One of our favorite things about our digital courses is that you can ask questions and start conversations inside of the course! We have a comment forum within each module of each course, and we LOVE getting in there to answer questions, brainstorm, and chat about progress!
Today’s episode is a conversation about a question that was posted inside of our primitive reflex digital course. We talk about different reflexes, different challenges associated with those reflexes, and strategies for the specific situation detailed in the question.
One of our favorite things about our digital courses is that you can ask questions and start conversations inside of the course! We have a comment forum within each module of each course, and we LOVE getting in there to answer questions, brainstorm, and chat about progress!
Today’s episode is a conversation about a question that was posted inside of our primitive reflex digital course. We talk about different reflexes, different challenges associated with those reflexes, and strategies for the specific situation detailed in the question.
Also, I would communicate with him as well and talk about the things that are difficult for him, the things that he's really good at, and talk about how there's this reflex that needs to go away and we need to help it get out of your body. And that way he can learn like, oh, this is why we're doing it. Like I'm really trying to get this reflex and then maybe you can talk to him about testing it. And you can be like, okay, every week we're going to test it. We're going to see if this reflex has gone away yet and make it motivating like that, if it's applicable. I'm Rachel.
Jessica:
And I'm Jessica. And this is All Things Sensory by Harkla.
Rachel:
We are both certified occupational therapy assistants, and together with Harkla, we are on a mission to empower parents, therapists, and educators to help raise confident and strong children of all abilities.
Jessica:
On this podcast, we chat about all things sensory, diving into special needs, occupational therapy, parenting, self care, overall health and wellness, and so much more.
Rachel:
We are here to provide raw, honest, and fun strategies, ideas, and information for parents, therapists, and educators, as well as other professionals to implement into daily life.
Jessica:
Thank you so much for joining us.
Rachel:
Hey there! Welcome back to all things sensory. Welcome. If this is your first podcast episode you've ever listened to, I do recommend going back a few, listening to some others if you, if we jive with you, which hopefully we do. But if we don't, that's okay too. No hard feelings. Anyways, welcome. Hi.
Jessica:
We are answering a question from our Primitive Reflex Digital course. We have a course that teaches you how to test for and integrate retained primitive reflexes in children ages 5 and up. If you are interested in learning more about that course, you can go to the show notes and click the link and you can get all of the details. It is approved for continuing education units for occupational therapists. So, one of the things that we have inside the course is discussion forums, and within each learning module, anyone, who's in the course, can ask a question or make a comment. And then each week Rachel and I get in there and respond, answer questions, move discussions along, that kind of thing. So, it's a really cool feature, and we've done this before where we took a question or a couple of questions from inside the course and answered them on the podcast. Because some of these questions are just so interesting, and we just want to talk about them. So, yep, that's what we're doing today.
Rachel:
Alright, so the question is, Hey there, I assessed a child today who presented with a 4 out of 4 TLR. So 4 is like significantly retained tonic labyrinthine reflex. Watching him outside, playing and running, he's fast, he's always moving, really smiley. He looks like he's always trying to create tone or create muscle tone. When he lies down, he can barely lift anything off the floor and can't even hold it for five seconds. So, she's talking about holding like a prone superman against gravity. It was hard to know if he just gave up or if he couldn't do it. His whole posture just collapses when he stops moving. Either onto a parent or when he goes in for a hug, he just flops on top of them and lying on the floor creating tone to move appeared so difficult. He also had a retained ATNR, which was about a 2 out of 4 actively and more passively. So more like maybe a 3 out of 4 when the therapist was like passively turning his head side to side as just one rotation was enough to bring him at the posture following a large elbow collapse. He also had about a two out of four palmar grasp reflex that was retained. My thought is to start with the ATNR and the palmar. But I'm wondering how you go about incorporating the TLR when the motivation is not there for the integration exercises, but the difficulty level is like maxed. So where do we go from here? What are we going to do if this was a kiddo that we were working with?
Jessica:
The first thing that I thought was really interesting was how she talked about how he's always trying to create muscle tone. He's fast. He's always moving. He's on the go. He probably appears athletic and strong, you know, a child who's like just going and moving and has endurance and can just go forever. But then when he's asked to hold a position against gravity, a static non moving position, and hold his extremities, arms and legs, up against gravity and use his muscle tone to hold that, he's unable to do that. He doesn't have the like, static muscle strength and tone to be able to hold a position against gravity when he's not in constant motion. And Rachel had a really good like example of what that looks like.
Rachel:
Oh, thank you. Yeah. Well, I just, you know, if we're unpacking this, we know that the TLR connects to the vestibular system and the vestibular system connects to muscle tone. So we know that there's a disconnect there and my thought was you think about the centrifugal force when you're, like, swinging a bucket of water around and around and around. You're, like, creating that muscle tone, right? The water is, is staying in the bucket, you're moving, moving, moving really fast, and as soon as you stop the bucket above your head, the water falls down all over you. And that's exactly what I'm picturing with this child. He's running, he's going, he's moving in order to just, like, stay upright, you know, and to help him process. My guess is to help him process vestibular input. And then as soon as he stops and he has to just like even stand and hold that position against gravity, just like hold his body upright. It's difficult for him. My guess is he probably struggles to sit in his chair during class as well. He's either like slouched over. or falling out of his chair.
