What are primitive reflexes?
Primitive reflexes are automatic, stereotypical movements that occur in response to specific stimuli in infants. These reflexes are present from birth and are crucial for survival and early motor development. They are adaptive responses developed during the neonatal period and slowly integrate over time, becoming more sophisticated movements. In occupational therapy, understanding and observing primitive reflexes in infants provide valuable information about their neurological development and assess the maturation of the nervous system. Reflex movements are the foundation of the nervous system and originate in the brain stem. It is crucial for reflexes to be fully integrated because they impact motor, cognitive, and overall development and wellbeing. They do not just occur in infant development either, the movement patterns remain ingrained at the brainstem level and may resurface in instances such as brain injury, stroke, dementia, or trauma. Below are the most common primitive reflexes seen, their significance to development, and exercises that can be used to reintegrate the reflexes.
What are the types of primitive reflexes?
- Moro Reflex: an automatic reflex in response to sudden sensory changes, such as a loud noise or loss of support. This reflex consists of spreading the arms, extending the legs, and then bringing the arms back together.
- Purpose: To react to potential dangers by signaling the need for protection and attention
- When it happens: The Moro reflex appears at birth and should be integrated by 2-4 months
- Signs of retention: sensory processing challenges, increased anxiety levels, and more of a prevalence of ADHD symptoms and learning disabilities
- Testing for retention: With the child seated in a chair or laying on their back, have them cross their arms over their chest and their legs. Look for the way this motion is performed.
- Exercise for retained Moro reflex: The Moro starfish helps to work on dissociating this pattern. In the testing position, have them open their arms and legs in a starfish position with the neck extended, cross their right arm and leg over the left with the neck flexed, then repeat the motion with the left side. With each motion, count to 5 seconds and perform on each side 10 times.
- Rooting Reflex: When the cheek is touched, an infant will open their mouth as an automatic response to locate food.
-
- Purpose: This reflex is important for breastfeeding and oral-motor development.
- When it happens: The rooting reflex appears at birth and should be integrated by 3-4 months
- Signs of retention: developmental issues related to oral-motor coordination, such as speech problems, feeding difficulties, and hypersensitivity.
- Testing for retention: With a stroking motion, move from the nose to the chin around the corner of each side of the mouth 3 times each. Look for a twitching motion.
- Exercise for retained rooting reflex: Lightly stroke the face in a horizontal movement from ear to mouth 3 times, moving 1⁄2 an inch lower each time. Implement this on both sides. This exercise, as demonstrated below, will provide input to integrate and decrease the automatic response
- Palmar Reflex: The automatic closing of the hand when the palm is stimulated. When an infant is playing and you see them grab something and seem unable to drop it, it is because they do not yet have voluntary control of the movement.
-
- Purpose: This reflex is a survival instinct that supports the development of fine motor skills and hand coordination
- When it happens: The palmar reflex appears at birth and should be integrated by 3-6 months
- Signs of retention: Poor hand dexterity, which can impact handwriting and all fine motor skills. It can also lead to poor visual coordination, sensory system dysfunction, and can be associated with diagnoses of dysgraphia and speech/language problems.
- Test for retention: Lightly stroke the line on the palm that originates on the thumb side to the wrist. Repeat this motion 3-5 times and look for any twitching or small motions.
- Exercise for retained palmar reflex: Using a resistance ball or playdough/putty in the palm, complete a finger sequence by closing the fingers while holding onto the item. The order of it is squeezing with all fingers, using the index finger and thumb, middle finger and thumb, ring finger and thumb, and pinky and thumb. Then you would complete the sequence backwards. This should be done 10 times, 1 to 2 times per day.
- Asymmetrical Tonic Neck Reflex (ATNR): The automatic reflex of while turning the head to one side, causes the limbs on that side to extend while the limbs on the opposite side flex. This position is also commonly known as the “fencer’s position” and is important for the learning of cross pattern movements.
- Purpose: This reflex mainly assists during the delivery process through the birth canal and is crucial in the early development of motor coordination.
