Effectiveness of Primitive Reflex Integration and Innate Rhythmic Movements

Relevance and Evidence-Based Rationale for Using Neurodevelopmental Movements from the Brain and Sensory Foundations Courses

By Sonia Story

The activities in the Brain and Sensory Foundations program are utilized by parents and professionals to improve physical, social-emotional, cognitive, and executive functioning for individuals of all ages.

The Brain and Sensory Foundations (BSF) courses combine integrative and neurodevelopmental movements for stress release and maturation of the neuro-sensory-motor systems. Neurodevelopmental movements include a variety of spontaneously expressed innate infant movements that drive healthy development.

The neurodevelopmental movements in the BSF curriculum are:

• Innate rhythmic movements
• Primitive reflexes
• Postural reflexes
• Protective reflexes
• Developmental movements
• Play and social connection activities

The innate neurodevelopmental movements of infancy are largely responsible for:

• Brain development (van der Meer & van der Weel, 2022; McGlown, 1990)
• Sensory-motor skills (Goddard Blythe, 2023)
• Gross motor skills (Utley, 2018)
• Fine motor skills (Utley, 2018)
• Language development (Iverson, 2010)
• Focus (Goddard Blythe, 2023; Blomberg, 2015)
• Upright posture and core strength (Porter, 2017)

Background, Relevance, and Evidenced-Based Rationale for Using Primitive and Postural Reflex Movements

All innate infant (neurodevelopmental) movements are important for development. They fuel brain growth and build the neuro-sensory-motor skills needed to progress to an upright, walking, talking, toddler. These neuro-sensory-motor skills are the founda­tion for balance, posture, strength, speech, gross and fine motor skills, social-emotional skills, executive functioning, and learning skills. Of the many types of neurodevelopmental movements, primitive and postural reflexes are among the most familiar and well-studied.

Though primitive reflex movement patterns are present in normally developing infants, ideally most are integrated (i.e., inhibited, and no longer active upon stimulation) by the end of the first year of life. According to authors of the Nelson Textbook of Pediatrics, the presence of primitive reflexes past the first year is considered abnormal and may indicate neurological dysfunction (Behrman et al., 2000). In healthy development, as the brain and body mature, postural reflexes and volitional movements replace primitive reflex move­ments. Unless they are underdeveloped in infancy or disrupted later in life, postural reflexes help in the integration of primitive reflexes and support human movement throughout the lifespan.

Observa­tion of infant reflex patterns during and beyond infancy tells us how the nervous system is functioning. Innate infant reflexes have long been used as signs for determining the health or dysfunction of the central nervous system (Fioren­tino, 1973). Because of their importance to development, assessing the primitive infant reflexes is often part of newborn exams (Behrman et al., 2000; Fletcher, 1998).

Children and adults with unintegrated, retained primitive reflexes and underdeveloped postural reflexes often experience mild to severe obstacles in functioning. Challenges in functioning—physical, social-emotional, and cognitive—have been consistently reported over many decades of research.

Consequences of Retained Primitive Reflexes

Primitive reflexes are stereotypical movement pat­terns in response to a specific stimulus. They should be integrated, or dormant, in infancy as the cortex matures and inhibits the reflex expression at the brainstem level. However, for many children these reflex patterns are not fully mature or inhibited. Even if an individual does attain fully integrated primitive reflexes, the movement pat­terns are still underlying at the brainstem level and may reemerge in cases such as brain injury, illness, stroke, dementia, or trauma (Melillo et al., 2022; McGlown, 1990). The persistence of primitive reflexes beyond infancy, called retained primitive reflexes, is associated with developmental delay.

