#288 - Primitive Reflexes: The Basics - Our Free Webinar

What are primitive reflexes? Why are they important? What are the signs of retained primitive reflexes? How can you help a child who has retained primitive reflexes

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Transcript

Rachel: 0:00

So the goal of our webinar today is to teach you what primitive reflexes are, why they're important, how to identify it, the child may have retained primitive reflexes, as well as some of those next steps for integrating those primitive reflexes, and we actually will share some integration exercises and activities. Today, we're going to keep it pretty short, and to the point just give you the basics, because that's what we're doing today. I'm Rachel.

Jessica: 0:26

And I'm Jessica and this is All Things Sensory by Harkla.

Rachel: 0:29

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: 0:41

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: 0:51

We're 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: 1:02

Thank you so much for joining us.

Rachel: 1:08

Hey, everyone, welcome back to All Things Sensory, we are so happy to have you here listening today. We have a unique episode for you. Yeah, it's a really good intro to primitive reflexes. If

Jessica: 1:17

Like always, unique and special. They really are. They're all good. That's why you're here just because you like them and us apparently. Today, we are sharing with you our free primitive reflex webinar. So this is a view on demand, free webinar that you can watch and receive three, free PDFs that go along with it. But we decided that we wanted to share it on the podcast as well. So for anyone, who prefers listening over watching, now you can listen to our primitive reflex webinar. We dive into a couple of primitive reflexes, what they are, what they look like, signs and symptoms of if they are retained, and then we give you a couple of activity ideas that you can do to target some of these primitive reflexes. you're new to the idea of what these are, if you're just heard The Q&A at the end? Y about it, and you're like, what the heck, or if you just need a refresher, it's a great way to just get some new information. The basics and we do talk about our new primitive reflex course, in this webinar as well or in this podcast episode as well, that includes the AOTA CEUs and we also spend some time at the end going through questions. We got a lot of questions. So that's always kind of my favorite part.

Rachel: 2:49

Yeah.

Jessica: 2:49

I like the Q&A as well.

Rachel: 2:51

I love the questions. So hopefully you enjoy this. If you want access to the PDFs, then we will put a link to the webinar in the show notes and you can sign up and register. You obviously don't have to watch it, if you don't want to, but that way you can access the PDFs.

Jessica: 3:10

All right, enjoy.

Rachel: 3:12

Welcome, welcome. We're talking about primitive reflexes today. This is a quick crash course. I'm Rachel.

Jessica: 3:17

And I'm Jessica. We're both certified occupational therapy assistants and as we're going to talk about later in this webinar, we recently became a certified primitive reflex clinical specialists. So that's been an exciting journey.

Rachel: 3:31

We designed this webinar for parents, caregivers, therapists, other professionals, just anyone who works or lives or spends time with kids. Not necessarily kids with developmental disabilities. Not necessarily kids with specific diagnose. Our goal is really to target every child because truly every child has primitive reflexes and every person working with kiddos needs to know about these as well.

Jessica: 3:59

So today's webinar, we're gonna give you as much information as possible, but we're gonna keep it simple and easy to digest. So that you can take things away from it today and not leave this webinar wondering what the heck did I just learn, right? We're also going to give you some free downloads. Those downloads will be emailed to you after the webinar, and then we will do a quick q&a session at the very end of the webinar. So if you have questions throughout the webinar, put your questions in the q&a box, and we will answer those at the very end.

Rachel: 4:34

So the goal of our webinar today is to teach you what primitive reflexes are, why they're important, how to identify if the child may have retained primitive reflexes, as well as, some of those next steps for integrating those primitive reflexes. And we actually we'll share some integration exercises and activities today. We're going to keep it pretty short and to the point just give you the basics because that's what we're doing today.

Jessica: 4:57

Like we already said, we're gonna have a q&a session at the end, so if you have questions, don't use the chat box. We will use the q&a box specifically for questions at the end of the webinar.

Rachel: 5:08

If you have questions that come up during the presentation, just feel free to put those in the q&a box so you don't forget. Because I know how it is when you think about something, and then it's gone. So just go ahead and pop those in the q&a box and we'll get to those at the end of the of the live webinar. If you're viewing us live.

Jessica: 5:22

All right, after this webinar, you are going to put in, put the work in, you're going to use what you learn here today and you're going to implement it into your child's routinem with your clientsm with your students, and you're going to try these activities out and see how they work. And you're going to learn how to modify them. You're going to use all of the PDFs that we give you and then you want to make sure that you're always keep, always keep learning. Never stop learning. That's what we've discovered is there's always more to learn. There's always new things coming out in the research. So just always keep learning.

Rachel: 5:59

Yep. Then we will talk about our brand new primitive reflex course that launched today that you get a special discount on for being here live with us today.

Jessica: 6:10

Since we have quite a few of you who've never been with us on a webinar before, we're going to give you a brief overview of who we are and what we do, where we're from, all the things.

Rachel: 6:21

Yes. So we met back in 2012. We went to college together and the funny story is we never were like friends in college. We never really hung out. We were assigned a couple of projects., but in school we're like, okay, partner up with someone you've never been with before. I'm stuck with Jessica.

Jessica: 6:37

Yeah, right.

Rachel: 6:38

But yeah, so we ended up just going to school together and knowing each other in school. Jessica had her son Logan in 2013. We ended up working at a clinic together in Boise and that's kind of when we became friends and realized that we were so like minded. Then, I had my son in 2020 and then I had my daughter in 2022. And we've just been doing a lot of various entrepreneurial OT projects in the past couple of years and we just love spreading this information far and wide.

Jessica: 7:14

And then in late 2020, Harkla approached us and we decided to join forces with them. And so in early 2021, we merged our podcasts and our courses with Harkla and since then we've just been creating more courses. Making our old courses better. We have the podcasts, we have the YouTube channel, and that's what we're doing. Yeah.

