Rhythmic movements and primitive reflex integration bring peace in the home.
This occupational therapist worked with the children's mother to help these three siblings diagnosed with ASD. The mother's overall goal was to stop the frequent and aggressive fighting among the three children at home. See how rhythmic movements and primitive reflex integration made a difference for these siblings. Conflict among them was greatly reduced and each made progress with significant developmental challenges.
Submitted by Angela Preston, Occupational Therapist
| Before | After |
|---|---|
Nick, age 9
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Nick
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Alex, age 7
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Alex Marked improvements in:
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Leah, age 5
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Leah Marked improvements in:
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I chose this family as my case study, Nick, Leah and Alex, due to the significant impact of the innate rhythmic movements (RM) and reflex integration on the whole family. The siblings each presented differently, with similar ASD diagnoses, with the mother advising that overall, her goal was for them to stop the significant and aggressive fighting amongst themselves that occurred constantly at home.
Heart connection [from the Brain and Sensory Foundations course] was done at every meeting and a lovely rapport was developed early on, making therapy a joy for all, with lots of laughter.
Nick, age 9
Nick is diagnosed with Level 2 ASD with severe written expression and below average receptive language difficulties.
When I first saw Nick on the playground, he was watching the children play on the monkey bars and equipment, and I saw a longing look in his eyes to participate. (I asked my therapy manager if I could fit him in for therapy and we found space).
Nick had forceps delivery at birth, didn’t like tummy time, and had toilet training trouble up to 5 years. Nick demonstrated significant tone issues and reduced muscle strength that was often evident. His gross-motor skills were well below average. At recess and lunch time he spent his time in the library doing sedentary activities, computer based. Nick had very little funding and I have only seen him a few times, doing an OT assessment in Jan 2021 and then 3 school-based therapy sessions (1 per month). However, many of the interventions for his siblings (see below) were transferable, including Rhythmic Movements and reflex integration activities. Nick has been doing the RM with his siblings since October, Mum advised not every day and not all movements, however fairly consistently.
In January, Nick came into a session we had planned for Leah, as the mum asked if I could observe the sibling interactions. I noted that Leah was very bossy towards Nick, who has a passive personality, with Leah shouting at him and generally being bossy. They were both in a heightened state and the session was difficult. I decided to do the 5-Step balance with RMs [Rhythmic Movements] and the Moro reflex integration [from the Brain and Sensory Foundations course]. Both children calmed down immediately. Then the children sat down and happily shared an activity of completing an alphabet puzzle, which they both did joyfully. The mother was amazed how well they worked together, as Leah and Nick could rarely achieve any mutual activity together, without fighting. The mother noted how Nick was walking better. Now that Nick was doing movements with his siblings, everything was better, as he is now sleeping better. Mum also does the RMs and said that when doing the RMs, “you can’t think of anything and its really calming.”
Overall, with only RMs and some Moro reflex integration, Nick now presents with reduced flicking of fingers, he can now reach the top of the climbing rope independently after 4 weeks. Sibling fighting at home has significantly reduced and they can play together, predominantly well. Nick’s gait has improved, and his mother has noted that he walks with more fluidity.
| Before | After |
|---|---|
| Frequent and repetative finger flicking | Reduced flicking of fingers |
| Longed to climb to the top of a playground rope, but was unable | Able to reach the top of the climbing rope independently |
| Poor gross-motor skills | Improved gait; walks with more fluidity |
Alex, age 7
Alex and his sister started therapy 2 weeks apart in August 2020. Alex’s therapy to date has consisted of 13 fortnightly school-based sessions. I was unable to do RMs at school due to his mum not being there and we do not do any hands-on therapy when we are alone with the children. Therapy was based around reflex integration, using reflex activities at school and some holiday sessions where possible. At the initial assessment at end of August 2020 the rhythmic movements were demonstrated to the dad.
Level 1 ASD, moderate speech delay and motor difficulties. Normal birth, some delayed milestones, did not enjoy tummy time. Didn’t crawl for long. Alex presented with significant reduced attention and difficulties with concentration. He was easily distracted and struggled with self esteem which he compensated for by "showing off" at any available time. His gross-motor skills in most areas were below average and with reduced tone and overall strength. He chewed on everything and was reported by his father to have reduced safety awareness on the road in the community.
Reflexes chosen were:
- Moro [Moro Reflex]
- TLR [Tonic Labyrinthine Reflex]
- ANTR [Asymmetrical Tonic Neck Reflex]
- STNR [Symmetrical Tonic Neck Reflex]
- Hand reflexes
RMs were done initially for about 4 weeks (by all 3 siblings) Moro reflex isometric passive exercise was done intermittently where I could. During each fortnightly session, integrative activities were done [for reflex integration].
