Sensory Processing Challenges and Reflex Integration
What does it mean to integrate a reflex? Sensory Processing Challenges and Reflex Integration
The primitive reflexes, or primary movement patterns, is a topic area that has generated significant interest and attention amongst allied health professionals. From an Ayers’ (1973) informed Sensory Integrative perspective, the primary movement patterns represent the building blocks for posture, balance, and overall regulation of arousal and affect.
But what does it mean to “integrate a reflex” and what does it look like in kids with sensory processing challenges? To answer these questions, one must first understand two things: (1) the role of reflexes in typical development and (2) how an unintegrated reflex can later interfere with the development of subsequent higher level skills and, ultimately, daily life.
Reflexes are an inherent part of typical development. They allow us to generate the necessary muscle tone to protect ourselves, to come up against gravity, and to orient to the environment. In the case of the early protective patterns, such as the Moro response, they contribute to an individual’s autonomic regulation.
Early reflexes are triggered by sensation
These early reflexes are triggered by sensation. In infancy, specific sensory input triggers an increase in tone in certain muscle groups. This increase in tone biases the infant to move in a corresponding predictable pattern (a reflex). The infant will then move in these predictable patterns for a window of developmental time. As other motoric competencies emerge, the child will be able to move against the pattern or use any component of the pattern as necessary to meet a goal in the most efficient and adaptable way
How can the integration of these reflexes be interrupted?
Some authors (Goddard, S., Blomberg, H., etc.) describe unintegrated reflexes as retained reflexes. While I agree, I see this as only one potential presentation of an unintegrated reflex. For many kids that I see in my practice, their difficulties processing sensory input impacts their ability to integrate these early movement patterns. This can present as incomplete expression or non-expression of the reflex.
An infant with difficulty processing sensation will exhibit atypical expression and integration of certain reflexes
Since reflex patterns are triggered by sensation, an infant with difficulty processing sensation will exhibit atypical expression and integration of certain reflexes. For example, children who have difficulties with vestibular-proprioceptive processing may not receive adequate information from their vestibular system and neck proprioceptors to elicit the Asymmetrical Tonic Neck Reflex (ATNR) when their head is turned. Thus this movement pattern may not unfold as expected (it may be absent or incomplete).
The significance of a lack of expression of the ATNR can be seen in functional limitations related to eye-hand coordination. ATNR’s movement pattern is a template for the infant to connect their eyes to a hand on each side of the body and differentiating the two sides of their body. As the infant integrates this movement pattern and later moves against the patterns in belly crawling, the head is able to move back and forth to scan the environment 180 degrees. This serves as a foundation for the ability to track across midline—the foundational oculomoter skill necessary for reading. Incomplete or absent integration of this reflex will impact such oculomotor skill, as well as balance, midline organization, and bilateral integration.
It is necessary to provide more precise and potentially more intense input
In these cases of incomplete or absent integration, it is necessary to provide more precise—and potentially more intense—vestibular and proprioceptive input to trigger the movement pattern (of the reflex). The combination of reflex-specific sensation and an individually determined level of intensity elicits the innate reflex pattern. At this point, clients then need an opportunity to work both in the pattern and, once clearly established, against the pattern.
I hope you find this broader perspective of reflex integration helpful to deliver more effective services for your clients.
~Sheila Frick, OTR/L
Ayres, A.J., (1973). Sensory integration and learning disorders. Los Angeles, CA: Western Psychological Services.
Blomberg, H. & Dempsey, M. (2011). Movements that Heal.: rhythmic movement training and primitive reflex integration. Sunnybank Hills, Australia: Bookpal
Goddard, S. (2005). Reflexes, learning and behavior: a window into a child’s mind. Eugene, Oregon: Fern Ridge Press.