Rachel: 7:38

Yeah, this course, the original course that we created, Yeah, whatever that is. Now you know our deepest, we did back in 2020 is when it initially launched. I was darkest secrets. So let's jump in and chat a little bit about pregnant with Trip. It was a great course, it was very straightforward, and so we've been working on this for the our background and our knowledge in OT. past year to make it bigger, better, and just more. Just provide more resources. bigger, badder, better.

Jessica: 8:12

So we're both certified occupational therapy assistants. We hold licenses in Idaho as well as nationwide. We have over nine years of experience working with children in outpatient pediatric clinics and we both have maintained our licenses throughout the years by taking a variety of continuing education courses on as many topics as we possibly can. And recently became certified as certified primitive reflex clinical specialists, which, as I mentioned already was quite the journey. So we've done a lot of research and continuing education on primitive reflexes, as well as working with clients in-person on primitive reflexes. So everything that we're teaching you here today, we have used. I currently use it in the clinic. I was just telling Rachel today that I did some primitive reflex testing on a new client today. So we do practice what we preach and were constantly learning more to make

Rachel: 9:06

Yeah. Hey, so now again, you know, our deepest, darkest it better. secrets. Let's jump into the primitive reflex basics today and we're going to chat a little bit about what primitive reflexes are. If you aren't already aware of what they are, we're all born with primitive reflexes, and they're designed to help us survive as babies and in utero. They help us with the delivery process, when we are just being born. They're automatic, stereotyped movements that are directed from the brainstem and they are executed without cortical involvement. So you think about the startle reflex when you set the baby down and they startle awake or the palmar grasp reflex when the baby grabs onto your palm or to your finger and doesn't let go, those are all primitive reflexes.

Jessica: 9:56

Yeah. And so like Rachel said, these primitive reflexes are meant to keep the infant alive and safe. It also works towards promoting developmental milestones. Which we're all familiar with those developmental milestones and these primitive reflexes start to integrate as the baby gets older and starts going through these developmental milestones. So these primitive reflexes are not meant to stay in our body forever. They should integrate and mature into more mature movement patterns, which lay the foundation for coordination and cognitive development. Some primitive reflexes integrate within the first year of life and then there are a few that integrate as late as three years. So there's kind of a varied timeline, and it's always a little bit different. It's very unique for each child.

Rachel: 10:43

So like we mentioned, if these reflexes don't integrate or mature into those higher level patterns on that timeline, on that unique timeline, it can affect different areas of development and that's generally what we see. So if one reflex doesn't integrate on its own, then, oftentimes, it's kind of like a cascade of interventions, right? So if one doesn't integrate, then the next one might not integrate. When we think about that waterfall of these reflexes, just kind of piggybacking on one another, and they're not integrating as they should.

Jessica: 11:18

So if a primitive reflex does not integrate naturally, when it's supposed to, it's actually an indication of structural weakness or immaturity within the central nervous system. Because those primitive reflexes live in our brainstem and so we know that there's a neurological connection there. So if that reflex gets stuck in the body, it's retained, then instead of the child developing mature motor patterns and cognitive development that they're in control with, they're going to develop abnormal movement patterns, which can result in clumsiness and poor body awareness and a variety of other things that we're going to talk about. But ultimately, these retained primitive reflexes will negatively affect the child's ability to participate in daily activities.

Rachel: 12:03

And that's really the kicker here, if you are an Occupational Therapist here with us today, that's what AOTA wants to see. They want to know that you are working on the functional implication of these reflexes. Not just a rote, boring, repetitive exercise to integrate these reflexes we want to see. Okay, is the child struggling to balance on one foot in order to get dressed or are they struggling to manage food in their mouth, and they're choking? Are these reflexes truly causing those underlying challenges to complete those daily activities, kind of like what Jessica just mentioned. So we want to make sure that we are focusing on the child's occupation. We want to focus on play based activities, which is really like the foundation of our course here.

Jessica: 12:48

And I do like to use this as an example my son Logan. If you've been following us for a while, you know about him a little bit. He's nine years old. I've tested his primitive reflexes and early last year, or yeah, early this last year, I tested them. He has a mildly retained ATNR. Now, it's not a concern for me, because it's not impacting his daily functioning and we'll talk about the ATNR in a minute, but he does not have reading and writing challenges, he does not have left and right confusion, which are kind of the main symptoms have retained ATNR. Because of that and because the retention is so mild, I'm not going to work on it with him because it wouldn't be functional. It wouldn't make sense. So that's just an example of like Rachel said, we want to make sure that if we're addressing primitive reflexes, it's because they are impacting the child.

Rachel: 13:38

Yeah, I always think about me as an adult, especially after pregnancy, my nervous system is all thrown off and I can tell a little bit that my ATNR is a little wonky, and especially my TLR, which we'll talk about those reflexes here in a few. But I noticed challenges with like ADHD type symptoms, which can also be correlated to these retained primitive reflexes. And so for me, I actually include these activities into like my workout. Because it's an easy way to make sure that we're doing these exercisesa and a lot of it is core strength based. So really, it depends on the goal here and those symptoms of those side effects and what you're noticing. So it's unique. The approach is unique for everyone, which makes our job interesting, but it also makes it challenging at the same time.

