TIPS FOR GROWING: Edition 13- INTERVENTION ACTIVITIES FOR CHALLENGING & INTEGRATING PRIMITIVE REFLEXES

11.20.2023

TOPIC: Integrating Primitive Reflexes

Interventions for Challenging & Integrating Primitive Reflexes

Welcome to the Thirteenth Edition of Tips For Growing! These blog posts will focus on important clinical topics that are regularly encountered when working with children. 

Today’s "Tips For Growing" will focus on therapeutic interventions that are known to help inhibit the activation of tonic reflexes and advance postural control as a foundation for optimal functioning. 

We hope these seeds of information will help with the most important job there is . . . helping children grow.

This blog will suggest therapeutic interventions that are known to help inhibit the activation of tonic reflexes and advance postural control as a foundation for optimal functioning.

A reflex is a stereotyped automatic involuntary response to a sensory stimulus. The sensory stimuli may be sound, touch, or movement. For the purpose of this blog, minimal to moderate motor delays will exclude children with severe deficits in mobility and gross motor functioning. This includes the need for moderate to maximum physical assistance from others to ambulate.
Primitive reflexes or primary movement patterns are present at birth and are integrated as the infant develops during the first 6-12 months of life. These reflexes interact and work together to help the infant organize their motor behavior. They lay the foundation for moving the development of motor skills forward.

The integration of reflexes refers to the inhibition by higher centers of neurological control which modify the reflex in such a way that the pattern of response is no longer automatic or stereotypical. The reflex or pattern is known to move into the background after it has played its part. The reflex does not disappear; it may reactivate under stress, when a highly precise motor skill is needed, or during activities that require great strength or power.

If these so-called primitive reflexes are persistently displayed beyond the expected or typical developmental time period, their presence has been considered an indication that underlying developmental or neurological issues may exist. Unintegrated or retained reflexes are those that are not used functionally. When these reflexes do not integrate, they may interfere with a child’s development of more advanced motor skills, emotional regulation, and overall learning. If such a delay or disruption exists, there may be an impairment in the child’s occupational performance. That is where an Occupational Therapist’s skillful assessment and intervention will make the difference for the child!

(1) Prone: 

• Remember to focus not only on maintaining this static position, but the transition into and out of prone.
• The child should remain static for brief periods; even minimal weight shifting from the child’s center of gravity may activate the muscles of the spine and shoulder girdle.
• Remember: upper extremity strength is important for ideal protective extension and use of the arms for transitioning between positions and minimizing the influence of primitive reflexes.

Prone Intervention Activities:

1. Hold a large dowel with both hands, use this to push a ball back and forth
2. Use arms to push a ball back and forth
3. Color, print, draw, read, or complete puzzles in prone
4. Pivot in both directions
5. Play games that require blowing through straw
6. Commando crawl with belly on the floor
7. Prone on therapy ball, platform swing, or over bolster
8. Cup stacking in prone- use hands to stack cups in front of child
9. Prone on scooter board- push off a wall with arms to glide backward
10. Prone on scooter board-being pulled by a rope while grasping onto it with both hands
11. Prone on scooter board- pivot in a circle in both directions
12. Prone on therapy ball- select ball that allows hands to touch the floor to complete a “walk-out”
13. Plank Position- maintain while head is forward and then is rotated off midline to both right, then left. Attempt to reach up with one arm and simultaneously extend a leg off the floor. Maintain while touching right hand to left shoulder, and the left hand to right shoulder.
14. Mountain Climber
15. Plank Jack

(2) Supine Flexion:

 Supine Flexion Intervention Activities:

Meatball Position: activates muscles antagonistic to the tonic labyrinthine supine reflex.

• Child uses their own hands to place/remove stickers on knees or feet.
• Child uses their own hands to place/remove rings from their feet.

