# Primitive Reflex Integration Case Studies

##  Parents and Therapist Impressed with 5-YO Boy’s Large Improvements in Short Time

   September 05, 2023

## Reflex integration and rhythmic movements help with motor delays, attention deficits, and impulsivity

After just 12 weeks of rhythmic movements and reflex integration, this little boy went from delayed fine motor skills to being on target for his age. He also showed much better attention and bilateral coordination, and his impulsivity had greatly reduced.

Submitted by Kristen Furnari, MS, OTR/L

![Giggling boy cuddling with mom. Text: Fine-motor improves to age-expected level.](https://moveplaythrive.com/images/2023_Case_Studies/CS_KrFu_M.webp)

 | Before | After |
|---|---|
| Delayed fine motor skills | Fine motor skills improved to age-expected levels |
| Struggled with attention | Attention greatly improved; able to participate in an adult-directed activity for 25 minutes |
| Difficulty with gross motor skills, specifically bilateral coordination and balance | Bilateral coordination is improved; able to complete jumping jacks, cross midline comfortably, and use non-dominant hand to stabilize paper or a toy |
| Struggled with impulsivity | Now much less impulsive |

Mario is a sweet 5-year-old boy who struggled with attention and impulsivity. I worked with him over a 12-week period with 1 session a week. When I first started to see Mario, he presented with delayed fine and gross motor skills, difficulty with bilateral coordination and balance, neck and shoulder tension while writing and completing fine motor tasks, and impulsivity. After talking to his family about his challenges at home and in community, I tested his primitive reflexes and noted ATNR \[Asymmetrical Tonic Neck Reflex\] and TLR \[Tonic Labyrinthine Reflex\] were significantly retained.

Over the next 2 weeks, I introduced rhythmic movements to the family and started each session with completion of rhythmic movements. During the first week, Mario was able to tolerate each rhythmic movement for 5 seconds. I then taught the parent how to carry over these movements in the home. I quickly found out that the family was struggling to carry the movements out, due to not having hands on experience with me present. Therefore, I sat down with Mario and his family and had his mother practice the rhythmic movements prior to leaving that session. **Within 2 weeks, Mario was able to tolerate 20 seconds of passive rhythmic movements** \[from the [Brain and Sensory Foundations course](https://moveplaythrive.com/index.php?Itemid=362 "In-depth, comprehensive, primitive reflex integration CEU course")\] **and his relaxation and enjoyment was observable during each movement.**

After 2 weeks of rhythmic movements, I started to introduce ATNR and TLR playful movements with Mario. I chose to work on these two reflexes first, as this was where I saw most of his challenges during testing and learned from the course that it is recommended to integrate ATNR and TLR prior to working on STNR \[Symmetrical Tonic Neck Reflex\]. Throughout the session, Mario engaged in play activities \[from the Brain and Sensory Foundations course\] to work on integration . . . Parents demonstrated good carry over with the playful development home recommendations.

By week seven of working with Mario, I started to incorporate the 5-Step Balance process \[from the Brain and Sensory Foundations course\]. We started each session with having Mario or his parent pick a goal for the day. Almost all of the goals were related to integrating the reflex and completing play activities related to the reflex. Mario almost always showed improvements with being able to engage in the goal or play activity afterward. I found the 5-Step Balance easy to implement with him and the carry over very successful.

At the end of the 12 weeks, **I found that Mario’s attention and impulsivity greatly improved from the first session. He was able to participate in an adult-directed activity for 25 minutes, his bilateral coordination improved, as he was able to complete jumping jacks, cross midline comfortably, and use his non-dominant hand to stabilize paper or a toy, and his fine motor skills improved to age expected skills.** There was some tension still noted in his neck and shoulders during fine motor activities and some balance challenges still observed. However, **parent verbalized how happy she was with his improvements in such a short time** and confirmed that she felt comfortable with being able to carry over the learned material at home, to continue to work with Mario. As a clinician, I was not expecting such large improvements and growth in such a short time period, and was just as impressed and happy with Mario’s results.

(Edited, emphasis added)

- [ Balance & Vestibular Issues ](https://moveplaythrive.com/case-studies-conditions/balance-and-vestibular-issues)
- [ Gross Motor Skills ](https://moveplaythrive.com/case-studies-conditions/gross-motor-skills)
- [ From Occupational Therapy Professionals: ](https://moveplaythrive.com/component/tags/tag/case-studies-from-ots)
- [ ADHD & ADD ](https://moveplaythrive.com/case-studies-conditions/adhd-and-add)
- [ Behavior ](https://moveplaythrive.com/case-studies-conditions/behavior)
- [ Fine Motor Skills ](https://moveplaythrive.com/case-studies-conditions/fine-motor-skills)
- [ Preschoolers ](https://moveplaythrive.com/case-studies-conditions/preschoolers)
- [ 5-Step Balance ](https://moveplaythrive.com/component/tags/tag/5-step-balance-case-studies)