Now that you have a basic understanding behind the why of primitive reflexes, we’ll discuss the how! As stated in the previous post, primitive reflexes are one of the first things we test for at a patient’s initial evaluation. Most offices test for the same basic reflexes, but with slight variation. At The Center for Vision Development we test for the Moro Reflex, Tonic Labyrinthine Reflex (TLR), Asymmetrical Tonic Neck Reflex (ATNR), Symmetrical Tonic Neck Reflex (STNR), Spinal Gallant, and the Duck and Pigeon. Some offices might test for these in addition to a few others, and some might not test for all of these. If there is one you would like for your child to be tested for that we don’t usually administer, let us know and we will be happy to include it in your child’s plan!
When being tested, we are determining if the reflex is present or not present. We do this by looking for very specific body movements, and based on how pronounced they are, we administer a score of 1-4 with 4 meaning that the reflex is completely present. I will walk you through how we assess each reflex, and what the presence of that specific reflex can look like in your child. If determined that the reflex is present, there are a variety of different exercises that can be assigned to inhibit the reflex. At the bottom of this post are youtube videos which show some of these exercises.
What is it? This is a baby’s primitive fight or flight reflex. Unlike when an adult gets startled by something, when a baby gets startled, they lose their postural control. This should be developed out of by around 4 months of age. If it is not, the child may display signs of hypersensitivity to sensory stimuli of all types. This sensitivity can manifest itself through:
· Physical timidity
· Poor balance
· Motion sickness
· Emotional and social immaturity
· Inability to ignore peripheral stimuli
· Poor coordination
· Poor impulse control and more of the like.
How we test for it. We have the patient sit down on their bottom with their arms to their sides and their legs straight out in front of them. With a pool noodle behind their back, we tell them to lay back as we catch their head in our hands. If they exhibit any sign of hesitation or resistance, then the Moro reflex is usually present. Also, if any part of their body flails, such as their arms, then we mark it as present.
Tonic Labyrinthine Reflex (TLR):
What is it? The TLR is how an infant’s head management affects the rest of their body. When lying on their back, if their head is tucked in, then their limbs tuck in as well. If the head moves backward, their arms and legs extend straight out. This reflex helps a baby prepare for rolling over, crawling, standing and walking. It should be developed out of by around 3 year of age. If retained, it can result in:
· Poor balance
· Poor coordination
· Poor spatial awareness
· Poor sense of timing and rhythm
· Oculomotor and eye teaming dysfunction
· Low muscle tone
· Poor posture.
How we test for it. We have the patient lie down on their stomach, with their arms straight out to their side like they are flying. We then have them lift up their head, chest, arms and legs. If their legs separate or bend, and/ or they cannot hold their body up, and/ or they cannot stay still, then we mark it as present.
Asymmetrical Tonic Neck Reflex (ATNR):
What is it? The ATNR occurs when an infant’s head is turned to one side causing their limbs on that side to extend, and the limbs on the opposite side to contract. This aids in the birthing process and should be inhibited by 6 months of age. If retained, it can result in:
· Poor hand- eye coordination
· Poor handwriting
· Poor visual tracking
· Poor visual perceptual skills
· Poor bilateral integration
· Difficulty crossing the midline.
How we test for it. We have the patient get on their hands and knees in a crawling position with their arms slightly bent. As they are looking towards the ground, we move their head from one side to the other. If their limbs, back, or any other part of their body moves or bends in any way, then we mark it as present.
Symmetrical Tonic Neck Reflex (STNR):
What is it? The STNR is a baby’s preparation for crawling. It should be inhibited by around 11 months of age. If a baby is on their stomach and they lift their head, their arms will straighten and their legs will bend. If they move their head down, their arms bend and their legs straighten. These automatic movements help babies support their upper body so they can learn to crawl and pull themselves up. If retained, it can result in:
· Poor posture when writing or reading
· Poor hand eye coordination
· Poor muscle tone
· Difficulty copying from board and changing focus from near to far and vice versa.
How we test for it. We have the patient get on their hands and knees in a crawling position. We then have them sit back on their legs with their arms extended straight in front of them and their head down. They then go back up into the crawling position as they look up in front of them. We mark it present if their arms do not extend straight out in front of them, their back arches when they come back up, and if the insides of their elbows are facing forward when in the crawling position.
What is it? The Spinal Gallant Reflex occurs when a baby’s back is stroked causing their hip to rise to the touch and their body to swing toward the side that was stroked. This reflex aids in the birthing process as well as encourages hip movement which later helps with crawling and walking. It should be inhibited around 9 months of age. If retained, it can affect the child’s ability to:
· Sit still
· Pay attention
· Can sometimes even cause bed wetting.
· ADHD is strongly linked to the retention of the spinal gallant reflex.
How we test for it: We have the patient get on their hands and knees in the crawling position. We then take a pen/pencil/ stick and draw an L on each side of their back. If they squirm, their back moves, or their hips move, then we mark it as present.
Duck and Pigeon:
What is it? The Duck and Pigeon is essentially just an exercise that assists in integrating the Moro reflex.
How we test for it. We have the patient turn their feet outward (like a duck), and take a few steps forward and then backward. If their upper body is not straight, they lock their legs, they cannot turn their feet out, and/or their arms and hands turn outward to match their feet, then we mark it as present. They then turn their feet inward (like a pigeon) and take a few steps forward and then backward. If their upper body is not straight, they cannot turn their feet inward, they lock their legs, and/ or their hands and arms turn inward to match their feet, then we mark it as present.
If you or your child are exhibiting some of the above symptoms, schedule an evaluation with Dr. Taddese today!
-Emily Thompson, Vision Therapist
References and for Further Information:
Videos showing exercises: