropriately right his head when tipped laterally. AP was regularly worked with over the course of 4 weeks 2x/week for 30min, for a total of 8 sessions. He engaged in reflex integration, rhythmic movement, heart-brain connection and 5-step balance process [activities from the Brain and Sensory Foundations course] during his occupational therapy sessions.  AP has very involved parents who assisted in carryover and consistent practice of the reflexes and rhythmic movements in the home, as well as encouraging AP to participate in the movements independently. 

Initially, AP had difficulty maintaining a rhythm during rhythmic movements. He initially participated in the activity with a game-like nature; determined to move to the beat more independently and accurately. Providing additional tactile, auditory, and visual cues was helpful. Using a mirror, songs with consistent beat that he found motivating, putting a toy on top of body parts that were not supposed to be moving excessively and constant encouragement were effective supports. 

Due to difficulties with pencil grasp, poor writing, fatigue with fine motor/writing based activities, and previously mentioned difficulties with balance and posture, focus on stimulating and integrating the grasp and palmar, ATNR, Babinski, and head righting reflexes were focused on, however he went through game-play and movements related to all the reflexes from this [Brain and Sensory Foundations] course both to practice for the treating therapist as well as for the potential positive benefits to the client. 

AP set a goal for himself to be able to participate in handwriting based activities with more positivity and enjoyment. AP worked to utilize the 5-step balance [from the Brain and Sensory Foundations course] during OT sessions. He was open to going through the process, but during the first attempts he reported feeling silly and childish. When re-visiting how he felt both after participating in the second acting it out as well as after participating in the true activity of writing, he reported feeling more confident and comfortable with his writing. This moment of clarity to the effects of positive thinking then lent itself to an open discussion of the heart-brain connection and positive thinking overall. AP was still hesitant and reserved in his engagement of the 5-step balance process, but was willing to engage thoughtfully in a private space. Overall, AP reported that he found the heart-brain connection and 5 step balance process centering and positive. It is worth reporting that during the active engagement in writing activities, AP required fewer cues for initiation and completed his work with increased attention to task.

During the fourth week AP demonstrated significant changes in his attitude towards participating in otherwise non-preferred writing tasks. AP also demonstrated improved ability to stand on one foot with hands on hips. Initially he was able to stand for an inconsistent 7 seconds. Following reflex integration activities he was able to hold his balance on one leg for over 12 seconds. 

It is worth noting that parents stated he has started Karate classes for the last 2.5 weeks as well. AP’s parents reported major changes in the home with respect to his patience with activities, his ability to sit still and attend, his willingness to complete homework, and most notably the organization of his room. AP stated that he’s been feeling stronger. His parent also reported that he has seemed less clumsy in the home. 

Though there are many factors that likely influenced AP’s development, parents report that they noticed him more focused following his rhythmic movements and reflex integration activities [from the Brain and Sensory Foundations course]. They also felt that having a routine time in which they participated in them together made for a more structured daily schedule and provided more ‘known factors’ during the day as well as bonding time. 

Parents plan to continue incorporating these movements and processes into their daily routines. AP’s mom even said that she has been participating in the rhythmic movements as of recently and has been enjoying the sense of calm and bonding with her son she gets from them! It was very nice to see that people of all ages and abilities can benefit from these movements. 

[Edited for length and clarity, emphasis added]