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Retained Primitive Reflex, cranial nerves and the 5th nerve
We cannot negotiate with a reflex. (or a terrorist)
Did you know that there can be invisible enemies hiding in the brains and bodies of many of our children, friends, family members and patients?
These enemies were once our biggest protectors : the primitive reflex patterns that taught us to be aware of danger, make changes to adapt to the environment and reach for things that we needed to survive. During normal development, these "friends" were supposed to allow us to grow up and not need them anymore as the protective reflex patterns converted to the postural reflexes of normal everyday living.
As we grow and evolve, these old primitive friends can reactivate when we sense that we are in danger or have trauma. They not only come for a visit, but they often decide to stay.......a really.........long........time........
The process of a reflex that was supposed to "go away" (integrate) being reactivated and "sticking around" (becoming retained) is referred to as a Retained Primitive Reflex. These old friends had good intentions at one time, but they tend to overstay their welcome in the presence of perceived danger or restriction.
For example, if you were being help against your will, would you want someone to come and rescue you? Of course you would, but what if they wouldn't leave your side from that point on? It might get old.
That's when these old friends become terrorists that cannot be negotiated with.
The good news is that we can recreate the movements that helped to convert these primitive reflexes to postural reflexes and create an environment of safety, playfulness and intention reminiscent of the natural developmental process that naturally integrates the reflex.
...and that's when simple solutions can be applied to solve complex problems!
Background noise: WHere is the music coming from?
Overload.
When a patient has the background noise of a retained primitive reflex running in the background of neurologic function, it "plays its music" over everything else that is going on and no one knows how to turn it off.
It can be confusing, overwhelming and exhausting for the person experiencing a retained primitive reflex. It is often misdiagnosed as:
Attention Deficit Disorder
Learning Disabilities
Movement Disorders/Torticollis
Sensory Processing Disorders
Sleep Disordered Breathing/Sleep Apnea
Bedwetting
Tongue Tied or restricted
and many others.
Moving on...
Primitive Reflexes- The Deep Dive
The transition from primitive reflex to postural control is not automatic and the best way to integrate primitive reflexes is by using them. Reintegration exercises can help start the process of balancing the brain and support the patient in overcoming developmental delays. These exercises can be done at any age because as many as 40% of our population likely has retained primitive reflexes.
As certain movements are practiced over and over, the movements mature and “integrate” the primitive responses. The brain stem is where sensory stimulation occurs and the impulse radiates upward and outward. Primitive reflexes are involuntary and are considered as part of the reptilian brain. Postural reflexes are part of the next level of evolution taking place in the midbrain, the undeveloped mammalian brain. The neocortex is the most advanced and complex. Postural reflexes depend on the integration of primitive reflexes as one builds on the other. To survive, a baby is given an essential set of primitive reflexes that are not meant to stick around. They usually integrate and mature into postural reflexes at the age between 6 and 18 months of life.
However, if they do remain as an active primitive reflex, it represents a structural weakness or an immature central nervous system that can have major implications in a child’s learning, behavior and future coping with ordinary life. Retained reflexes can be a result of not enough self-movement. With proper motor function training therapy, the neurological pathways can be strengthened through playful movement.
A Brief Explanation of a Few Primitive Reflexes
The Fear Paralysis Reflex. Fear Paralysis results in a functional freezing. During the embryonic stage, the embryo reacts to their mother’s stress and stimulation by withdrawing and freezing. This protects the baby from the increased levels of maternal cortisol and allows mom to fully focus on the stressful situation. As the embryo develops into a fetus and awareness develops, the withdrawal response gradually lessens and the FPR naturally converts to the Moro reflex. In a baby, child or adult with retained primitive reflexes, an active FPR often goes hand-in-hand with an un-integrated Moro reflex.
While the Fear Paralysis Reflex is “Freeze,” Moro is “Fight!.
There are three parts of the Moro Reflex in developmental sequence.
Moro A. Part A is what babies do when startled. Babies extend their arms. Adults have an exaggerated startle response that is uncontrollable. This repetitive and fierce startle response keeps the fascial system of the body very tight. After all, this person is ready for a fight at any moment. Relaxation is difficult for these patients. Chronic muscular tension and levels of anxiety are routinely high. Retention of this reflex can result in the tightening of the fascial system of the head and neck resulting in lack of muscular range of motion of the tongue in the absence of the visual structural frenum restriction associated with the anterior tongue tie.
Moro B. The next part of Moro is the contraction – the body compacts to protect itself. This familiar movement is referred to as the fetal position. Moro B also reflects the way that we get our first breath. Kissing and blowing assist in integrating this reflex. Rocking side-to-side is an integrative motion that helps diffuse stress.
Moro C. The last part of the Moro is the social impulse. As the baby reaches for its mother, we reach out to one another for comfort and companionship. Integration can be supported through positive physical contact such as holding hands, giving high five's or fist bumping.
Rooting and Suck Reflexes. Babies “think” with their mouths, searching for their food source with the lips, tongue and jaw all moving together.
Babkin & Palmar Grasp: People with an active babkin or grasp reflex will usually have poor fine motor skills. They will lack the pincer grip and will also often make movements with their mouth when trying to write, draw, or cut with scissors. Non-integrated babkin & palmer grasp can develop TMD and tension in the facial muscles.
Tonic Labyrinthine Reflex (TLR) The TLR reflexes are postural in nature.
Asymmetrical Tonic Neck Reflex (ATNR) This reflex is involved in eye-hand coordination, visual tracking, reading, comprehension and falling asleep at night.
The Incredible Importance of Primitive Reflex Integration
Movement is not only what we do, it shapes how we were formed. As we developed as an embryo, hormones are created and changed. Movement patterns are developed in specific ways and are timing sensitive. The movement patterns are present from the beginning of development.
The movement patterns that we developed as embryos are reflected in our movement as growing children and adults. Triggers such as stress will return us to the primitive reflex patterning.
The return of these primitive reflexes can look like extreme rigidity about routines, smells, foods and other seemingly non-related triggers. These incidents can present as tantrums, meltdowns, anxiety, lack of coordination and disconnect from reality.
By recreating the movements in the proper context of a safe and playful environment and in ways that our brains can remember, we can reconnect the dots that were disconnected during development to allow reflex integration. Adults and children, the low functioning and high functioning can learn to move, feel and think in more integrated ways.
What happened?
So....where has this information been during the formal training of so many health care professionals?
That is a great question with no good answer.
The important thing is to do better once we know better.
What do we do with this information ?
You have two options:
- Make an appropriate referral to a health care provider who can implement a comprehensive assessment and treatment plan for patients who you suspect have retained primitive reflexes
- Learn to implement simple screening assessments in your office and incorporate some simple and effective therapeutic interventions within your scope of practice.
CNF GPS
Cranial Nerve Function GPS
Performing an individualized baseline assessment of how the patient’s cranial nerve function (CNF) in the analogy of GPS can help people understand the importance of optimizing our operating system. If we do not know where we are, we cannot efficiently make a plan for where we are going.
The impact of trauma acts like a roadblock and alternate routes are utilized to reach the desired destination. Sometimes this can be highly inefficient and can present with symptoms of chronic pain, allodynia and referred pain.
The concept is fairly simple but the interpretation can be as complex as the level of training achieved by the provider analyzing the results. When you turn on the light switch, does the doorbell ring? If so, the location of the switch might be correct, but there is a wiring issue This is an example of how the anatomy can be right and the function be wrong. In the context of the assessment of the 12 cranial nerves in the context of the bias of the retained primitive reflexes, this is often referred to as cranial nerve dysfunction.
SUpportive research and references
Persistent Childhood Primitive Reflex Reduction Effects on Cognitive, Sensorimotor, and Academic Performance in ADHD
Robert Melillo1, Gerry Leisman1,2*, Raed Mualem3, Alon Ornai3 and Eli Carmeli1
For now, integrating somatosensory, motor, and hemisphere specific training based on sound principles of neurodevelopment with school and educational environments that incorporate hemisphere-specific training along with comprehensive programming to reduce maintained primitive reflexes, after careful controlled clinical trials and investigations of neuroplastic effects can be a promising approach as part of a multicomponent system that could potentially reduce the effects of developmental deficits and delays in both developing and developed counties with little expense.
Rhythmic Movement Training Website
Rhythmic Movement Training is a movement based, primitive (infant or neo-natal) reflex integration program that uses developmental movements, gentle isometric pressure and self-awareness to rebuild the foundations necessary to help overcome learning, sensory, emotional and behavioural challenges for children and adults.
https://www.rhythmicmovement.org/fear-paralysis-reflex
Adults with sensorimotor disorders: enhanced physiological and psychological development following specific sensorimotor training
Mats Niklasson,1,2,* Peder Rasmussen,3 Irene Niklasson,1,2 and Torsten Norlander1,4
"Conclusions were that motor problems do not disappear with age and that the same diagnostic instruments and treatment methods can be used for both children and adults with sensorimotor difficulties."
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Just in case you needed even more information
Additional Information
Primitive Reflexes and Brain development reference articles
There is much evidence that can be found in medical, neurological and pediatric journals on primitive reflexes and brain development. Here are a few references from the great body of evidence.
- Zafeiriou, D. I., MD, Phd. (2004). Primitive Reflexes and Postural Reactions in the Neurodevelopmental Examination. doi:10.1016/j.pediatrneurol.2004.01.012
- Futagi, Y., Toribe, Y., & Suzuki, Y. (2012). The Grasp Reflex and Moro Reflex in Infants: Hierarchy of Primitive Reflex Responses. International Journal of Pediatrics. http://dx.doi.org/10.1155/2012/191562
- Schott, J. M., & Rossor, M. N. (2003). The grasp and other primitive reflexes. Journal of Neurology, Neurosurgery & Psychiatry,74, 558-560. http://dx.doi.org/10.1136/jnnp.74.5.558
Impact of Retained Primitive Reflexes
There is a growing body of evidence connecting retained primitive reflexes with a variety of disorders including cerebral palsy, autism spectrum disorder, ADHD and learning difficulties. Here are a few of these references.
- Konicarova, J. & Bob, P. Act Nerv Super (2012) Retained Primitive Reflexes and ADHD in Children. 54: 135. https://doi.org/10.1007/BF03379591
- Konicarova, J. & Bob, P. Act Nerv Super (2013) Principle of Dissolution and Primitive Reflexes in ADHD. 55: 74. https://doi.org/10.1007/BF03379598
- Konicarova, J & Bob, P. (2013) Asymmetric tonic neck reflex and symptoms of attention deficit and hyperactivity disorder in children, International Journal of Neuroscience, 123:11, 766-769, DOI: 10.3109/00207454.2013.801471
- Gieysztor, E. Z., Choińska, A. M., & Paprocka-Borowicz, M. (2018). Persistence of primitive reflexes and associated motor problems in healthy preschool children. Archives of Medical Science : AMS, 14(1), 167–173. http://doi.org/10.5114/aoms.2016.60503
- Gieysztor, E., Sadowska, L., Choinska, A., & Paprocka-Borowicz, M. (2018). Trunk rotation due to persistence of primitive reflexes in early school-age children. Adv Clin Exp Med.,27(3), 363-366. doi:doi: 10.17219/acem/67458
- Goddard Blythe, S. (2006). The Well Balanced Child: Movement and Early Learning(2nd ed., Early Years). Hawthorn Press.
- Brandes, B. (2016). SYMPHONY OF REFLEXES: Interventions for human development, autism, adhd, and other neurological. S.l.: CREATESPACE.
Efficacy of Movement Programs for Helping Those with Retained Primitive Reflexes.
This is an emerging area of research which continues to grow. Here are a few of these references.
- McPhillips, M., BSc, Hepper, P., Phd, & Mulhern, G., Phd. (2000). Effects of replicating primary-reflex movements on specific reading difficulties in children: A randomised, double-blind, controlled trial. The Lancet,355(9203), 537-541. doi:https://doi.org/10.1016/S0140-6736(99)02179-0
- Fredericks, C. R., Kokot, S. J., & Krog, S. (2006). Using a developmental movement programme to enhance academic skills in grade 1 learners. South African Journal for Research in Sport,P hysical Education and Recreation,28(1), 29-42.
- Krog, S. (2010) Movement programmes as a means to learning readiness, University of South Africa, Pretoria, <http://hdl.handle.net/10500/3514>
- Krog, S. (2015). Movement activities: A critical link in developing motor skills and learning in early childhood. African Journal for Physical Health Education, Recreation and Dance,21(1.2), 426-443.