Jessica:
Or like unable to even sit still.
Rachel:
Yeah. Or he's like wrapping his legs around the chair. He's probably like, his chest is probably like leaned up against the desk as well. Like really compensating. You can, you can probably spot that a mile away. But that's, that's the challenge here is that this reflex is probably impacting him more than we actually know. So the goal is to integrate this reflex because ideally it will help his muscle tone. It will help his vestibular processing. He'll be able to function better during the day and throughout the day. He won't be collapsing onto people and onto his desk and, you know. Maybe he can perform more like slow, controlled movements during the day. Like if he's playing, if he's like playing a game or something like Jenga or, you know, I don't know, we'll just do whatever he needs to do during the day. It'll probably get a little bit easier for him. So.
Jessica:
Yeah, and the person who posted this question said they wanted to start with the ATNR and the Palmer. I would actually start with the TLR.
Rachel:
Me too.
Jessica:
Because it's so much more retained and it does have an impact on the ATNR and Palmer. So what I would start if this was my client, is we would do the superman activity in every session. I would send it home as the exercise program and if this child was able to like see himself in a video or, you know, count how many seconds he can hold the superman and then have a goal of being able to hold it for longer by next week. Then that would be the goal and then if he meets that goal, we celebrate. We cheer, you're stronger, nice job, let's keep going. But I would start with that and then also incorporating some of those other activities into the treatment sessions. Send them home if possible.
Rachel:
I would even just start doing games and activities on the floor in prone.
Jessica:
That's one of the things that I was. Yeah, absolutely.
Rachel:
Yeah, you know, even before we're going to do more of like the functional activities, just like have him pick out a game, lay on the floor, hold yourself against gravity, maybe put him on a peanut ball and have him play the game like while he's his like trunk is on the peanut ball. And his arms are on the ground and then flip over and you know, make sure that you're practicing that supine flexion as well and holding that bouncy ball pose. Maybe draw, play games like under a table or like, you know, do a, like a ball bouncy roll down the crash pads or the cushion.
Jessica:
Supine ball kick.
Rachel:
Yes. Yeah. So anyways, what else do you think?
Jessica:
No, those were all the things that I was thinking of too, of incorporating those flexion and extension pattern activities into the session. But yeah, just going back to tummy time. I'm, I'd be so curious if he tolerated tummy time as an infant?
Rachel:
Yeah. I wonder if his Landau is integrated as well.
Jessica:
Probably not.
Rachel:
You know what else I was thinking? Working on more of that, like static positioning, I would put like a visual on the ceiling and I'd put a visual on the floor and I'd have him with a metronome look up and read one item. Like you're reading a book, like a page from a book, read from left to right. So read one item, look up and then go down. Maybe not with the metronome at first, and then look down, read the next item up and down. So you're alternating between that neck flexion and extension while standing. Give him like a visual for his feet, so his feet stay there. I would also take a video of him if you have permission, and show him what his body is doing. My guess is he'll probably wanna collapse down to the floor.
Jessica:
Fall over. Yep.
Rachel:
Mm-Hmm.. But challenge him. You should do it with him.
Jessica:
Yep.
Rachel:
See if you guys both can do it. Maybe alternate.
Jessica:
The challenge with this kid is going to be that like motivation, right? How can you motivate him to do these activities that are really difficult for him? So doing the activities with him so that he's not alone, but you're also doing it together. Having some sort of goal for him to work towards, whether it's to just be able to hold it longer and it gets easier, or having some sort of reward system set up for him. So that he does his OT homework, and then he is able to have a reward or a prize at the end. And, you know, obviously getting the parents permission for something like that. But figuring out what's motivating for him. Maybe he loves obstacle courses. So you incorporate these activities into the obstacle course. That's one of my go to ways to work on these challenging positions and exercises is you incorporate it into an obstacle course and you make it fun and engaging and you can achieve so much success with just a simple three to five step obstacle course with these kiddos and work on those primitive reflexes simultaneously. It's amazing how you can just get it, get it done, and the child is having fun while they do it.
Rachel:
Yeah, I'm just thinking too, like, more scooter board activities.
Jessica:
Mm hmm. Yep, the scooter board.
Rachel:
Prone and supine.
Jessica:
Using his arms to pull himself forward or grabbing a rope and pulling himself forward while he's laying on his stomach on the scooter board. As well as while he's laying on his back on the scooter board.
Rachel:
Yeah, and then also I would communicate with him as well and and talk about the things that are difficult for him, the things that he's really good at, and talk about how there's this reflex that needs to go away and we need to help it get out of your body and mature into a you know. However you want to explain it to him to make it make sense, and that way he can learn, like, oh, this is why we're doing it, like, I'm really trying to get this reflex. And then maybe you can talk to him about testing it, and you can be like, okay, every week we're going to test it, we're going to see if this reflex has gone away yet, and make it motivating like that, if it's applicable.
Jessica:
Yeah, if he can understand it, yeah.
