Primitive Reflex Integration Case Studies

Rhythmic movements and reflex integration help with severe picky eating

This toddler with autism and ARFID experienced oral motor deficits and oral sensory issues that severely restricted his food intake and variety. After receiving rhythmic movements and reflex integration from the Brain and Sensory Foundations course, he showed better participation in feeding therapy and regularly tried new foods!

Submitted by Amanda Fink, MOT, OTR/L, SWC

Client challenges and goals: Walker came to me as a 2 year, 7-month-old boy for a feeding evaluation and treatment after lifelong eating struggles. His mother reports he had been receiving OT, PT, speech, and feeding therapy but not much progress was made. His diagnosis at the time of starting treatments was ARFID, and he later received an autism diagnosis as well. Client challenges include: extreme picky eating, delayed speech and echolalia, poor balance, gravitational insecurities, difficulty integrating with peers, poor ability to transition, and overall fear and anxiety. Walker’s goals here are only related to feeding therapy, as he receives regular OT at another facility that is within his insurance network.

Clients goals are as follows:

1. Walker will lateralize tongue to place food between molars for mastication of IDDSI level 6 (soft and bite sized) foods with model in 8/10 trials, across 3 consecutive therapy sessions.
2. Walker will transition from IDDSI level 6 (soft and bite-sized) foods to level 7 (regular) foods by adding a minimum of five new foods to his diet within the next six months.
3. Walker will use rotary mastication pattern with IDDSI level 6+ (soft and bite- sized) foods as judged by clinician to form a cohesive bolus in 8/10 opportunities with facilitation as needed across 3 consecutive therapy sessions.
4. Walker will decrease reliance of Kate Farms for supplemental nutrition, as measured by his ability to eat a minimum of 15 bites of food each meal, seven days per week, within 30 minutes as measured by OT observation and parent report.
5. Parents and the treating feeding therapist will work together to implement home program strategies to reduce the reliance of distractors for mealtime and increase Walker's independence in oral eating.

I suspected the following unintegrated reflexes: STNR [Symmetrical Tonic Neck Reflex], ATNR [Asymmetrical Tonic Neck Reflex], Tonic Labyrinthine, Moro, Spinal Galant. During the first session where I attempted to assess reflexes, Walker was too anxious and defensive. Walker was so defensive that he couldn’t follow directions for integration for the first two sessions following assessment. So instead our sessions focused on rapport, trust, and beginning the Brain Tune Up and rhythmic movements [from the Brain and Sensory Foundations course]. He could only complete the first two steps of the Brain Tune Up. Walker allowed me to do several of the rhythmic movements while singing. We then transitioned into feeding therapy and worked on oral motor stimulation and desensitization. We continued with a crawling obstacle course where poor coordination and gravitational insecurity were noted. He had a hard time during the eating portion of our session, so we went back to sipping water and humming at the table and ended with successfully calming him down and getting him to participate.

Over the next three sessions I was able to get Walker to engage a little more each time after completing the rhythmic movements passively. Walker gravitated towards obstacle courses, so each session we worked on building the same course with the isometric integration exercises [from the Brain and Sensory Foundations course] incorporated in. I noticed marked improvement in prone extension and symmetrical crawling, along with overall body calmness. By the end of the fourth session Walker understood the routine and was able to transition between activities with more ease. The biggest difference was his ability to sit at the table and engage with feeding therapy for 20 minutes. He no longer got upset during the meal and tried two new foods within one month.

In total I’ve been working with him for nine sessions, and then he moved to someone else’s schedule. In that time his gravitational insecurity decreased significantly and overall he was more engaged and focused during sessions. And by using the foundations of the [Brain and Sensory Foundations] course, he was able to eat at least one new food per week.

(Edited, emphasis added)