Exten­sive studies explore the relationship of retained primitive reflexes and dysfunction in individuals with cerebral palsy and with other known neuro­logical conditions (Rashikj Canevska et al., 2020; Zafeiriou et al., 1995). Retained reflexes that are less severe than those occurring in cases of brain injury can still drive changes in psychomotor skills (Rashikj Canevska et al., 2020), muscle tone, and postural control (Goddard Blythe, 2023). Retained reflex-driven tonal and postural changes, though less severe, may still significantly affect function (Goddard Blythe, 2023; Rashikj Canevska et al., 2020; Kohen-Raz,1986).

Retained primitive reflexes are associated with the following physical, social-emotional, and cognitive challenges:

Physical challenges associated with retained primitive reflexes

• Sensory processing disorders (Pecuch et al., 2020)
• Balance deficits (Bob et al., 2021; Niklasson, et al., 2017; Wahlberg & Ireland, 2005)
• Coordination issues (Grzywniak, 2017; Niklasson et al., 2017)
• Pelvic asymmetry and irregular gait (Gieysztor et al., 2020)
• Gross motor deficits (Preedy et al., 2022; Pecuch et al., 2021; Gieysztor et al., 2018)
• Fine motor deficits (Brown, 2010)
• Head lag in infancy (Bradshaw et al., 2023; Flanagan et al., 2012)
• Visual motor skills deficits (Domingo-Sanz, 2022; Andrich et al., 2018; Gonzales et al., 2008, McPhillips et al., 2000)
• Challenges with chewing/eating (Hobo et al., 2014)
• Abnormal muscle tone; poor postural control (Goddard Blythe, 2023; Fiorentino, 1972)
• Scoliosis (Sharma & Saxena, 2024; Bly, 2011; Ferrari et al., 2010)

Social-emotional challenges associated with retained primitive reflexes:

• Poor attention and opposition-defiance (Hickey & Feldhacker, 2022) 

• Weak emotional regulation (Grzywniak, 2017)

• Anxiety (Carter, 2020; Forrest, 2002)

• Severe emotional and behavioral challenges (Taylor et al., 2020)
• Schizo­phrenia in adults (Hyde et al., 2007; Murray et al., 2006)
• Social and language impairments (Bradshaw et al., 2023; McPhillips et al., 2014)

Cognitive challenges associated with retained primitive reflexes:

• ADHD (Wang et al., 2023; Konicarova et al., 2014; Konicarova & Bob, 2013; Konicarova et al., 2013; Taylor et al., 2004)
• Reading (Feldhacker et al., 2021; McPhillips & Jordan-Black 2007; McPhillips et al., 2000)
• Writing (Richards et al. 2022)
• Mathematics (Oliver, 2020; Jordan-Black, 2005)
• Analog clock-reading difficulties (Kalemba et al., 2023)
• Developmental language disorder (Matuszkiewicz & Gałkowski, 2021; McPhillips et al., 2014)

The above physical, social-emotional, and cognitive challenges associated with retained primitive reflexes are among the same challenges that co-occur with both attention deficit hyperactivity disorders (ADHD) and autism spectrum disorders (ASD). Retained primitive reflexes in ASD and other neurobehavioral disorders have been associated with absent or delayed developmental milestones (Melillo et al., 2022; Uljarević et al., 2017).

Can the use of innate neurodevelopmental movements help promote development beyond the infant stage?

Supporting Evidence for Addressing Retained Primitive Reflexes

Use of innate infant movements to mature primitive and postural reflexes and promote functional skills can serve as part of an overall plan for intervention to increase functional skills; both research and clinical observation support this assertion. Reflex integration activities, along with other neurodevelopmental movements, make use of the natural processes of neuroplasticity and development that are innately wired in the design of human beings to promote maturity and function. These activities appear to organize and mature the neuro-sensory-motor systems later in life just as they do in the natural healthy development of human infants. The following lists give supporting research showing improvements in physical skills, social-emotional function, and cognitive skills.