At school, Alex’s new teacher advised me that he did not see any of the issues mentioned in the August 2020 report and that Alex was a fantastic student with average skills in all areas, especially writing and focus!
| Before | After |
|---|---|
| Alex could not hold his attention for more than a few minutes, always looking left and right and requiring lots of prompting to remain on task. | During therapy, and as reported in the classroom by his teacher, Alex can maintain his attention and concentrate to complete tasks in a timely manner at age-appropriate level. |
| Could not stand on one leg for more than 5 seconds (hands waving all over the place and wobbling). He was unable to master the monkey bars (could not hold on longer than a few seconds). Struggled with running (awkward) and reduced participation in team sports and school carnivals. | Can now do a fantastic cartwheel, run, jump, and walk on balance obstacle course with increasing skill. He can stand on one leg with hands on hips for 20 seconds, both legs. He can complete the monkey bars at school with increasing speed, strength, and accuracy (very proud of himself – this was a goal). Alex now enters all school carnivals, doing well. |
| Could not catch a medium-sized soft ball. | Can now catch and throw a tennis ball with both hands with great accuracy (unilateral improving) and play hand ball with friends. |
| Worried about everything, no self-confidence. | Lower anxiety levels; demonstrating improved capacity to remain calm and think through situations. |
| Impulsive; would do random movements and run here and there during the playground-based therapy. | Rarely acts impulsively; can stay focused on task. |
| Could not identify or write the alphabet. | Can write well-formed letters. |
Leah, age 5
Leah was diagnosed with Level 1 ASD, developmental delay (gross motor). Leah did not crawl at all with delays in all developmental milestones, including speech. Leah was referred for assistance with sensory processing, behaviours, social skills, motor planning related to fine motor skills for self-care (feeding, dressing). She had no tolerance to play with siblings at home.
The RMs were implemented from the start, with the children’s mum advising she was doing them as ‘much as possible’, at least 4 – 5 times per week for Leah.
I started working with Leah and Alex in late August 2020 and they started almost immediately with the RMs. By the time I got to see them in their school environments we began with the reflex integration activities (by late September 2020, with only a month break over the Christmas holidays).
Leah commenced therapy on a weekly basis at her kindergarten, where we were able to have the use of a whole room, with lots of space to run jump and play. Activities that were demonstrated and recommended, were able to be implemented on a daily basis at preschool, when Leah attended. Leah demonstrated her determinedness to improve and was very motivated to do her exercises. This in turn motivated her 2 brothers, as they watched her transform. Leah loved the RM and the Moro reflex integration exercise, and they quickly became part of her home routine. Leah is now at ‘big’ school in kindergarten and the transition has been wonderful and less of a challenge than expected due to her capacity to self-regulate and tolerate changing environments.
After doing innate rhythmic movements for 4 weeks, we did playful activities for Leah [from the Brain and Sensory Foundations course] to integrate the following reflexes: Moro, TLR, ATNR, STNR, Hands, Spinal Galant [Reflex], Headrighting.
[Leah's improvements were dramatic, and are summed up here:]
| Before | After |
|---|---|
| Scored much more than others [siblings] in her sensory processing for touch and movement, more than others in auditory and social emotional. Leah demonstrated difficulties with registration (shut down) at school missing many important cues and instructions. This created frustrations for her. | Able to tolerate noise and being in close proximity to others is less triggering. Still working on visual perception (registration issues) however this is less. Able to tolerate different environments better with less meltdowns and related behaviours. |
| Body awareness almost non-existent. | Body awareness and movement improved. |
| Would hold everything together at school, then meltdown at home, lashing out at siblings and demonstrating oppositional defiance toward her parents. | Due to her increased physical capacity (tone improved), her avoiding behaviours and frustrations at school have diminished. Mum said, Leah had changed dramatically and now the meltdowns at home were minimal compared to 4 months ago. |
| Predominately played by herself, or only with her brothers, at school. | Now more likely to engage with others (apart from her brothers) and has expressed a desire to find a friend (her new goal for school). |
| Struggled with fine-motor skills related to self-care, such as feeding herself, holding utensils and pencils; immature grasp; minimal finger isolation with tension in shoulders and hyper-extension of her thumb and index finger. | Handwriting has significantly improved. Now has a mature tripod grasp, with some hyper-extension of her index finger only and improved posture, with letters showing great form, size and spacing. |
| Struggled with gross motor skills. | Can now do cartwheels and handstands; climb on a monkey bar and balance equipment with nil difficulties; able to swirl rainbow ribbons, one in each hand, with much improved bilateral coordination; hop on both legs with moderate balance; and swing upside down on the lowest playground bar and land on her feet. |
| Little control over eye movement; eyes would often roll around, especially when doing [rhythmic movements]. | Eyes have become increasingly steady, significantly improving gross-and fine-motor skills. |
| Toileting issues with regular urinary accidents, due to poor registration and not receiving the cues to go to the toilet. | No ongoing toileting issues. |
| Poor concentration, attention, and short-term memory (recall) to do with her poor registration and difficulties with auditory, movement and visual processing. | Can now attend to tasks that are up to 30 minutes; even challenging ones, she will persist with encouragement and some prompting. |
| Unable to sit still for more than a minute or two and struggled in her participation within the classroom, particularly in groups. | Can now sit and listen to instructions and will ask when she does not understand, she continues to require more time to process however this is significantly reduced. |
Overall, Leah attempts new tasks with greater confidence and enthusiasm, and will now [join] group activities at school. The only issue Leah’s teacher has indicated, is her auditory and visual processing difficulties, where she requires additional time and visual supports to be more independent in completing her work in the mainstream kindergarten class.
Summing up
In 7 months, witnessing, such dramatic change in a family’s life has been so very rewarding and humbling as a therapist and human being. As a therapist, the way I look at a child now, is very different to before doing this amazing course. Prior to this [Brain and Sensory Foundations] course, the road ahead for each child was slow and laborious with changes taking years, mostly.
The parents were overjoyed with the children’s progress especially their attitude and tolerance towards each other, which had been a constant stress for them.
[Edited for brevity; emphasis added]