Jessica: 14:25

So some of the signs or symptoms that we often see with routine primitive reflexes are going to be challenges with social skills. We almost always see challenges with coordination. So coordinating both sides of the body, coordinating upper and lower body for games or sports or climbing, running riding bicycles. We will see challenges with emotional regulation because the child's body is in fight or flight because their body is stuck in these retain primitive reflexes. We'll see challenges with executive functioning and cognitive development, which affects problem solving, focus and attention in like a classroom setting, reading and writing, and then even anxiety. Yes, so clearly impacting all areas of functioning here. So a lot of people ask us what causes a primitive reflex or multiple primitive reflexes not to integrate and in our years of experience, years of researching, we haven't found one definitive reason as to why a reflex isn't integrating on a specific timeline. But we found some potential factors, as well as just in our interviewing with our clients and other people too, we can kind of see patterns. Which we'll outline here and we just want to make sure that we're approaching this kindly. We're not blaming. We don't want anyone to feel guilty. This is really just informationa, just so you know, like, Okay, this could be a potential cause, or Oh, yeah, I had that my child had this when they were younger. So maybe that's the cause. But it's really not to place blame or cause anyone to feel guilty and for therapists here joining us, it's really important that you share that message with your clients when you're evaluating their primitive reflexes and doing that occupational intake form as well. So a quick So during pregnancy, some of the things that we've seen disclaimer. associated with future retained primitive reflexes would be hyperemesis or severe morning sickness, a viral infection during the first 12 weeks of pregnancy or between 26 and 30 weeks, alcohol, drug use, medications, smoking, radiation exposure, severe stress or trauma especially during weeks 25 through 27, a stroke in utero, conceived as a result of IVF.

Rachel: 16:45

Now remember that these primitive reflexes develop in utero, which is why pregnancy is such an important part of these reflexes. So they're developing while mom is pregnant. So that's why these are important to keep in mind. So with the delivery process, oftentimes, premature births or a prolonged or fast labor can cause some retained reflexes, using forceps or vacuum extraction to assist the delivery, any, I say trauma during birth, but honestly, every birth is so traumatic in its own way. Like I mentioned earlier that those cascades of intervention when we're inducing labor, which is leading to the baby being distressed, which is leading to a c-section, chord significantly wrapped around the neck, we just want to keep in mind that these reflexes are enforced during the delivery process. So they're kickstarted, because they're actually used to assist with the birthing process. So the ATNR helps to corkscrew out of the birth canal. The spinal galon helps to stimulate the sides when it's the contractions are happening. It's stimulating the sides of the baby to help twist them out and move them down that birth canal. So we see a lot of these complications during the delivery process show up in our intake forms of oh, yeah, we I had this happen with my delivery, or I had this happen with my delivery and no one's fault. The doctors aren't gonna say, hey, just so you know, there's these potential complications. It's like, let's make sure everyone's safe, obviously. That's the goal here. So it's our job as therapists to make sure that now you know these reflexes need to be integrated, we need to be looking for them, which is why it's so excited that you all are here today. But going along with that jaundice, problems with feeding, motor delays, minimal floor time, low birth weight, and excessive use of containers. It's kind of like the container baby syndrome as what we say in a kind of way, but really just any, any type of trauma to the event.

Jessica: 18:52

We can also see some things in infancy or even toddlerhood that can affect primitive reflex integration such as torticollis, tongue or lip ties, CP or other motor disabilities, Down syndrome, any type of severe traumatic event has been shown to engage primitive reflexes and even in adults. If an adult goes through severe trauma or say a car accident, something that really affects their body and their brain. We can see those primitive reflexes come back so we like to take that into account as the child gets older. Same with a TBI, traumatic brain injury, epilepsy, autism, a lot of these kind of go together as what we've seen.

Rachel: 19:33

So again, this is not an exhaustive list, just some potential factors that we want you to be aware of and it also does not guarantee that the reflexes will be retained. It's just something to have on your radar and to be aware of.

Jessica: 19:46

Okay, now the fun part.

Rachel: 19:49

I love talking about this.

Jessica: 19:51

I do too. I really like\ this part because this is the part that's actionable, right? So we're gonna go through five primitive reflexes, and we're going to show you what they are and we're gonna give you an activity that you can do to address each of these reflexes.

Rachel: 20:06

Before I go on, our full course has eight primitive reflexes that we cover and so we just kind of it was this was a really long webinars, we had to break it down and only talking about five. But we did add three more reflexes because in our very first edition of the course, we just talked about five. But we did add those three extra reflexes, which is so exciting.

Jessica: 20:26

Okay, the first one is the Moro reflex and this is often connected to the startle reflex. So when you think of the startle reflex, we'll also say the Moro reflex, but it's present at birth and it's an involuntary response to sudden stimuli.

Rachel: 20:43

Yep. So an article published in 2020, it talks about the Moro reflex as an involuntary protective motor response against abrupt disruption of body balance or extremely sudden stimulation. So you think about startling, right? It's important to keep the baby safe. It's important to make sure that they're clinging on to mom and they're being protected. It's really that that safety response.

Jessica: 21:09

Yep. Now the Moro reflex is produces a physical response, as well as an auditory response. The infant will cry during this startle response, as well as their arms will open up and their legs will also have a movement here. So it's really meant to alert the adult that the infant is in danger. Like Rachel said, it's a safety response.

Rachel: 21:30

It also is directly connected to the fear paralysis reflex, which the Moro reflex emerges as the fear paralysis, integrate. So the fear paralysis reflex is really early, early, early to integrate, and then that Moro reflex kind of comes in and takes over.

Jessica: 21:48

So this is a video of Austin, Rachel's daughter, and I am providing her with an intense physical change of quick movement to show you what the Moro reflex looks like in infancy. We don't promote doing this with your babies, If you do it, maybe do it once, and then make sure you give them some comfort immediately afterwards, because it does reproduce stress chemicals during the reflex. So we don't want to just continually test. Yeah, you don't want to keep doing this to your infant or even your child when we do testing and the full course. You can see her arms and her legs go out and then you can see you can't hear me you can see on her face that she's getting ready to cry, immediately afterwards. She did not like it. So what it is she gets that sudden movement change, and her arms and legs come out, she starts to cry, and then her arms and legs are going to come back in towards her body looking for comfort.

