Primitive Reflex Integration Case Studies

OT uses neuro-sensory-motor intervention to address root causes of client’s low motivation, aversion to physical challenges, and gravitational insecurities

This young girl with anxiety and sensory processing challenges struggled to know where her body was in space. Her balance, coordination, and posture were poor, and she avoided physical activities. She had a tendency to be very rigid, and needed high-levels of encouragement to engage in tasks. See how her occupational therapist used rhythmic movements and reflex integration from the Brain and Sensory Foundations course to help with all of these issues.

Submitted by Cheuk Yan Wong, Occupational Therapist

Client Background 

SY is a 4-year, 9-month-old girl attending a mainstream K3 kindergarten. She presents with a small physical build, congenital ptosis, and long-sightedness. While generally cooperative, SY demonstrates low motivation and significant avoidance of physical challenges, often resulting in tantrums or refusal to participate. She requires substantial positive reinforcement to engage in even mildly challenging tasks.
Initial Observations and Challenges: SY exhibits generalized weakness in oral-motor, limb, and core strength. This manifests as:

• Oral-Motor: Constant drooling and unawareness of food residue; messy eating.
• Posture: Poor sitting posture and slumped back.
• Motor Planning: Clumsiness with utensils and poor bilateral coordination.
• Sensory Processing: Significant vestibular and proprioceptive issues, including a fear of heights (swings, slides) and difficulty navigating stairs.
• Spatial Awareness: Frequent falling, bumping into objects, and difficulty organizing her body in space.

Clinical Rationale and Intervention

Based on these observations, the following reflexes were targeted for integration:

• Moro & Fear Paralysis (FPR): Targeted to address SY's emotional "freeze" response, her extreme inflexibility to try new things (especially those off the ground), and her tendency to be very reserved.
• Asymmetrical Tonic Neck Reflex (ATNR) & Tonic Labyrinthine Reflex: To address poor balance, weak core strength, and difficulties with visual-motor tasks like diagonal line writing.

Treatment Progress and 5-Step Balance process

We have worked together for 2 months, have had 6 sessions and each lasted for 1 hour. Mother joined in the sessions and a movement log was given for them to practice at home. SY engaged in a movement program consisting of the Brain Tune Up and Rhythmic Movements [from the Brain and Sensory Foundations course]. To increase engagement, a "snowball" game was used where SY drew out a crumpled “snowball”, with written reflex activities in it, from a bucket, providing her with a sense of control and fun.

She enjoyed the movements, and passive integration was done for the reflexes. We implemented the 5-Step Balance process [from the Brain and Sensory Foundations course] during the 6th session. SY expressed a desire to use the bolster swing without falling, a task she previously avoided due to poor core stability and vestibular insecurity. We went through the 5-Step Balance process, and afterwards SY successfully completed a previously unattainable task on the swing three times consecutively. Despite her core appearing slightly slouched, she maintained her center of gravity on the swing without falling. On the third trial, she tolerated slight linear movement (pushing by OT) while successfully hitting the target. She ended the session smiling with confidence.

Results and Improvements

• After 12 weeks of consistent practice, SY demonstrated the following improvements:
• Physical: Improved accuracy in beanbag tosses and enhanced postural stability during motor tasks.
• Functional: Increased awareness of her body in space and the ability to write diagonal lines (improved directionality).
• Behavioral: A significant reduction in "fear of the new." She is now more willing to participate in therapy activities with simple encouragement.
• Social/School: The school reported a major milestone: SY is now willing to go on stage and stand on the choral riser with her classmates for graduation rehearsals, representing a breakthrough in her vestibular confidence and social participation.

What I Learned from working with SY

Working with SY has been an eye-opening experience regarding the foundational role of primitive reflexes. I learned that her "stubbornness" or "lack of motivation" could actually be a physiological protective response to unintegrated reflexes. By focusing on the neuro-sensory-motor, I witnessed a child move from a state of fear to one of active participation. This case reinforced that when the body feels safe and the reflexes are integrated, a child's natural desire to explore and succeed can finally emerge.

(Edited, emphasis added)