Improvements in physical skills with primitive reflex integration

With the use of primitive reflex patterns and/or activities designed to reduce the severity of retained primitive reflexes, researchers report improvements in the following physical skills:

• Fine motor abilities (Brown, 2010)
• Visual motor skills (Domingo-Sanz, 2022; Andrich et al., 2018; Gonzales et al., 2008; McPhillips et al., 2000)
• Balance (Grzywniak, 2017; Niklasson et al., 2017; Wahlberg & Ireland, 2005)
• Coordination (Grzywniak, 2017; Niklasson et al., 2017)
• Motor skills (Pecuch, et al., 2021)

It is worth noting that improved balance has been linked to reduced anxiety and increased self esteem in children (Bart et al., 2009). Researchers have linked balance deficits to both ADHD (Konicarova et al., 2014) and to ASD (Oster & Zhou, 2022; Kohen-Raz, 1992). Other researchers have found that primitive reflex integration is associated with improved balance (Jeong et al., 2021; Grzywniak, 2017; Wahlberg & Diamond, 2005). We can reason that improvements in primitive reflex integration leading to better balance could reduce anxiety in individuals with ADHD and ASD (Stins & Emck, 2018).

Improvements in social-emotional function with primitive reflex integration

In addition to better physical skills, the use of reflex integration methods was associated with improvements in social-emotional functioning in children (Grigg et al., 2018; Grzywniak, 2017). Giving children neurodevelopmental movements was also associated with improvements in self-regulation (Overvelde, 2022).

Improvements in cognitive and learning skills with primitive reflex integration

Giving children primitive reflex integration movements has been associated with cognitive gains in several areas such as:

• Reading (Grigg et al., 2023; McPhillips & Jordan-Black 2007; Wahlberg & Ireland, 2005; Jordan-Black, 2005; McPhillips et al., 2000). In a study implementing movement corrections for several retained infant reflexes, children showed significant improvement in reading fluency and reduction of headaches (Wahlberg & Ireland, 2005). In another study, oculo-motor functioning and reading skills improved as retained reflexes were corrected (Bein-Wierzbinski, 2001, as quoted in Goddard, 2005).

• Mathematics and Reading: Jordan-Black (2005) found that the movement intervention, based on infant primitive reflex movements and the use of child-friendly songs and rhythms, “had a very significant impact on reducing the levels of ATNR persistence in children and that this was associated with very significant improvements in reading and mathematics, in particular” (Jordan-Black, 2005, p. 101).

• Copying ability [fine motor] (Brown, 2010)

• Writing speed (McPhillips et al., 2000)

In addition to the above supporting research, according to Shereen D. Farber, MS, OTR, FAOTA, author of Neurorehabilitation: A Multisen­sory Approach, delays in primitive integration may result in:

"Decreased segmentation of the trunk, de­creased isolation of movement, decreased rotation component in any action, postural insecurity, decreased ability to develop anti-gravity muscles, increased synergy patterns (mass movement patterns) and increased dependence on environmental stimulation for changes in posture. One of the main goals of multisensory theory of neurorehabilita­tion is to integrate primitive reflexes while facilitating higher-level responses." (Farber, 1982, pp. 113-114, emphasis added)

The basic premise supporting the use of neurodevelopmen­tal movements is that the brain recognizes and responds to these innate movements whose original function is to integrate primitive reflexes and develop brain, body, and sensory maturity for optimal functioning. These innate neurodevelopmental movements stimulate and develop important neuro-sensory-motor and brain pathways as a regular course of human develop­ment, and we can use these movements at any age to create maturation similar to what we see in infancy (Blomberg & Dempsey, 2011; McGlown, 1990).

Increased brain and body maturity via neurodevelopmental movements is the explanation given by Harald Blomberg, MD for the successes he witnessed with both his adult and child psychiatric patients (Blomberg, 2015).