Rachel: 22:49

So the timeline for integration. Again, this is a very general timeline, this is what we normally see. It's developed in utero. It should be fully developed at birth, but it can be a little bit weaker in premature infants because it hasn't had that entire time to develop in utero and then it should be integrated or matured or go away by about six months after birth. So that's the timeline that we often see an integrating by and it's directly connected to the vestibular system, which is directly connected to a baby's development of head control. So that's why it's really important to continue with that floor time to increase head control and that control vestibular integration. Okay, so here's one of our favorite activities to

Jessica: 23:32

That neck strength for sure. So for our older children may be our school aged children, some signs and symptoms of a potentially retained Moro reflex might be motion sickness, stimulate that Moro reflex and work towards integration. We're decreased eye contact, light and sound sensitivity so kind of that hyper responsive sensory system, allergies, maybe a low alternating between that supine position, that head is going immune system, anxiety and mood swings are ones that we really see associated with the Moro reflex. Because of that rush of stress hormones, their body's in fight or flight all the time into full extension, arms are coming into extension, and when this reflex isn't integrated, and then challenges with sports that are involving hand eye coordination, pulling up into that flexion position and tossing it. So specifically with that vision because of the vestibular connection. And in this second part of the video, you can see how we're just taking this motion of going into an extension pattern I'm stabilizing Rachel at her knees. This is what we and a flexion pattern and we're adding in that functional activity. definitely recommend you do with your child during this activity, especially if they're unstable and they have that routine Moro reflex because they might not be able to keep their balance on that therapy ball enough to successfully complete the activity. So provide them with as much stability and assistance as necessary so they can be successful with this. And keep in mind when they're going upside down into that inverter position, they're getting a lot of intense vestibular input. So you want to follow this up with a good proprioceptive, heavy work, deep pressure activity.

Rachel: 25:23

Yep, the only other thing that I will mention is you see how my entire back is supported over the ball and especially when Jessica is helping me, that's really important, because she can shift my weight forwards here to make sure that my back is supported the entire time. And so that's something that we want you guys to keep in mind if you do participate in this activity. Make sure that the child's back is completely supported and then once I'm going to pull up, she can shift my weight forward even more to help my core activate and pull up. So that is a really big modifier, just shifting those legs back and forth. So especially if the child can't touch the ground, you want to make sure that you're moving that ball with they're moving the ball with their legs. That makes sense.

Jessica: 26:11

With their body as they move. Yeah. Keep in mind, this is not the test, or the Moro reflex and it's not the specific exercise for integration. This is what we call a functional activity. It's an activity and a game that you can play with your child or your clients that targets the Moro reflex, can help stimulate it, and can potentially assist with an integration.

Rachel: 26:34

Okay, sorry, this is a little bit wordy here. But this is the TLR or the tonic labyrinthine reflex and so this is the reflex that helps the baby identify gravity and kind of modulate gravity. Because it affects their muscle tone, it affects their ability to move their arms and legs and trunk, and it also is connected to the vestibular system. If you take away anything from this webinar, you'll just be able to say, Yeah, Rachel and Jesst told me that it's all connected, because it really is all connected. So it helps to it kind of cuts the body in a front end backplane. So we have two different versions, of the not versions, but two different components of the TLR. The TLR forward and backwards. We have the flexion version, which works on the forward position and then we have the extension version, which works on those extensor or those back muscles.

Jessica: 27:26

So this reflex is responsible for muscle tone, posture, head, writing, vestibular, proprioception, and a lot of body awareness. And then because the head movements affect the TLR, which will show in the video in a minute, it's also directly related to the Moro reflex.

Rachel: 27:45

Okay, so here is the video of the TLR in forward and extension. So with that neck flexion, so the head is moving forward, that causes their arms and legs to flex or curl towards the body. So you can see here, when Jessica brings her neck forward, the rest of her body flexes or bends and then when her body goes when her neck extends, it extends then her arms and her legs extend. So the her body is at the mercy of what her head and what her neck are doing.

Jessica: 28:23

And even though in this video, it's not directed by her vision, because I'm actually like manipulating her. In like a typical play scenario, when the baby is on the floor, her head position is directed by her eyes and where she is looking, and so that's really that connection between the vision, the vestibular system, and the association of the rest of the body.

Rachel: 28:48

Okay, so the timeline on this one is a little unique because there's the forward and the backwards extent of patterns and so for the forward, or the flexion, it emerges in utero, and it should be fully developed at birth and then the integration should be around four months. So that's usually around the time the baby is you think about a baby sitting on your legs and they're starting to do those like little baby sit ups in that like inclined position. So that's kind of the reminder for me.

Jessica: 29:18

Yeah. Where they're intentionally moving their body versus being at the mercy of their eyes in their head and then the backward or the extension pattern is developed at birth, and then it can integrate as early as three months. But we've seen it also integrate as late as three years. So this is kind of a tricky one to say, yes, it should be integrated by this point or three years old. Okay, maybe they still have a little bit of time left. So just keep in mind that this one has a longer timeline or potential lifespan with that extension pattern.

Rachel: 29:55

I just want to quickly say I remember in school learning about just like the very basics of these primitive reflexes and we were learning about the name of them and their timeline of integration. And I had such a hard time really understanding why it was important. And it wasn't until we really started diving into like early childhood development and you realize that these reflexes are connected to those specific milestones. And so we see the tummy time here, and the connection between developing tummy time and holding that extension when you think about the baby doing that sit up. And so they're so connected those milestones, and once you connect it to those functional patterns, it starts to click. At least that was how it was for me.

Jessica: 30:41

Well, and it's interesting, too, because we often get questions from people asking if we work on primitive reflex integration with infants and toddlers and typically, the answer is no. We focus on developmental milestones, which in turn will affect primitive reflexes. So side note.

Rachel: 30:58

Yeah.