- When it happens: The ATNR appears at birth and should be integrated by 6 months.
- Signs of retention: Poor coordination, which can lead to the inability to cross midline, balance/gait difficulties, and poor handwriting. It can also lead to problems with visual perception and tracking.
- Test for retention: Have the individual standing with their arms directly in front of them at around a 90 degree angle. Have them turn their neck side to side. Watch for any movement of the arm, shoulder, or elbow.
- Exercise for retained ATNR: Begin on their stomach with their head turned to the right side. Bring the right arm and leg up into a “L” shape and then turn the head to the left side. Return to center and repeat on the opposite side. Complete this exercise 10 times, 2-3 times per day.
- Symmetrical Tonic Neck Reflex (STNR): The reflex that causes legs to straighten and arms to bend when the neck is flexed and the opposite to occur when the neck is extended. This reflex is commonly referred to as the crawling reflex due to its ability to allow the upper and lower body to move independently of one another.
- Purpose: This reflex is integral to the step of crawling by requiring coordinated movements of the head and limbs. This reflex, when present inappropriately, can impact activities like reaching and crawling.
- When it happens: The STNR appears at around 6-9 months and should be integrated by 9-11 months.
- Signs of retention: Poor posture, poor muscle tone, uncoordinated gait, and poor hand eye coordination.
- Test for retention: Have the individual on their hands and knees with a flat back. With a slow 8-10 second count, have the child tuck their neck in as far as they could with their back up. Then instruct them to extend their head all the way back and stomach down with the same slow count. Observe for any twitching or arching of the back when tilting the head back.
- Exercise for retained STNR: The exercise for this reflex is the same as the test for retention. Maintain the hands and knees position and flex the neck slowly while bringing the back up then extend the neck back while bringing the stomach down. Repeat 10-15 times, 1 time per day.
- Spinal Galant Reflex: The Spinal Galant reflex is a primitive reflex that is typically present in infants and may be observed during the prenatal and early postnatal periods. This reflex is elicited by stimulation of the skin along the side of the spine, particularly in the lower back area. When stimulated, the infant will typically respond by laterally flexing their trunk toward the stimulated side. The test for this reflex is done on newborns to rule out brain damage during birth.
- Purpose: The purpose of this reflex is to assist during the birthing process.
- When it happens: The Spinal Galant reflex appears at birth and should be integrated by 3-9 months.
- Signs of retention: Postural issues such as scoliosis, misaligned pelvis, and low back pain, You may also see decreased lower body coordination, bedwetting problems, and difficulties concentrating.
- Test for retention: Have the individual on their hands and knees. Stroke along each side of the back along the spine. Watch for any twitching or jerky movements.
- Exercise for retained Spinal Galant reflex: While laying on their back, have the child start with their arms and legs at their sides. Then, instruct them to move their arms and legs in a starfish position. Both motions are completed slowly to the count of 10. Repeat 10 times, one time per day.
- Tonic Labyrinthine Reflex (TLR): The TLR is the foundation for postural stability in big muscle groups. This reflex has two movements it causes. When an infant’s head is flexed forward, this reflex causes the arms and legs to flex. When the head is extended, the arms and legs move into an extended position. This prepares infants for the movements of rolling over, crawling, and walking.
- Purpose: The purpose of this reflex is to help with the birthing process in the flexed position and to develop postural stability.
- When it happens: The TLR appears in utero and should be integrated by 3 ½ years.
- Signs of retention: Decreased balance, poor posture, toe walking, and decreased strength. The retention of this reflex is commonly seen in those with ADD and ADHD.
- Test for retention: On their stomach with their arms to their sides and legs flat. They then will lift up their head, arms, and legs while keeping their extremities straight. Watch for any deviations in this movement.
- Exercise for retained TLR: While laying on their stomach with their arms in front of them, instruct them to lift their arms and legs off the floor while keeping them straight for 15 seconds. Repeat 10 times and do one time per day.