Rachel:
Yeah, totally.
Jessica:
Yeah, I think working on the TLR for this child would be really important and with so many of these activities that we're talking about, you're simultaneously going to be working on other reflexes, like the ATNR, you know. When we're doing a scooter board activity and we're alternating the left and right sides of our body to propel ourselves or pull ourselves forward, we're going to be working on that ATNR. When we are, you know, weight bearing on our hands or holding things like a rope to pull ourselves forward or playing catch with a ball, we're working on that palmar grasp reflex. So you can kind of work on those other reflexes simultaneously while you're focusing on that TLR. But also this person is not wrong to want to work on the ATNR and the palmar grasp reflex first. Especially if they used the checklist that's in the course where the parents can fill out like, from a functional standpoint, what is happening in the child's day to day life that they're struggling with. And if they're struggling with reading and writing, if they're struggling with hand dominance, left and right confusion, those bilateral integration activities, then that would make sense why we would want to address the ATNR and the palmer grasp reflex.
Rachel:
Yeah, this is a good question. I'm really, I really want to hear like how it goes, you know. Keep us posted. You know, like I I feel like this kid has so much room for potential especially having like a retained, you know four out of four score. I feel like with even just a little bit of progress. And you know, I used to work with a kiddo who it just really could not hold that prone extension position. That superman position and it was almost like a musculature reason. It wasn't like a strength thing. That was obviously included, but it wasn't it, it was just an interesting. It was an interesting thing that was happening when we were practicing this. So we just.
Jessica:
Wait. What do you mean? You think it was musculature, though?
Rachel:
Like, it was almost like tension. Like, he didn't have the range of motion to, like, extend his neck.
Jessica:
Oh, yeah.
Rachel:
And, like, the key was that position. He was just
Jessica:
very tight.
Rachel:
Very tight. Yeah, like rigid. Yeah. And so we would, we were like modifying all the activities because they were like going through the reflex integration program. They're like, well, he, he's not holding it. Like they, they did the exercises every day and they're like, how long are we going to be on this? Well, I go on, let's move it forward a little bit and so then we just kind of modified it a little bit and, and did more of the, like fly to the moons instead. And we weren't working on, on that, like full extension quite as much. It was more of like the ocular motor, the visual tracking, like we were kind of like laying halfway on a couch sort of like on the armrest of a big couch and like holding our body and extension off of the couch like we were flying. So just like random things that we were trying to make it a little bit more fun and and exciting for him, but still working on the visual component. So that's something that I would make sure that you're including too is those flight of the moons and like the visual tracking rolling a ball back and forth like a rainbow drawing.
Jessica:
Throwing the ball at a target.
Rachel:
Infinity loops. Yeah. Yeah.
Jessica:
Yep. That's tracking as well.
Rachel:
Prone on a swing, like a platform swing, throwing balls at targets as well.
Jessica:
Yep.
Rachel:
There's so many things. Like, I love this. Like, I could literally talk about this all day. So let us know if you're listening to this episode and if you try any of these things and if they're helpful and, you know, let us hear the progress report.
Jessica:
Yeah.
Rachel:
Progress report? The progress, this progress story. The story.
Jessica:
The progress report, how you're progressing along. Report back on your progress.
Rachel:
Yes. Keep us in the loop and then if you have questions too, let us know about, about your own primitive reflex questions.
Jessica:
Yeah, absolutely. Let us know, share this with a friend, get into the course so that you can learn more about what we're talking about. If you are in the course, make sure that if you have questions, you leave them in the discussion forum. Yeah.
Rachel:
Let us know leave us a review on iTunes or Spotify. Give us your feedback We need some we need some love on the podcast.
Jessica:
We need some new reviews. Yeah.
Rachel:
Yeah. Yeah. Okay. Well, anyways, this has been fun Thanks for hanging out with us and we'll plan on chatting with you next week.
Jessica:
Okay. Bye.
Rachel:
Thank you so much for listening to All Things Sensory by Harkla.
Jessica:
If you want more information on anything mentioned in the show, head over to harkla.co/podcast to get the show notes.
Rachel:
If you have any follow up questions, the best place to ask those is in the comments on the show notes or Instagram account, which is at harkla_family or at all things sensory podcast. If you just search Harkla, you'll find us there.
Jessica:
Like we mentioned before, our podcast listeners get 10 percent off their first order at Harkla. Whether it's for one of our digital courses or one of our sensory swings, the discount code sensory will get you 10 percent off. That's S E N S O R Y.
Rachel:
Head to Harkla.co/sensory to use that discount code right now.
Jessica:
We are so excited to work together to help create confident kids all over the world. While we make every effort to share correct information, we're still learning.
Rachel:
We will double check all of our facts, but realize that medicine is a constantly changing science and art.
Jessica:
One doctor or therapist may have a different way of doing things from another.
Rachel:
We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties, and what we have found to be beneficial that will be as evidence based as possible.
Jessica:
By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your child.
Rachel:
Consult your child's pediatrician or therapist for any medical issues that he or she may be having.
Jessica:
This entire disclaimer also applies to any guests or contributors to the podcast.