Supine:

• Bounce ball off hands while child’s shoulders flexed to 90 degrees with elbows straight; therapist drops ball from above for child to volley back
• Move legs to kick a rolled or suspended ball with feet
• While propping self on forearms, trap a ball between both feet and then transfer back and forth to another child or into a basket
• Supine on therapy ball; transition into sitting and vice versa
• Bridge position- try to extend one leg at a time by straightening knee
• Side Sit-Ups
• Cross Crunch
• Trunk Twist
• Table Position: lower legs (below the knee) and arms form the legs of the table, while the thigh and torso form the tabletop
• Rolling: Outside-down or up hills, with arms overhead or at side. Be sure to encourage chin tuck
• Crab Walk

(3) Long Sit:

•  Long leg sitting offers the opportunity to stretch muscles that are often tight in children that need to “fix” due to immature balance and ongoing influence from primitive reflexes.
• This position can help lengthen the hamstrings; a muscle that often tightens as children over-use to stabilize. Strive to have child free both hands to manipulate an object at midline.
• This position also provides a chance to develop balance by narrowing the child’s base of support.

Long Sitting Intervention Activities:

• Encourage the child to reach forward to touch toes without bending knees.
• Seated Forward Fold Yoga Pose

 (4) Prone Extension:

Prone Extension Intervention Activities:

• Superman/Super Woman-prone extension with arms and legs fully extended activates muscles antagonistic to the tonic labyrinthine prone reflex
• Try on a scooter board, platform swing, or therapy ball
• Prone on scooter board- push off a wall with arms to glide backward
• Prone on scooter board-being pulled by a rope while grasping onto it with both hands
• Swimmers

(5) 4-Point Quadruped:

4-Point Quadruped Intervention Activities:

• On tilt board
• Turn head side to side, raise head up and down, or “roll” neck without moving knees or hands
• Rock body back and forth or side to side while knees and hands planted
• Creeping on hands and knees
• Creep though tunnel forward and backward
• Creep over obstacles such as cushions, pillows, bolsters, etc.
• Creep forward with head turned toward the right while stabilizing a soft toy between the chin and shoulder. Do the same for head toward left.
• Creep sideways
• Creep forward while using top of head to push a large therapy ball forward
• Cow Yoga Position
• Cat Yoga Position
• Table Yoga Position
• Bear Walk
• Quadruped Cross Touches
• Quadruped Cross Kicks

(6) 2-Point Quadruped:

  2-Point Quadruped Intervention Activities:

• Two Point- maintain one arm and one leg in full extension
• Quadruped Cross Kicks
• Donkey Kicks- raise one leg into extension, then flex/extend knee so as to kick

(7) Sidelying

• The sidelying position offers the opportunity to increase strength and endurance while moving in 3 planes. The child will learn to balance by keeping their head and body oriented in midline; remember to not only focus on maintaining this static position, but the transition into and out of sidelying.
• The child should remain static for brief periods; even minimal weight shifting from the child’s center of gravity may activate head and torso righting.
• Be sure to encourage the use of this position on the their right and left sides. This will lengthen muscles needed for full rotation of the trunk.
• Remember…full expression of equilibrium reactions requires torso rotation and freedom of movement in the upper and lower extremities. 

Sidelying Intervention Activities:

• Reach- Use free arm to encourage reaching and other movement/manipulation
• Play games such as “Connect Four” in high sidelying
• Swat at suspended ball with free arm while in high sidelying
• Work puzzles with free hand while in high sidelying

(8) Side Sit:

• While side sitting strive to have child free both hands free to manipulate object at midline; this may require considerable time and practice. To work toward this encourage the child to adjust to small weight shifts away from their midline.
• Remember…diagonal control sets the stage for isolation of movement for each limb, important for minimizing the effects of primitive reflexes on functional movement.

Side Sit Intervention Activities:

• String beads in side sit
• Lace in side sit
• Toss a ball while side sitting
• Catch a balloon while in side sitting

(9) Tall Kneel:

 Transitioning between tall and one-half kneel provides an excellent opportunity to develop the strength and balance to not only minimize the influence of primitive reflexes, but to develop the motor planning for energy efficient and functional movements.

• Slowly transition between tall and one-half kneel
• Use hands to complete tasks placed on vertical surface 

(10) One-Half Kneel:

Stand-Ups-

• Start in a tall kneeling position
• Raise one leg up and push using that leg to stand up
• Do not use hands on floor or furniture while standing or returning to kneel
• Return to tall kneel through the same motion

(11) Squat:

• When encouraging transitional movements, such as standing to squat, be sure to focus not only on the end position, but accomplishing the movement in a smooth and efficient manner. This will set the stage for the child to adopt this pattern in to their functional movements.
• Squatting provides an opportunity for developing hip stability and balance.

