Reflex Integration
Infants are born with automatic responses, primitive or primary movement patterns that are hardwired, to help them survive during early months. Sometimes called “primitive reflexes,” they emerge at predictable ages and assist with development of new skills and more complex movement patterns. They facilitate muscle tone to protect an infant, cause the infant to generate movement against gravity, and assist with orienting to elements in the environment.
These early reflexes or primitive movement patterns are produced as a response to sensation. Particular sensory input causes an increase in muscle tone for specific muscle groups. This increase in tone creates a predictable movement pattern which the infant uses within a predetermined developmental timeframe. In a typically developing infant, each pattern has an opposite pattern that helps modulate it. As the infant uses the primitive movement pattern to develop new skills, other motor competencies emerge which help the infant move against the primitive movement pattern or use only a part of the pattern. In the first year of life, each primitive movement pattern typically becomes “integrated” and then is less fixed and more readily adapted to achieve a goal. More complex movement skills meet a child’s higher developmental level needs.
An example of a simple response/reflex is the rooting response/reflex. It is a very early primitive movement pattern which is seen in utero in preparation for searching for food. At birth, the infant responds to touch against the cheek by searching for the nipple. Over time, with multiple experiences and increased control of head, neck, and eyes, the rooting response recedes and the infant uses more complex movement patterns to find the nipple.
What happens when reflexes are not integrated into more complex movement patterns?
Reflexes are automatic movement patterns that first emerge in utero and infancy that are elicited by sensory input in the environment and from one’s body. They provide an early foundation for survival and development of higher-level, more complex, adaptable skills. When a primitive movement pattern emerges at the predictable time, it meets a specific need and fulfills a particular function. When skills are achieved, the movement pattern is no longer consistently elicited and evolves into more complex functional movement patterns within a typical developmental sequence.
When reflexes have not been fully integrated into controlled functional movement patterns, it will adversely affect development and a child’s ability to adapt to changes in the environment. Poorly integrated reflexes mostly affect achievement of appropriate developmental milestones, emergence and expansion of body awareness–how one’s body works and body parts relate to one another, integration of two sides of the body, and production of fluid, controlled movement to complete age-appropriate tasks/activities.
Moro Reflex
We can think of the Moro as the “startle” reflex. It is caused by sudden movement, lights, or sounds; these sensory inputs will cause whole body extension and a sharp inhale of breath. Its purpose is to facilitate a baby’s first breath after birth and support extension patterns of movement after months of flexion in the womb.
When a moro reflex continues to exert influence past the usual age, it can contribute to hyper-responsivity and difficulty with regulation of the autonomic nervous system (fight-flight-fright responses).
Tonic Labyrinthine Reflex (TLR)
TLR is seen when a baby’s head is tipped back, and arms and legs extend; conversely when the baby’s head is tipped forward, arms and legs flex/bend. TLR assists in the birthing process and helps prepare for rolling. TLR is the earliest integration of vestibular and proprioceptive information to facilitate a baby’s orientation of their body in space.
Poorly integrated TLR can contribute to poor balance, poor sequencing, and difficulty judging space, distance, depth, and speed.
Asymmetrical Tonic Neck Reflex (ATNR)
ATNR emerges around the same time that the oculomotor nerve becomes myelinated (myelinization speeds transmission of neuronal impulses to the brain). When the baby’s head turns to one side, the arm extends on that side and flexes on the opposite side, putting the hand at a distance from the eyes that makes it easier for the child to focus on a toy or object. ATNR helps an infant with shifting weight for rolling over and stomach crawling, and contributes to developing oculomotor skill needed for tracking moving objects and for reading; balance; midline orientation; and bilateral integration.
Poorly integrated ATNR can contribute to distractibility, poor attention, difficulty crossing midline, and poor visual tracking.
Symmetrical Tonic Neck Reflex (STNR)
The influence of STNR is first seen when an infant looks up (extends the neck) and looks down (flexes the neck). Looking down causes arms to bend and legs to extend/straighten. Looking up causes the opposite response–arms extend and legs bend/flex. STNR assists with propping oneself on forearms and extended arms, and helps an infant move into hands and knees position, and to move by four-point crawling.
Poorly integrated STNR can contribute to late or absent crawling, poor coordination, poor posture, difficulty sitting still and upright, and visual perceptual problems.
TREATMENT FOR POORLY INTEGRATED REFLEXES
Reflex integration can be incorporated into an overall therapy treatment plan, and consists of participation in specific exercises that will train the brain to inhibit the automatic response elicited by sensory inputs. This typically involves moving the body in the opposite way that the reflex triggers, while receiving the sensory input that evokes the reflex. Treatment will help a child integrate the primitive movement pattern into more complex, adaptable, and functional skills and movement.