Jessica: 30:59

So some symptoms of a potentially retained TLR, challenges with crawling, poor posture, or low muscle tone, vision challenges, auditory processing challenges and this comes from that connection between the auditory system and the vestibular system, poor sense of space, time and organization, and then challenges with sports, which is going to be that coordination piece.

Rachel: 31:24

Alright, so one of our activities, ourfunctional activities, we call this the problem, it's not really a good name.

Jessica: 31:30

It's really not a good name, we need a better name. If anyone has an idea for a name for this one, let us know.

Rachel: 31:35

Like a Superman ball pass or something like that.

Jessica: 31:39

Let's say prone, because that's the like OT term or PT term.

Rachel: 31:45

So you can see Jessica here is holding a prone extension against gravity and she's tossing that ball at the wall and catching it. So we're working on not only that extension position, but also the ocular motor skills and that vestibular system as well with this one. So it's a fun engaging, a little bit challenging, especially if you're having a child can struggle to even get into that position. It can be a little bit difficult. But if they're struggling to hold that position, I would recommend getting across from them, and laying across from them in that prone position, getting on their level and tossing that ball back and forth. It's a little bit more motivating that way.

Jessica: 32:23

For sure, if the tossing the wall or tossing to you, as the partner, is too difficult, you can try rolling the ball across the floor. You can modify so that maybe they keep their legs on the floor for part of it. Keep it short and sweet, because you want it to be fun and motivating.

Rachel: 32:39

So our full course has all of these activities in it just like this and we go through and explain each one and the modifications. Kind of like what we're doing now. We just have tons more in it. There's just a little sneak peek.

Jessica: 32:52

All right, next is the ATNR, which is the asymmetrical tonic neck reflex. This is often called the fencing reflex and what I think is super cool is anytime you feel the kicking of that baby in utero, that is actually due to the ATNR. I wish I had known that when I was pregnant.

Rachel: 33:11

I know I find it so fascinating.

Jessica: 33:12

I think that is so cool.

Rachel: 33:13

I already mentioned this a little bit earlier, but the ATNR actually plays that role plays a big role in kind of corkscrew, corkscrewing, out of the birthing canal and so when the head position changes, the arms and the legs move, and it kind of helps her rotate out of the birth canal. It's connected to that head movement. Obviously, you can see, this little Trip here, his head is turning and his arm is following. So it's led by vision, led by that vestibular system, which also affects balance and muscle tone as well.

Jessica: 33:45

Yep, it's all about that vision.

Rachel: 33:47

Yep.

Jessica: 33:47

Okay, so here's a good video. This is Austin again. So when an infant is laying on their back, and their head turns to one side, the arm on that same side will extend while the opposite arm flexes toward the body. And then there's also typically a leg movement that happens as well. We don't see it a lot in her right now, because it's not as pronounced as the arm movements. But you can see why it's the fencer.

Rachel: 34:12

What was the other - the dab!

Jessica: 34:13

It was referred to as the dab reflex, as well. So what happens is, it's led by the vision, so baby looks to one side, and automatically those arms go into that position, and it's uncontrollable. They don't have control of it. So you think about if an older child has a retained ATNR, if they're on the playground or if they're at school or if they're at home doing something, and they have a retained ATNR, and they turn their head, they have no control of what their arms and often their legs.

Rachel: 34:40

The timeline again. It's developed in-utero usually around 18 weeks, which is usually around if you have an, if you have a what is it? Anterior placenta? Then you can generally feel the baby kicking around this time, and then it should be integrated by about six months and so this is the trick that helps me remember. When a baby is sitting at six months, generally we see them sitting at six months, they can pass toys back and forth and they have more of that direct control over their eyes, their hands so that and even feeding themselves. That's another time that we'll see this reflex really integrate because they're able to self feed. So the Palmer grasp is integrating, the Moro reflex is integrating, so they're able to do more of those goal directed tasks.

Jessica: 35:26

Some signs and symptoms of potentially retained ATNR going to be challenges with crawling, poor handwriting, challenges with visual tracking or establishment of hand dominance, left and right confusion. You know, we kind of talked about this when I mentioned my son, and then challenges with gross motor skills, things like skipping, riding a bicycle.

Rachel: 35:47

Jump roping.

Jessica: 35:48

Jump roping, yes.

Rachel: 35:49

Those typical childhood activities. Did you say riding a bike?

Jessica: 35:54

I might have.

Rachel: 35:54

Riding a bike is a big one, too. Challenges riding a bike. Okay, this is a really, really good.

Jessica: 36:01

I know, this is a really good one, though.

Rachel: 36:02

It's not a fun one. So I am putting a cup tower on top of a cookie tray and just because in midline, here, her legs are flexed, and what her goal is here is to turn her head and read a letter off of the chart each time. So she's rotating your head side to side, reading in order, and she has to be able to maintain her arms in that neutral position without knocking the cups tower over.

Jessica: 36:28

Here's the deal that was really hard for a couple of reasons and the biggest reason I think was because the cups are so light. So I couldn't always tell, it was hard to tell if I was keeping the tray straight. So not a lot of feedback. So keeping that in mind, if you do this activity with your kiddos, use, maybe use something heavier or maybe you just have them have to hold that tray and not move their arms as they turn their head. You can start there.

Rachel: 36:55

Yeah, but for older kiddos who are working on this, it's a really fun way to get some feedback when the cups fall all over them. So it's just it's more of like a fun, engaging, silly way to to get them to participate in this activity. You don't have to add the visual charts back and forth like this is a pretty advanced activity, but you can see the goal here. We're keeping our arms and our trunk and midline, and we're rotating our head and we're making sure that our arms aren't having those associated movements, and maneuvering and you'll probably not see like a full arm movement. When they're working on this, you'll probably just see shifts in their shoulders, their scapulas, their arms, but you likely won't see like those really pronounced movement.