Squat Intervention Activities:

• With the back facing a wall, trap a ball between child’s back and wall; roll ball up and down the wall while squatting and standing. No use of hands.
• While facing the wall, use hands to stabilize a ball on the wall. Roll the ball up and down the wall while squatting and standing. Do not drop the ball.
• Wall Squats
• Squat Exercises

(12) Standing:

Standing Intervention Activities:

1. Wall Pushups - Stand facing a wall to perform wall pushups; do with head facing wall and while head is rotated away from wall
2. Stand facing wall with straight elbows and palms against wall, slowly rotate head left to right without bending elbows
3. Stand sideways (perpendicular) to a wall. The wall side hand is on wall with a straight elbow. Opposite arm is on hip. Child turns head away from wall without bending supporting arm. Repeat several times and then on other side.
4. Stand with back to wall and legs apart; touch right foot to left hand, then left foot to right hand
5. Stand while using hands to complete tasks placed on vertical surface
6. Walk while holding a tray full of objects; pause and turn head side to side and up/down without moving arms
7. Walk and catch objects with a play fishing pole; use one hand to hold the pole and other to remove “caught” object
8. Stand with feet planted while catching a ball thrown slightly out of reach toward the side
9. Balance on right foot while turning head to the left
10. Balance on left foot while turning head to the right
11. Inchworm- begin in standing position, then reach down to floor until hands are planted. Walk hands forward to a plank position. Walk hands backward toward feet and then come back to standing position.
12. Ball Walk-Ups- While facing the wall, use hands to stabilize a ball on the wall. Roll the ball up and down the wall. Do not drop the ball.
13. Jumping Jacks
14. Scissor Jacks
15. Cross Crawls
16. Crazy Jacks
17. Back Cross Crawls

Tools To Grow Resources Used To Target the Integration of Primitive Reflexes: 

1. Primitive Motor Reflexes: Informational Article (Printed Book):

• NEW!!! Find this booklet in our shop only!
• A 15-page informational printed article on primitive motor reflexes and their impact on a child’s function.
• Includes visuals and descriptions of tonic reflexes, how persistent reflexes present in a child, considerations for treatment, and sample intervention activities.
• Printed on high quality paper
• Transparent PVC Binding Cover

*Ships to Canada and USA only at this time

>> Find it here!

 Watch video here!

2. Reflex Packet – Digital Download:

This packet includes:

• Primitive Motor Reflexes Infographic
• A 15 page informational article on primitive motor reflexes and their impact on a child’s function
• Position Cards
• Roll A Position Game
• Spin A Position Game

* This is a digital download packet. Downloads will be in PDFs!

>> Find it here!

3. Position Picture Cards:

• A fun way to encourage children to develop balance and postural control.
• The process of assuming & maintaining these postures helps minimize the effect of primitive reflexes on a child’s functional movements.
• Encourages the development of strength and endurance while holding anti-gravity positions.
• Helpful for those children that resist adult directed tasks; minimizes possible conflict as the position is determined by “chance”.
• The therapist/adult can customize the use of the body positions in a variety of ways.
• Included is a set of 16 picture cards. Each 4 by 4 inch card has an attractive, easy to copy image of a different position.

 >> Find it here!

 Watch video here!

 4. Spin a Position:

• This game includes a high quality game cards and detailed instructions.
• Child flicks the spinner.
• Use the accompanying “Position Picture Cards”; these provide a larger view of the posture the child is to assume.
• With the adult’s assistance as needed, the child is to assume the position depicted on the spinner.

 >> Find it here!

 Watch video here!

5. Roll a Position:

• This game includes a high quality game cards and detailed instructions.
• Child rolls a die and finds the corresponding pictures on the board. He/she can select one of the two.
• Use the accompanying “Position Picture Cards”; these provide a larger view of the posture the child is to assume.
• With the adult’s assistance as needed, the child is to assume the position depicted on the game card.

 >> Find it here!

 Watch video here!

 Additional Tools: Click for Links!

• Bilateral Coordination Exercises 
• Core Strength Packet 
• Yoga Cards 
• Strengthening Exercises 
• Animal Walks 

We hope these seeds of information will help with the most important job there is . . . helping children grow.

Related Topics: Reflexes , Tips for Growing

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