Rhythmic movements and primitive reflex integration help a preschooler progress from gravitational insecurity to confident movement (and more)!
See how a school-based physical therapist used tools learned in the Brain and Sensory Foundations program to help a 4-year-old girl with walking, posture, and speech.
Submitted by MacKenzie Robbins, Physical Therapist
| Before | After |
|---|---|
| Demonstrated gravitational insecurity and fear of movement | Walking and moving more confidently |
| Hunched over posture | Walking with a more upright posture |
| Took small steps when walking | Taking much bigger steps |
| Refused to walk up steps, instead choosing to crawl | Walking up stairs independently, occasionally using a reciprocal gait pattern |
| Unable to stand on one foot | Can stand on one foot for 5 seconds |
| Unable to jump | Can broad jump forward 10 inches |
| Very quiet and shy; would barely speak during sessions | Talking the PT's ear off during sessions; chatting in the hallways |
| Demonstrated startle response when not supported by PT during movements | Able to complete the movements independently |
I am a physical therapist in a local school district and Caroline was a 4-year-old preschool student at my school. I have worked with Caroline for 6 months and I am amazed with how far she has come with her confidence and skills.
At the beginning of our time together, Caroline demonstrated many gravitational insecurities and fear of movement. She was very cautious when she walked and had a hunched over posture and took small steps when walking. In our therapy room, there are large floor mats on the ground that have a 1.5-inch lip or edge on them that you must step up on to get onto the mat. When Caroline first started, she would not step up onto the mat; instead, Caroline would slowly drop onto her hands and knees and crawl onto the mat and then stand up again. She would also crawl over the .5-inch gap between floor mats as she was too anxious to step over it. Caroline was unable to stand on one foot, jump, or negotiate stairs due to her anxiety and fear of movement and all these skills were included in her goals for the school year. Caroline was also a very quiet and shy girl that would barely say any words in our sessions.
I noticed that Caroline would startle easily with loud sounds and changes in body position, which led me to believe that she had a possible unintegrated Moro reflex. I started by introducing the Brain Tune up sequence [from the Brain and Sensory Foundations course] to help her body and brain get ready for movement. She required help and modification due to her balance difficulties and anxiety. I then started to slowly introduce movements, including supine flexion and prone extension, to help integrate the Moro reflex over many sessions.
When completing these movements for the first few sessions, Caroline required maximal physical assistance to achieve the movement. When attempting supine flexion specifically, she would demonstrate a startle reflex if she felt that I was attempting to remove some of the assistance, even if it was the slightest amount. So, I took a step back and made sure that she was consistently comfortable in each position with whatever amount of assistance she needed. Over the coming sessions, I was able to start decreasing some of the assistance and eventually, she was able to complete the movements independently. This is when we added in the Moro movement patterns. She really enjoyed them at this point! We were able to start adding these movements into games and start completing some isometrics [from the Brain and Sensory Foundations course] in these positions to help further integrate the reflex.
After working with these positions, I started to notice very positive changes. She was starting to walk with a more upright posture and hold conversations while she was walking in the hall. Before long, she was able to talk your ear off for the whole session! She was now taking much bigger steps in the hallway when walking and would even do a fun little body sway side to side while walking.
She started to be more interested in the therapy equipment in the room and would want to try the different swings and was even requesting to jump on the trampoline. She was then able to walk on a balance beam with one handheld. She was starting to demonstrate the ability to gallop as well. The most amazing part was to see her improvement in skills with jumping, stairs, and single-leg balance. She was able to stand on one foot for 5 seconds, walk up stairs independently using a non-reciprocal gait pattern and even using a reciprocal gait pattern occasionally, and broad jump forward 10 inches. All these positives were seen from her whole team including the speech therapist, classroom teacher, and parents!
When working on Caroline’s jumping skills, I used a modified version of the 5-Step Balance Process. [from the Brain and Sensory Foundations course]. I simplified the 5-Step Balance Process due to Caroline’s age and developmental stage. We both talked about the goal of jumping from a red dot to a blue dot. We acted out the goal by having a stuffed bear “jump” from the red dot to the blue dot. We completed the integration of the Moro reflex because she was familiar with it and enjoyed it! We then had her jump from the red dot to the blue dot (about 10 inches apart) and she was able to do it with a mature pattern and with confidence!
[Edited for length and clarity; emphasis added]