Jessica: 37:37

Depending on how much it's retained.

Rachel: 37:39

Maybe some elbow flexion.

Jessica: 37:41

I think I was thinking just make sure they get full rotation of their head all of the way so that their ear is pointing all the way at the floor. You can position the visual charts that they have to turn a certain amount. You can also use a laser pointer to have them visually track side to side. So some different options there.

Rachel: 37:59

Alright, the next one is the symmetrical tonic neck reflex or the STNR and this is one that's a little controversial if it actually is a primitive reflex or not. Because it doesn't develop inutero it develops after the child has already been born and so we have found it has a really significant impact on development as well as those developmental milestones, which is why we include it and we feel like it's a really important reflex to chat about.

Jessica: 38:27

So, it has a direct correlation with the TLR, which we've already talked about. As the infant begins to integrate the TLR, the STNR begins to immerge to help progress to crawling, and the lifespan of the STNR is very short. It's just a couple of months. So is that pre-crawling and once the event begins crawling, and then they master crawling, that's when we know that STNR has integrated. So if you've ever seen an infant on all fours on their hands and their knees before they learn to crawl, and they're rocking back and forth, that's actually the STNR.

Rachel: 39:04

That's how it's working towards integrating and this one's really cool because again, the baby's at the mercy of their head position and their eyes with this one. So if they are, they're looking up, then they're going to sit back on their knees. If they're looking down, then they're kind of going to go into that down dog position.

Jessica: 39:22

I have to apologize for the quality of this video. This was nine years the over nine years ago because this is Logan and Logan's almost ten. So this video is quite old, but it does show that STNR really well. So it shows him rocking. He's in his pre-crawling phase here. He's looking up and down and it affects his arms and his legs when he does this.

Rachel: 39:46

This is giving me baby fever.

Jessica: 39:47

I know. Look at him. You can actually see a little bit of STNR when he turned his head, but he's rocking he goes up on his feet here. When he started to look down he started to kind of go up into that downward dog a little bit. Let's watch it one more time. Okay.

Rachel: 40:00

Okay, pull up my leg.

Jessica: 40:02

Ultimately, the STNR has such a huge impact on head control, sitting, rolling, visual motor skills, auditory processing, muscle tone and posture, vestibular, balance, I mean, pretty much everything because it's connected to the TLR. So if we think about if the TLR doesn't integrate, the STNR might not have even had a chance to get started in the body, which can cause difficulty.

Rachel: 40:32

So a big one is crawling and if a child skips crawling,

Jessica: 40:33

They probably know. So like we already mentioned, the we can often assume that this reflex either didn't develop. It didn't integrate. It's a really important reflex for crawling, and we will die on the hill of advocating for the importance of crawling, it should not have been removed from the CDC STNR might not even be considered an actual primitive milestones Just a quick little soapbox there. But you can see here she's looking down and flexing her neck and her bum is going up here and those legs are extending. So she was just about seven months here, and she wanted to move forward, but she couldn't move forward because her body was in a control of her eyes and her neck position. So once she integrates that STNR, then she can crawl forward in that pattern. I'll never forget the first time I watched her crawl. I have it on video, actually and I was just like, she just crawled gonna and it's just, it's so amazing to see just see like that developmental progression of integrating that reflex in order to progress forward. Can you tell we love this stuff? reflex, but we include it anyways. It appears between six and nine months of life as the TLR has integrated then the STNR can emerge to help with that next phase of development, which is crawling. It should be integrated by 11, we say 11 to 12 months typically.

Rachel: 42:02

Generally once a child has started crawling.

Jessica: 42:04

Yes, once the child has mastered crawling, we can typically say they've integrated their STNR.

Rachel: 42:10

Yep, sometimes that happens sooner, sometimes it happens later.

Jessica: 42:14

Some signs or symptoms of a potentially retained STNR are going to be challenges with crawling or totally skipped crawling, or posture, low muscle tone, w-sitting, clumsiness and poor body awareness, challenges with attention, challenges with reading and writing.

Rachel: 42:33

Alright, so a fun activity. A fun functional activity for this one, we call down dog to cobra. So downward dogs to cobra, sorry. I say down dog to cobra. So here we're working on alternating between neck extension, neck flexion, or kind of pushing the body through those different motor patterns in order to work on integration.

Jessica: 42:57

Kind of a simple little yoga routine, but it's also really great like brain break movement to do a couple of times. It's a great stretch throughout the whole body. You're getting some really good weight bearing on your hands and your knees. You're getting some proprioception there proprioceptive input. So it's actually it's a really fun simple activity to do a couple times throughout the day.

Rachel: 43:19

If a child has a retained STNR or it has not integrated, you might see them bend their elbows or maybe they can't maintain that position. You might see their legs collapse. You might see them struggle to get into that full neck extension and full neck flexion. You just might see some of those compensatory movements here with this activity. But again, this isn't the specific exercise that we use to integrate the reflex. It is just one of those fun functional activities.

Jessica: 43:50

All right, last one for today. The Spinal Galant Reflex it is triggered by stimuli to the back. So it contributes to the development of the inner ear, which is super interesting. So you know there's going to be a correlation here to like auditory processing, but I think Rachel mentioned this earlier, the spinal column also helps with the birthing process along with the ATNR. Because when the contractions that stimulate the lumbar region of the infant's back, it causes movement in the hips, which helps the body move down the birth canal.

Rachel: 44:25

And what I find so interesting about this one is the connection to urination, with bedwetting, which we'll talk about a little bit, but when you stimulate the side of the spine in an infant, like a very new fresh infant, the fresh baby smell. It can potentially elicit urination and so that's really important to keep in mind as the child grows and they aren't integrating this reflex, we can struggle with elimination, we can struggle with potty training, we can struggle with nighttime bedwetting as well.

