Menu
Menu

Support

Understanding Reflexes for Gross Motor Development

· ·

UNDERSTANDING REFLEXES FOR GROSS MOTOR DEVELOPMENT

Over the past few years, during June, we have covered various aspects of Gross Motor Skills, including Core Strength, Muscle Tone, Motor Planning and Coordination and Gross Motor Developmental Milestones. Despite all this, there’s still more to share about this fascinating topic.

Continuing with our theme of transitions, let’s start at the very beginning of movement development, which begins in utero, further develops upon birth, and builds the foundational movement patterns followed by all human beings – Primitive Reflexes!

What are Primitive Reflexes?

Primitive Reflexes are involuntary motor responses that are genetically part of a newborn’s structure and makeup. They form the primary movement patterns on which all our gross and fine motor skill development is based, enabling us to do everything we do today. These foundational movement patterns provide postural support for our daily activities and work in conjunction with sensory systems like the vestibular, proprioceptive, and tactile systems. How cool is that!

What is the Purpose of Primitive Reflexes?

Primitive reflexes provide the human body with foundational movement patterns on which we can base all our gross and fine motor skill development. These patterns are foundational in all movement and postural patterns we engage in daily. 

“At the beginning they are necessary for the nutrition, survival, protection of the new-born, and later in life they are important for the process of learning, communication, emotions, motivation. In typical development, primary reflexes are naturally inhibited in particular order during the first year; they are displaced by substitutional reflexes called postural reflexes. Postural reflexes are more mature models of motor responses that coordinate balance, coordination and senso-motor development.” (Rashikj-canevska, & Mohajlovska, 2020)

Examples of Primitive Reflexes and What Do They Do?

Here are some examples of Primitive Reflexes and a brief overview of their role and appearance. Please note that these are only some of the many primitive reflexes present in our bodies.

The Moro Reflex:

The Moro reflex, also known as the “Startle Reflex,” is observed when a baby’s head suddenly shifts, or if their head falls backward or is startled by a sudden movement, bright light, or loud sound.  The baby will throw their arms away from their body and extend their neck. They may also open their fingers, cry or make no sound. The baby will then quickly bring their arms back together and relax them. 

This reflex is crucial for developing future flexion and extension movement patterns and integrating the adrenal ‘fight or flight’ response to surprises or stress, as well as the connection to the mother in ensuring safety when exploring the world around them through development space and is integrated (no longer present) around six months of age. 

Spinal Galant Reflex:

The Spinal Galant Reflex is an involuntary movement pattern in infants, thought to be crucial during the natural birthing process. Contractions during labour stimulate the lower back, causing hip movement that helps the baby descend the birth canal, which in turn aids in developing the hip movements necessary for crawling and walking. The Spinal Galant is activated by stimuli to the back, such as stroking down one side of the spine while the infant is on their stomach, encouraging hip movement. This can also be done when the child is on all fours. This reflex is also involved in developing the vestibular system and is linked to the Asymmetrical Tonic Neck Reflex (ATNR), which also plays a role in birth. The Spinal Galant Reflex is often associated with urination. Developing in utero around 20 weeks, the Spinal Galant Reflex should be fully developed at birth and is typically integrated between three to nine months of age.

Tonic Labyrinthine Reflex (TLR):

The Tonic Labyrinthine Reflex (TLR) appears in infants when they lie on their stomachs in a pose resembling Superman’s. 

It consists of two types of movements: forward and backward. This reflex is triggered by either bending (forward) or extending (backward) the neck – moving the head up or down. When infants look down (neck flexion), their arms and legs tend to flex or curl towards the body. Equally, when infants look up (neck extension), their arms and legs extend (like Superman!). The TLR is believed to assist infants in adapting to the challenges posed by gravity and affects muscle tone and movement of arms, legs, neck, and trunk. Since head movements activate the TLR, this reflex is closely linked to the Moro Reflex. The integration of this reflex typically occurs around the age of four months.

Asymmetrical Tonic Neck Reflex (ATNR):

The Asymmetrical Tonic Neck Reflex (ATNR) is commonly known as the “fencing reflex” because when a baby lies on their back and turns their head to one side, the arm on that same side will extend, while the opposite arm will flex towards the body – giving the appearance of being ready to fence. The ATNR is activated by a simple head turn to either the right or the left. The kicking sensation felt in the womb is actually due to the ATNR! Additionally, this reflex aids in the birthing process and impacts balance, muscle tone, and hand-eye coordination. This reflex is expected to be integrated around six months of age.