Rationale for the Use of Innate Rhythmic Movements to Support Reflex Integration and Function

The experiences of Blomberg described here, have a bearing on the discussion about the use of innate rhythmic movements for helping with reflex integration and overall functioning. Blomberg was a student of Kerstin Linde, a self-taught movement therapist, who pioneered the use of infant rhythmic movements as an intervention to help individuals with developmental and functional challenges. Blomberg found that these innate rhythmic movements were especially helpful for his own challenges with balance and coordination from having had polio as a child. He also found these rhythmic movements beneficial for his adult psychiatric patients with severe mental illness (Blomberg, 2015). After engaging in the infant rhythmic movements, these adult psychiatric patients showed relief from anxiety and depression, and they reported more interest in social activities, less irritability, and greater well being (Blomberg, 2015). Blomberg’s results with innate infant movements were consistent with the findings of two related studies. First, Hyde et al. (2007), found that retained primitive reflexes were more prevalent in adult patients with schizophrenia than in healthy controls. Second, childhood neuromotor dysfunction was found to be a risk factor for adult schizophrenia (Murray et al., 2006). The use of innate rhythmic movements in mental health remediation may work in part by helping to overcome motor dysfunction, which could simultaneously improve abilities in other areas.

After working with adult mental health patients, Blomberg used a combination of innate rhythmic movements and primitive reflex movements with children. Together, these neurodevelopmental movements appeared to promote academic skills and emotional regulation, and were effective in overcoming ADHD symptoms (Blomberg & Dempsey, 2011). Based on extensive work with children with challenges, Blomberg and Dempsey (2011) developed the Rhythmic Movement Training program (RMT), a combination of innate rhythmic movements, primitive reflex movements, and postural reflex movements designed to address neurodevelopmental challenges. There is promising preliminary evidence showing that rhythmic and primitive reflex motor interven­tion can reduce muscle tension, diminish sensory processing challenges, and improve balance, co­ordination, and physical function (Blomberg & Dempsey, 2011; Gazca, 2012).

Grigg et al., (2023) used innate rhythmic movements and found that doing as little as five minutes per day, four times per week, reduced primitive reflex retention and increased reading scores in school children, from ages six to eight years.

There is a body of research showing that symp­toms of ADHD may arise from a delay in normal brain maturation (Sripada et al., 2014; Rubia, 2007). The fact that retained primitive reflexes go hand-in-hand with poor cortical maturation (Melillo, 2011), gives further support to the idea that the use of innate neurodevelopmental movements could be a key factor in promoting brain maturation and creating successful outcomes for those who struggle with ADHD symptoms.

Another researcher studied the innate rhythmic movements in terms of their function in healthy development. Thelen (1979) found that all healthy infants spontaneously engaged in stereotypical rhythmic movements that appear to have critical importance to development. In her landmark study of healthy infants, Thelen (1979) described rhythmic movements such as rocking, arm waving, and leg kicking, and found these particular infant movements were highly correlated with advances in motor development. Like infant primitive reflexes, Thelen (1979) found that the innate rhythmic movements had peaks in expression that gradually diminished as the infant matured. Iverson (2010) noted that infant rhythmic movements of were associated with the development of speech and language. Rhythmic crawling may make a difference in our ability to learn well. For example, crawling in 9 month-old infants was associated with more flexible memory retrieval (Herbert et al., 2007). Goddard Blythe (2023) noted the importance of infant belly crawling and hands-and-knees crawling—both rhythmic in nature—for the development of visual skills, and she cited research observing that a high percentage of children with reading difficulties skipped the crawling stages in infancy. When infants engaged in rhythmic movements, they smiled more (Zentner & Eerola, 2010) which suggests that rhythmic movements also promote positive emotional states.

The benefits of rhythmic input may be more apparent when we consider that the lack of rhythmic ability is associated with the following challenges (Ladányi et al., 2020):

• Speech and language disorders
• Developmental coordination disorder
• ADHD symptoms
• Dyslexia

Rhythmic sensory input beneficial in rehabilitation

Here is supporting research showing that rhythmic input has been beneficial accros a wide age range and for various conditions:

• Improving gait in patients with Parkinson’s dis­ease (Kadivar et al., 2011) and following stroke (Hayden et al., 2009; Doidge, 2007).
• Helping children exposed to trauma, most likely by means of calming and regula­tion of the brainstem (Perry, B., 2006).
• Promoting better outcomes for babies in the NICU (Provasi et al., 2021).

