Primitive Reflex Integration Case Studies

Submitted by Molly Barker, M.S., OTR/L

Gavin is a 6-year-old boy on the autism spectrum. He is sweet, talkative, and energetic. I have been working with him for a about a year in my private practice occupational therapy setting. Gavin has a lot of motor planning and coordination challenges – difficulty isolating his limbs/fingers, difficulty learning new movements/activities, difficulty moving his body in a fluid way. He also presents with anxiety, especially around challenging/new activities. Sometimes his anxiety presents as being overly silly. He has behavioral outbursts at home, but not at school.

Since Gavin was young and had difficulty following directions/motor planning, I started with just doing the passive rhythmic movements with him. I had spoken to his adaptive swim teacher who had noted unintegrated Moro [Reflex], TLR [Tonic Labyrinthine Reflex], STNR [Symmetrical Tonic Neck Reflex], and ATNR [Asymmetrical Tonic Neck Reflex] (this was just as I was starting the class and was not comfortable reflex testing yet).

I work with Gavin once a week and have limited face time with his parents. His nanny brings him to sessions, and while I educated her on the rhythmic movements and provided home instructions for parents, it was hard to know if there was home carry over. I expected Gavin’s progress to be slower since I was only sure that I was giving him movements once a week.

I have continued to give Gavin the rhythmic movement exercises [from the Brain and Sensory Foundations course] weekly during our sessions for the last year. I also incorporate playful developmental movement exercises in our sessions – these vary based on the session but we often do belly crawling, puppy stretches, balloon games, crawling games, and we always do roly poly and eagle (I call them popcorn and airplane).

When I first started this program with Gavin, he could not achieve the popcorn or airplane position without significant help from me. He could not belly crawl with use of all of his limbs – he somewhat used his arms but his legs would drag behind him. His throwing pattern was awkward – his hand would turn at odd angles and it wasn’t smooth. He had difficulty pumping a swing.

He got very anxious for any movement activity that had a height component – such as jumping into the ball pit, from a loft into pillows, and trying to move his body between pieces of suspended equipment in an obstacle course.
When I first started the rhythmic movements with him, his body was stiff and tense and his head stayed stationary for rocking in supine. He could not coordinate how to do the windshield wipers – I had to help him move his legs symmetrically. Slowly, with weekly work on this, I started to notice progress. His body wasn’t moving as stiffly during the RMs, and he appeared more comfortable with them.

At first, we only did the RMs for very brief periods – he would often ask to stop quickly and so I only did as much as he could tolerate. Then I started noticing he wasn’t asking to stop anymore. I used to encourage him to nod his head while I rocked him on his back, but slowly but surely he didn’t need this cue anymore. He could do windshield wipers symmetrically by himself! His anxiety around heights lessened somewhat. He was able to throw overhand without twisting his arm, and his accuracy started to improve. His left leg started moving while he was belly crawling.

In our 1:1 sessions he has definitely been less anxious and I haven't seen a big emotional outburst in a while. His nanny also reports that he's having an easier time trying new activities with her. He continues to have some emotional outbursts when he is with his parents (related to things like bedtime, mealtime, getting dressed) but there have been no notable reports of those in the last few weeks.

I started trying to target his pumping a swing with the movements using a modified 5-step balance. He is motivated to be better at this activity and knows it’s hard for him, so I thought it would be a good goal. We did a few sessions where we would start with him pumping the swing, then we would do the rhythmic movements and other developmental movement activities (typically popcorn, superman, and a belly crawl or crawling game). I tried to use movements that specifically target TLR and STNR, as I felt these reflexes was getting in the way of his ability to coordinate his upper body and lower body as needed.

Then, I would guide him through an abbreviated, passive support re-patterning sequence before going to try pumping again. There were no HUGE changes that I noticed, but there were subtle ones. And, he kept asking to do our sessions this way over again. Clearly, something about the modified balance process was working for him. So I added that to our routine – pumping the swing first, completing developmental movements and play activities, modified re-patterning sequence, and then pumping again.

I will never forget the day (just a few weeks ago) when he finally was able to coordinating pumping the swing to actually get the momentum and rhythm to get himself higher! He was so excited and proud of himself. Working with Gavin has been a slow and steady process, and the changes that happened in him were subtle at first and have gradually become more noticeable.

We have a lot more to work on, but it’s exciting to see how reflex work can support him. He is getting to the point where I think we can start trying isometric activities soon, and I am excited to see where that leads him.

[Edited for length and clarity; emphasis added]