Symmetrical Tonic Neck Reflex (STNR):

The Symmetrical Tonic Neck Reflex (STNR) emerges between six and nine months of age and is crucial for transitioning from lying on the belly to crawling. This reflex is connected to the TLR. The STNR splits the body into two halves – the lower half and the upper half. There are also two types of movements – flexion and extension. As the baby transitions from lying on their belly to being on all fours, they will extend their neck, look up, flex their neck, and look down. These movements will then trigger responses in the upper and lower limbs. When the neck extends, the arms will straighten while the legs will bend. Conversely, when the neck flexes, the arms will bend while the legs will straighten – this moves the baby into a position similar to a downward-facing dog. 

You know babies’ “rocking” motion on all fours just before they start crawling? That might be the STNR starting to integrate! The STNR should be fully integrated and no longer present by the time the baby reaches eleven months old.

What If Reflexes Do Not Integrate?

All reflexes are designed to support and help the infant grow properly and safely. As the babies get older and begin to mature, the reflexes are no longer needed, often taking a back seat (integration), and the higher brain can take control, allowing the body to control and move with thoughts behind it. This is a normal and essential part of our baby’s development. However, when reflexes persist, they can prevent the emergence of more complex movement patterns, which can present delays in achieving developmental milestones.

Each reflex has its own individual way of presenting, as well as its particular symptoms related to the reflex not being integrated. Persistent primitive reflexes can be associated with learning difficulties, emotional challenges and attention. It is recommended to discuss your concerns with your Occupational Therapist or Health Professional who specialises in primitive reflexes to determine if reflexes are impacting your child or infant’s development. 

Additionally, there was a study completed by Rashikj-Canevska, O & Mihajlovska, M (2020) that looked at the persistence of primitive reflexes and associated problems in children and identified these potential factors for unintegrated primitive reflexes, including the ATNR:

  • Stress during pregnancy
  • Substance abuse during pregnancy
  • Cesarean section birth
  • Brain damage during labour
  • Premature and low birth weight
  • Significant illness during the first year of life
  • Insufficient stimulation and tummy positioning
  • Lack of free movement time on the floor
  • Stressful environment
  • Not enough nourishment/insufficient weight gain

Can Reflexes Reappear After Being Integrated?

Yes, they can. If a child has successfully integrated their primitive reflexes, a sudden or chronic bout of trauma, stress, or injury can reactivate these reflexes. This has even happened to me personally in my adult years based on challenging personal situations and the increased stress due to COVID-19 during the years 2020 and 2021. 

“Routine testing of primitive reflexes helps determine the causes of disharmonic development, behavioural problems or learning difficulties, and the use of the reflex integration methods leads to a significant improvement of the condition.” (Rashikj-canevska, & Mohajlovska, 2020)

How can Occupational Therapists help?

Pediatric occupational therapists, trained in primitive reflexes, among other professional development courses, are ideal for supporting your child. By observing and testing different movement patterns, an OT can identify whether a primitive reflex is still present during movement activities. When a reflex is apparent, the OT can provide the child with various types of sensory stimulation and engage in activities that support reflex integration.

Can Other Health Professionals Help with Integrating Reflexes?

Occupational Therapists can work closely with Chiropractors who have training in Retained Neonatal Reflexes. They use specific techniques to assist in integrating these reflexes. Other health professionals, such as Paediatric Physiotherapists, can also assist in integrating these reflexes. 

Primitive reflexes are complex, and not all health professionals have the training to support the integration of reflexes. It can be complex as the human body is complex; however, it is very important. Remember that every case is unique, and if your child matches some of the characteristics mentioned above or you have observed them, that does not necessarily mean that they have retained that reflex. If you are concerned about your child’s abilities and how they may relate to retained reflexes, we recommend talking to your pediatrician. 

Don’t let unintegrated reflexes hold your child back. Our expert team is here to help! Connect with us today to learn how we can support your child’s development and ensure they confidently reach their milestones. Contact us now and take the first step towards a brighter future!

If you’d like to chat more, please don’t hesitate to contact us today! Call us on 0477 708 217 or email admin@exploreandsoar.com.au

Until Next Time,
Jess

PUBLISHED JUNE 2024

Case-Smith, J. (2010). Development of Childhood Occupations. In Occupational Therapy for Children.  6thEdition. Mosby Elsevier.

Berk, L.E (2009). Infancy: Early Learning, Motor Skills, and Perceptual Capacities. In Child Development. 8thEdition. Pearson International Edition. 

Latest Posts

Navigating Therapy Transitions: Your Path to Growth, Health, and Adaptation

· ·

NAVIGATING THERAPY TRANSITIONS: YOUR PATH TO GROWTH, HEALTH, AND ADAPTATION

In our previous blog posts, we discussed various life transitions, such as parenting, regulating emotions, and adapting to change. One of the most significant transitions we experience is therapy transitions, whether as therapists or clients. In this blog, we’ll explore our approach to therapy transitions and the services we offer to ensure the best outcomes for our clients and their families. 

Client-Centred Approach 

At Explore and Soar, we believe that every child’s journey is unique, which is why one of our values is “Client Adaptability.” We want to work closely with you and your child to achieve your goals and help them grow and adapt so they can engage, connect, and confidently navigate the world in their own way. As Occupational Therapists, we are privileged to help your child. However, we also understand that we are just one tool in your toolbox. Our role is to provide clinical knowledge and reasoning skills while empowering you to make informed decisions about the best path in your child’s therapy journey.

Transitioning Into Occupational Therapy 

As a parent, transitioning into health services, such as Occupational Therapy, can be overwhelming and daunting. Our mission is to make accessing services as seamless as possible, providing high-quality intervention support to help achieve your goals. 

We understand the mixed feelings that come with reaching out to us, whether through a phone call or an email. However, we are here to help and work with you. The best way to start is by having a phone conversation with us. Talking to someone and gaining clarity on the next steps can be reassuring. Depending on your individual needs, we can provide different therapy intervention options customised for each child and family’s needs. So, rest assured that we are here for you every step of the way.

Factors Considered in Therapy Recommendations

When recommending therapy supports, we consider several critical factors, including –

  • Your child’s age and development stage.
  • Motivation and ability to participate in therapy.
  • Functional goals tailored to your child’s needs.
  • Critical periods in your child’s life include early intervention and key transition periods.
  • Your family’s motivation, availability, and ability to support your child’s therapy journey.
  • The level of clinical knowledge and support required to attain the desired goals.

Based on these factors, we make clinical recommendations on the best approach for your child’s therapy journey.

Range of Therapy Options

At Explore and Soar, we use different intervention frequencies to work towards your child’s specific and diverse goals. Some goals can be achieved quickly, while others may take longer or may only partially achieve. This doesn’t mean that your child should be in therapy interventions continuously or forever.

 Regular Term-Based Appointments  

  • Regular term-based appointments are offered based on school terms. This is one of the most common intervention therapy approaches we implement. 
  • This allows for regular ongoing therapy, enabling us to check in at regular intervals to modify and adjust therapy intervention to work towards achieving an individual’s goal. 
  • Depending on the situation, we may offer either fortnightly appointments (5 sessions per term) or weekly appointments (10 sessions per term). 
  • This helps us adjust intervention recommendations for further practice and refinement at home, offering a consistent approach for both child and family to work towards goals.

Intensive Therapy

  • Intensive therapy involves a daily session for a week, with five sessions in total. 
  • This approach is ideal for clients who require a high intensity of therapy to achieve their goals or to consolidate their skills. It is particularly helpful for rapid progress and building upon existing skills.
  • Intensive appointments are an excellent opportunity for those looking to achieve a specific goal. 
  • This program consists of five one-hour therapy sessions in a week, in which we expose our clients to hundreds of repetitions of particular exercises, activities, or functional skills in a short period. 
  • This method allows for increased progress and quicker results compared to our fortnightly therapy sessions. If term appointments do not suit your family, the intensive model is an excellent alternative. 
  • This type of therapy is effective only if the client’s family fully commits to ensuring that the client attends all five sessions within the week. 
  • Following up the intensive therapy with home programming is crucial to supporting further development and consolidation of skills.

Block Therapy

  • Block therapy interventions follow a structure similar to regular term-based appointments. However, their frequency is slightly different. Instead of being assigned a weekly or fortnightly ongoing therapy session, you will be allocated a block of therapy to work on a specific goal, which may span one school term.
  • Once that block of therapy has been completed, there will be an equal-duration break from therapy, followed by re-engagement for another block of therapy in the following term. Alternatively, this could be done over two terms in a year, for instance, six months of therapy followed by six months of integration time.

School Holiday Group Programs

  • Exploring small group programs during school holidays is a fabulous way to simulate social interaction in a safe and supportive environment. 
  • These groups are designed to offer clients opportunities to practice their social skills with others. 
  • Group programs provide a platform to explore different interests, make new friends, or expand on old friendships in their local communities. 
  • Group programs offer an interactive and creative way of teaching, supporting, and achieving goals rather than one-on-one sessions with a clinician. 

Peer / Sibling Sessions

  • At times, one-on-one sessions may not provide enough challenge, while group programs may prove to be too challenging for our clients. In such cases, we find peer sessions to be the most effective therapy intervention approach.
  • Peer sessions strengthen our clients’ social relationships with family members, siblings, or other clients. These sessions can help clients build initial connections that may eventually develop into solid friendships. 
  • They are an excellent way for clients to motivate each other, work towards common goals, and learn how to encourage and support one another.

Home Programming

  • Home programming is offered as additional support for our clients to practice and improve their skills or tasks that we work on during our sessions.
  • The home program includes strategies, ideas, and activities that can help clients achieve their goals and develop new skills.
  • While we understand that our sessions are only a part of the overall support system for your child, we highly recommend completing the home programming set as it is essential for achieving the best possible outcomes in the shortest time.

Integration Time – Therapy Pauses

  • Many of our clients require a strong brain-body connection to achieve their goals. Once this connection is made, we can celebrate reaching our goal!  YAY! 
  • Not many people talk about the importance of integration time. After a goal is achieved or a skill is developed, the body needs time to process and integrate the new skill into everyday life. Have you ever learned a new skill and felt unsure of what you were doing, but later, it became second nature? That’s because your brain and body need time to integrate the skill into your lifestyle.
  • This is also true for children. Allowing time for pause and integration of new skills gives the brain and body time to practice and refine these goals. It also enables clients, families, and therapists to observe what is happening with the child, their priorities, and what additional support may be required. 
  • Alternatively, it gives our clients, families, and therapists time to observe what else is happening with the child, what is of concern, and what is a priority in achieving next. 
  • The timeframe for integration varies for each person and therapy option. For example, with intensives, there is usually a 10-week integration and skill-building period. Ongoing therapy can vary from 3, 6 or 12 months, depending on the length of appointments and required breaks.
  • Therapists are still available to provide support and check-in during the integration period. Remember that as the client or family member, you can reach out to the therapist if unexpected issues arise and receive the necessary support.

Parent Coaching Sessions

  • We understand that you play a crucial role in your child’s development as a parent or caregiver. By investing time, effort, and support in learning and implementing different strategies in your daily routine, you can become a more confident and effective caregiver. 
  • The more confident you are in implementing strategies, the more consistent you become, and the quicker positive changes occur for your child.
  • This is one of our favourite ways to support you and your whole family. We usually offer these sessions as a one-on-one appointment via face-to-face or telehealth, depending on your preference.

Understanding Family Needs

In reviewing goals for each child and family, we understand that goals are hit or life fatigue is felt; families are busy, and our world is constantly changing; therefore, you may require breaks from therapy at different times in your journey with Explore and Soar.

As so many of our families need to attend multiple services such as physio, speech, and psychology along with OT appointments on a regular basis, then add in school, other activities for the child and siblings, working parents, and the fact that families are generally time-poor we recognise the importance of flexibility and the need to support our families to see that taking a break from therapy is normal, okay and does not mean that we are ceasing to support your family. Instead, we believe it is critical to allow some breathing space for things that we may not be seeing yet to come to light so we can adapt our goals and refine our intervention. Or it may be that you and your child are ready to move to periodic check in’s where we catch up, review one specific goal, provide some ideas & strategies with home programming, and you implement them at home as you are now the key person in being able to do this.

Focus on Mental Health

At Explore and Soar, we prioritise not only your child’s mental health but also your family’s well-being. We recognise the impact of therapy transitions on mental health and aim to provide support that fosters resilience and positive outcomes.

Transitions in therapy can be challenging, but they also signify new opportunities for growth and development. At Explore and Soar, we’re committed to supporting you every step of the way. If you’re ready to embark on the next phase of your child’s therapy journey, we’re here to help. When one door closes, another opens.

Thank you for joining us in exploring transitions in therapy. For more information, please get in touch with us today.

If you’d like to chat more, please don’t hesitate to contact us today! Call us on 0477 708 217 or email admin@exploreandsoar.com.au

Until Next Time,
Lori

PUBLISHED MAY 2024

Trembath, D., Varcin, K., Waddington, H., Sulek, R., Pillar, S., Allen, G., Annear, K., Eapen, V.,Feary, J., Goodall, E., Pilbeam, T., Rose, F., Sadka, N., Silove, N., Whitehouse, A. (2022). National guideline for supporting the learning, participation, and well-being of autistic children and their families in Australia. Autism CRC. Brisbane.

Bailes, A.F.; Reder, R., & Burch, C. (2008) Development of Guidelines for determining frequency of therapy services in a pediatric medical setting. Pediatric Physical Therapy, 20 (2), pp. 194-198.

Latest Posts

Subscribe to our newsletter

Receive our news and updates via email. That's all.

View our Terms of Use.

Your feedback is always valued at Explore & Soar. If you have some feedback to help us support your needs better, please click here and share your valued feedback with us today.