Common disorders linked to sensory-motor abnormalities

Sensory-motor abnormalities—often with a lack of rhythmic quality to movements—are a core feature of the following disorders:

• Developmental Coordination Disorder (DCD)
• ADHD
• ASD
• Learning Delays
• Apraxia
• Speech Delays
• Parkinson Disease
• Stroke
• Traumatic Brain Injury

Understanding that the innate neurodevelopmen­tal movements of infancy are fueling brain growth and sensory-motor maturity helps us grasp why these unique movements appear to be highly beneficial for helping with these sensory-motor-based disorders. Therapists and caregivers using neurodevelopmental movement tools may contribute greatly to help­ing individuals with these issues.

Plausible Mechanisms Explaining Benefits of Neurodevelopmental Movements in Remediation

The underlying rationale to support the use of infant movements in remediation of neurodevelopmental challenges is based on the principles of development itself. The human brain grows faster in infancy than at any other time in life (Carmody et al., 2004), and this development is in part fueled by the innate infant movements. Sampaio-Baptista et al. (2013) found that learning new motor skills was associated with increased myelin in the brain. Since learning new motor skills is something infants are regularly engaged in as part of the normal course of development, it follows that the innate infant movements stimulate myelin formation and develop neuro-sensory-motor pathways important for functional skills. In their imaging study, Carmody et al. (2004) found great increases in myelin during normal development of healthy infants. Given what we have seen in natural development, it is very possible that innate infant movements are unique in their ability to stimulate and develop the brain and body, more so than other types of movement, and at least one study has supported this conclusion (McPhillips et al., 2000). Further research is necessary to confirm the unique qualities of innate infant movements.

Another plausible mechanism explaining the brain maturation and beneficial effects of infant neurodevelopmental movements is their tendency to pro­mote relaxation and calm. With a basis of calm, our brain and body systems are better able to rest, digest, grow, and learn. Innate rhythmic move­ments especially have been observed for millennia to promote calm in infants. Sucking is one of the first calming rhythmic movements, and human be­ings instinctively rock their infants rhythmically to soothe them. And research has shown that even newborn infants respond to rhythm (Winkler et al., 2009). In the multisensory approach to neu­rorehabilitation, rhythmic movement is suggested to help clients relax and as appropriate sensory input in cases of hypertonicity (Farber, 1982).

Conclusion
The above research and rationale suggests that the simple reason the innate neurodevelopmental movements are effective is because human de­velopment itself is effective. It seems the brain is inherently wired to recognize and respond to the innate movements of infancy. Utilizing this inborn sensory-motor tem­plate of movements appears to fuel brain growth and sensory maturity. It also seems to provide calming and increased receptivity to learning new skills.

What is most significant is that the principles seen in infancy—whereby reflex patterns stimu­late the development of increasingly complex sensory-motor skills—can be utilized beyond infancy to improve function at any age.

The Brain and Sensory Foundations curriculum offers a wide variety of intervention strate­gies using neurodevelopmental and integrative movement tools. In the Brain and Sensory Foundations curriculum we combine tools for brain, body, and sensory maturity, plus activities for calming, and stress release—all for the purpose of helping individuals achieve their goals with greater ease and effective­ness.

The evidence suggests that through the use of in­nate neurodevelopmental movements, parents and professionals can create measurable, functional, and beneficial outcomes for individuals in their care. Because of their fundamen­tal importance in human life, the neurodevelop­mental movements show great promise for helping individuals of all ages overcome a large variety of challenges while enhancing meaningful partici­pation in work, play, leisure, education, and social activities.

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