Jessica: 44:57

Okay, so this is a really great video that shows it so so clearly. This was at the chiropractor.

Rachel: 45:04

We were just prepping for the tongue tie, lip tie frenectomy and so we were seeing the chiropractor and they rolled this little machine, the scanner, along her back. And again, it's not like the true test for the spinal galant. But you can see that stimulation is really causing like that shifting, that flexion, that like lateral flexion side to side, and I just was like, oh my god, I have to get a video of this. This is wild.

Jessica: 45:32

Typically, what we'll do is we'll see we'll do stimulation to either side of the spine, both sides of the spine, but not simultaneously, and you will see that hip flexion and movement each direction.

Rachel: 45:45

Yeah.

Jessica: 45:45

Which I think in this she's giving stimulation to both sides of the spine simultaneously, which is why she kind of wiggles back and forth. But again, it's involuntary. It's not within her control, because it's that primitive reflex.

Rachel: 45:58

Okagy, so the spinal galant is a true primitive reflex. It does develop in utero, generally, around 20 weeks. Later in pregnancy, it can cause the baby to move into an inverted position so getting into that head down position. I always wonder if there's a connection between maybe a baby who's breech or who is just not able to get into that head down position. Is there a connection to maybe some challenges with primitive reflexes? I don't know. I haven't found any studies. That's just my preliminary theory. And that should be integrated or mature around three to nine months. So it's a pretty big span. But generally, it's to help that hip movement, prepare for crawling, we can see just some of that connection between that spinal galant and the ATNR as well.

Jessica: 46:48

Some signs or symptoms of a potentially retained spinal galant reflex are going to be challenges with developmental milestones, such as rolling and crawling, challenges with like a natural gait pattern. So how a child walks, we found some really good studies about walking patterns in children with routine spinal galant reflexes. Could have an effect on scoliosis potentially, challenges with focus, attention and sitting still. So those ADHD symptoms that we see with let's use the example of a child who's sitting in class, and they can't sit still seems like they have ants in their pants. Could it be that spinal galant reflex is getting stimulated by their clothing or their chair, touching their back, and it causes that involuntary movement, which looks like they're not paying attention. Like Rachel already mentioned, it could be bedwetting beyond the age of five or six after the child is already potty trained successfully. But they're still wetting the bed at night and then tactile hypersensitivity, specifically with clothing.

Rachel: 47:51

Okay, you've all seen this core exercise of shifting back and forth. We decided to add some stickers to our feet to make it a little bit more functional,. Grab a sticker from one side, hand it to the other hand, and stick it on the other foot.

Jessica: 48:06

For older kiddos you could do the traditional heel reaches exercise. But ultimately, what we're doing is we're getting that stimulation to the back, keeping the lower body still and stable; instead of moving the entire body when we're getting that stimulation down the back.

Rachel: 48:22

If you need to provide assistance, like when you hold their legs when they're going to do a sit up. If you need to provide assistance to keep their legs stationary, you could hold them or you could have them stick them under like a little weighted blanket or something in order to keep them stationary. This is a fun one.

Jessica: 48:38

Going with the stickers for sure.

Rachel: 48:40

Okay. So, if you are a parent watching this and you're like, what do I do? I'm pretty sure my kiddo has retained primitive reflexes. if you're a therapist, and you're like, I have got to learn more about this. If you're a teacher, and you're like heading to get my kids, my students reflexes integrated in the classroom. What are you going to do? Really the goal here, the first thing should be in-person occupational therapy services. Someone who can test and give you a specific integration plan. We always want to advocate for in-person OT services. We want to include crawling, climbing activities, really just normal childhood activities, if possible, and if the child is able to get them down on the floor. Even if they're older, get them down on the floor and crawl.

Jessica: 49:30

Obstacle courses. We love obstacle courses in OT, but you can complete them at home or maybe at school, maybe in the gym or outside. But really what we're looking for with obstacle courses is having the child complete different movement patterns through a sequence of events or a series of activities, and they go through it kind of circuit style. So some jumping and crashing, some crawling. Includes some of those activities that we just showed you into the obstacle courses.

Rachel: 50:01

And last but not least, you can take our primitive reflex digital course, which teaches you how to test for reflexes, teaches you how to integrate reflexes, teaches you how to incorporate those functional activities, which we'll go through, and it's all self paced, which is really cool.

Jessica: 50:18

Okay, so let's talk more about that.

Rachel: 50:21

Let's talk about it. Because we are so beyond stoked about this course. It's called assessment and integration of primitive reflexes for improved independence in daily life.

Jessica: 50:33

We might still refer to it as the primitive reflexes digital course, because it's a little bit easier to say. But like Rachel already mentioned earlier, this is like the updated bigger, badder, better version of our original course that we created three years ago.

Rachel: 50:53

Three and a half. So you can see here, we've got testing videos. We've got case study videos. We have actual like webinar style, like what we're doing now, webinar style recordings. We have hundreds of digital PDFs that you can download and we even have a really exciting new thing that we can't talk about. I can't wait.

Jessica: 51:16

This full course, we teach you specific testing for eight different primitive reflexes, including the five that we talked about today. We teach you the specific integration exercises, plus functional activities that are fun, engaging, you can use an obstacle courses in the classroom, everything and then like Rachel said, we have lots of PDFs and videos. We included modification modules, where we teach you how to modify for different scenarios. We included a lot of research and then we do have case studies, which we're going to talk about some purchasing options here in a minute where the case studies are.

Rachel: 51:51

We keep mentioning the eight primitive reflexes, but I don't think we've told you what the other three are.

Jessica: 51:56

Okay, so there's 14 modules inside of the course. We just have a basic introduction and then our first module is what are primitive reflexes. We dive really deep into what they are, why they're important, why we're so passionate about them, and we include all of the research.

Rachel: 52:12

Then we cover the Moro reflex, we cover the TLR, and the Landau, which is one of those ones that we didn't get to today, the rooting reflex and other ones we didn't get to today, the ATNR, the spinal galant, the palmar grasp reflex, which we didn't get to today.

Jessica: 52:28

Those are the new ones.

Rachel: 52:30

The symmetrical tonic neck reflex, the STNR, and then we talked about tools for kids who push back. So if you're struggling to not only test for the reflexes. If you're struggling to get them to participate in the actual activities or the testing exercises. If you are working with a child who has maybe a physical or cognitive challenges, and they aren't able to participate in like those normal exercises that we recommend, we have strategies for that. We created four different screening checklists, which are honestly worth so much. It's amazing for specific for parents, specific for teachers and educators, specific for clinicians, therapists and other professionals working with clients and then we also have a checklist for adults. So if you are like, hmmm, I wonder if I have some retained from the reflexes. We have some background knowledge on adult primitive reflexes as well.

Jessica: 53:27

And then our bonus module has a lot of other just kind of random things that we wanted to include. Put it in the bonus module. We talked about postural reflexes, we talked about overflow associated movements, how to include primitive reflexes into sensory diets and obstacle courses, and then we have a really cool yoga routine that addresses all of the primitive reflexes. And then we have a module, where we include all of

Rachel: 53:50

Yeah, as a full video, you can turn it on and have your our research, that you can see that we took pieces from tons child deal with, you know. Jessica mentioned the sensory diets, but I just want to give these a quick shout out. We have and I mean, so many different research articles that we have found and then just our quick thank you and disclosure module a sensory diet specific for every primitive reflex. So if you're like really trying to target the Moro reflex this month, we have a specific sensory diet with activity that at the end. you can do to target that Moro reflex. So, really cool, cool, cool things in that bonus module, and then module 13, we have eight case studies of kiddos, who we actually tested in-person so you can see what they look like integrated and then you can see what they look like when they are retained as well. We're going to talk about the different options, he different course options, because the case studies are only included in the master and AOTA purchase options. So if you're a parent, and you're like I just need the basics, you don't need the case studies. You're just trying to work on your own kiddo. You don't have to purchase those. Yep.

Jessica: 54:59

So We've got a lot of video demos. This is actually a video example of one of our case studies that we have, where we were able to test kids in-person and do videos with them. But the course includes videos just like this, videos of all of the testing, all the integration exercises, and so much more.

Rachel: 55:19

You also have those printable downloads, like we mentioned, there are so many handouts that you can print, you can save, you can add to your file, you can save those. If you, I want to talk about already. I know because I can't. I keep I keep teasing it.

Jessica: 55:33

Well, let's just go to it, then.

Rachel: 55:34

Well, okay, well. Okay, let's talk about click the comment forum, because that's a really cool part of the course. Inside the course, you can ask us questions, you can ask other participants questions, you can have those conversations inside the course. Jess and I are the ones who are answering those question so it's a really cool way to just have a little more one on one time with us inside of the course.

Jessica: 55:59

Like we've already mentioned a couple of times, we are certified primitive reflex clinical specialists. So we feel like that just gives us that extra edge to be able to give you guys some really good knowledge of what we've learned and what we use as well.

Rachel: 56:13

We also are officially AOTA approved providers. So if you're a therapist, you do get 1.05 AOTA CEUs, which is 10.5 contact hours. So that is a huge bonus.

Jessica: 56:28

So we'll talk about that. Now. Starting from the left here, like Rachel just said, this course, our big full version is approved for continuing education units. Once you go through the full course and you pass the post test with 80% or more, you get your certificate for those 10.5 contact hours.

Rachel: 56:49

The master level really includes everything that this AOTA CEU level includes, except you don't get the AOTA CEUs. So if you aren't a therapist, an occupational therapist or occupational therapy assistant, but you still want all of the case studies and everything, then this is the option for you. If you don't need those AOTA CEUs, then this is the option for you.

Jessica: 57:13

Our expert version or expert option is really geared towards parents, maybe teachers, who just want those basics. You don't need the case studies, like we already mentioned. You just want to be able to help your child or your children integrate any of their reflexes and you want those basics to Good point. The other really cool thing about the AOTA help them.

Rachel: 57:30

This version does not include all of the functional activities as well. So it does include I think, three CEU purchase option is that you get a physical workbook. So you functional activities in each primitive reflex. The master and the AOTA CEUs levels, include over 10-15, a lot of functional get all of the PDFs that are inside of the course, already activities for al. put together, in color, in a spiral bound workbook. So it's already organized. It's in order, just like the course. So you don't have to like search through everything. You know exactly where it's at. You can make copies for your clients. You can make extra copies for whoever needs. Really, this was the missing piece that we found from all the continuing education that we did in order to become the primitive reflex specialists. We felt like there was no like guide as to okay, this is what you do first, and then you do this, and then you do that. And so that's why we created the workbook with all of our PDFs, because we wanted you to be able to use it as a reference. If you're testing someone's reflexes and you're like, oh, wait, I can't remember real quick, do I need to have them do this or do that you can just quickly flip to the activity, quickly flip to that reflex, and know exactly what you need to do. Because that was really a huge missing piece that we were finding in the clinic. So.

Jessica: 59:05

Super excited for this.

Rachel: 59:06

Really, really exciting. You can go at your own pace throughout the course. You can pick up where you left off. You can. If you've already been in the course, if you've purchased our previous course, and you've gone through the course you do have access to our basic level. We will send an email about that as well. So make sure you are checking your email with a discount code to get more of like one of the master level or the AOTA version if needed. So a couple of details.

Jessica: 59:37

We're in the course. We will answer any questions you have within the course that's what the discussion forum is for. We created this course, