Primitive Reflexes The Bottom Line Gabby Marshall, OD, FCOVD Behavioral Optometrist Elemental Eyecare, Bend Oregon

General Concepts Movement patterns directed from the level of the brain stem Not conscious Emerge pre-natal and early post-natal Designed to ensure immediate response to the new environment and encourage movement patterns Have limited life span (9 weeks (IU) -12 months (PN))

General Concepts Provide rudimentary training for later voluntary skills Lack of integration may prevent development of succeeding postural reflexes Lack of integration may cause immature systems to remain prevalent Lack of integration causes poor organization of the central nervous system

Moro Emerges 9 weeks in utero Integrated between 2 and 4 months of life Vestibular Auditory Tactile Visual “Umklammerungsreflex” = clasping reflex

Physical Response Instantaneous arousal/involuntary reaction to threat Startle, rapid inhalation Activation of fight or flight – sympathetic NS – Adrenaline & Cortisol (stress hormones) – ↑ heart rate, breathing (hyperventilation) – ↑ blood pressure – Reddening of the skin – Outburst or crying

Affect of Retained Moro Motion Sickness, poor balance or coordination Physical timidity Oculomotor and visual-perceptual problems Poor light/dark adaptation Auditory confusion Allergies, lowered immunity Poor stamina Dislike of surprise, change Emotion profile

Tonic Labyrinthine Emerges in utero, present at birth Forward and backward reflex Integrates approximately 4 months, backwards reflex is linked to HRR and STNR and can take up to 3 years to integrate Head control Affects communication between the proprioceptors and the vestibular nuclei, in turn affect the eyes “where am I”

Affect of Retained TLR Can prevent the child from creeping (head movement= leg extension) Lack secure reference point in space “where am I” Difficulty judging distance, depth and velocity Posture, hypotonicity, balance, toe walking Oculomotor dysfunction Spatial problems, poor sequencing, sense of time

Symmetrical Tonic Neck Emerges 6-9 months Integrates 9-11 months Flexion and Extension Presence helps integrate the TLR Forms bridge to creeping

Affect of Retained STNR Poor posture – Slump when sitting – “W” legs position when sitting on floor Poor eye hand coordination Difficulty with near to far focusing

Asymmetrical Tonic Neck Emerges 18 weeks in utero Integrates at about 6 months Head movement elicits reflexive extension and opposite flexion Facilitates movement “kick” in utero and vestibular stimulation Seeds eye-hand coordination and focusing

Affect of Retained ATNR Difficulty crossing midline, bilateral integration Focusing spasm Poor handwriting Oculomotor dysfunction Mixed laterality Visual perceptual difficulties

Spinal Galant Emerges 20 weeks in utero Important for movement and delivery Integrates 3-9 months Should be bilaterally symmetrical

Affect of Retained SG Fidgeting, wiggle worm Bedwetting Poor concentration Poor short term memory Connection to irritable bowel syndrome

Palmar Emerges 11 weeks in utero Integrates 2-3 months

Affect of Retained Palmar “overflow” to mouth when writing Poor handwriting grip and form Speech difficulties Pain and fatigue with writing

RESOURCES – Bend’s pediatric and vision therapy clinic – Home programs – Dr. Svetlana Masgutova Sally Goddard Blythe MSc