Primitive Reflex Integration Case Studies

Less clinginess and toe walking, fewer outbursts, better transitions and feeding after rhythmic movements and reflex integration

This toddler struggled with a wide array of sensory-motor, behavioral, emotional, and sleep issues. Tantrums were common, he exhibited toe walking and delayed speech, and only ate a narrow selection of foods. After just one month (6 sessions with the therapist) of rhythmic movements and reflex integration activities from the Brain and Sensory Foundations course, he showed global improvements—including sleeping through the night for the first time.

Submitted by Jenna Duvall OTR/L, ACN

Jason is a 19-month-old child diagnosed with autism spectrum disorder. His development has been challenged by several reflex patterns, including the Fear Paralysis reflex, Moro reflex, and TLR [Tonic Labyrinthine reflex]. He faces significant developmental hurdles, including delays in speech and movement, hypersensitivity to various stimuli, and emotional dysregulation. These issues manifest as clinginess to his mother, excessive drooling, and chronic sleep difficulties and frequent tantrums that include biting and hitting.

Challenges:

At the onset of therapy, Jason presented a range of difficulties:

Communication and Speech: Jason demonstrated delayed speech, making it challenging for him to express needs and feelings.

Movement: He engaged in toe walking and exhibited difficulty following directional or movement instructions, which impacted his ability to participate in play activities.

Sensory Sensitivities: High sensitivity to sound, touch, and visual stimuli resulted in feelings of overwhelm and frequent emotional outbursts.

Behavioral Responses: Jason’s low tolerance to stress and challenges with transitions made everyday activities perplexing for both him and his mother.

Gross Motor Skills: Poor core strength hindered his ability to engage in physical play and participate actively in therapy.

Assessment:

A comprehensive neurodevelopmental assessment revealed positive signs for retained primitive reflexes, specifically:

•     Moro Reflex
•     Fear Paralysis Reflex
•     Palmar/Babkin Reflex
•     Asymmetrical Tonic Neck Reflex (ATNR)
•     Symmetrical Tonic Neck Reflex (STNR)
•     Spinal Galant

These challenges created a need for a tailored therapeutic approach that focused not only on Jason's physical and sensory needs but also on emotional support for both him and his mother.

Integration:

An individualized occupational therapy treatment plan was created for Jason that spanned several key interventions:

1. Rhythmic Movements: Implemented on a weekly basis, rhythmic movements [from the Brain and Sensory Foundations course] were designed to help integrate Jason’s reflexes and bolster his motor skills. He allowed both therapist and mom to perform these exercises with him, appearing calm with good eye contact while these exercises were fulfilled.

2. Education for Caregivers:  Jason’s mother was educated about the importance of these exercises and how they could be incorporated into their daily routines. While implementation was initially inconsistent, ongoing support and encouragement provided her with the tools needed to reinforce therapy practices at home.

3. Play-Based Integration: we fostered an enjoyable and responsive environment for Jason by incorporating several of the playful reflex integration activities [from the Brain and Sensory Foundations course].

4. Sensory Strategies: We introduced strategies to manage Jason’s hypersensitivities and emotional responses, including calming techniques and sensory breaks to help him navigate overwhelming situations.

Progress and Outcomes:

After a month of therapy, Jason demonstrated notable improvements:

- Enhanced Communication: While speech skills took time to develop, Jason began to express preferences and engage in non-verbal communication, including gestures and sign language. He also began to vocalize more consistently in attempts to communicate. Soon after, words began to develop.

- Improved Motor Skills: His toe walking lessened and he showed better coordination and physical engagement during activities, demonstrating increased core strength and stability over time.

- Behavioral Regulation: Jason began managing transitions more effectively, showing reduced clinginess to his mother and a decreased frequency of emotional outbursts. He exhibited newfound resilience in the face of sensory challenges, leading to reduced feelings of overwhelm. Mom also reported he was sleeping through the night without interruption which he had not done since birth. He also began trying new foods which had been a significant challenge previously. Jason was a problem feeder with a very limited repertoire of foods he would eat prior to treatment.

- Family Engagement: Through continued education and consistency in implementing reflex activities, Jason’s mother reported higher confidence in managing his daily routines and a stronger bond with her son during play.

Conclusion:

Jason’s treatment is ongoing, however, over the past 6 sessions he was given 5 minutes of rhythmic movement exercises each session with the remainder of his 60-minute session using play activities to help integrate retained reflexes. A total of 360 minutes has been dedicated to using the tools from this [Brain and Sensory Foundations] course, with sessions continuing.

While working with Jason, it has been eye opening to see how the rhythmic movements impact the nervous system and bring calm, focused engagement between the child and provider. Mom reported that Jason remained calm and better regulated after the exercises were performed. Sleep also improved with fewer nighttime waking. Some play activities had to be modified to adapt to working with a toddler who did not always mimic or follow directions. For the most part, these sessions were meaningful not only for Jason and his mom, but also for the therapist because his engagement and regulation was so noticeably improved.

(Edited, emphasis added)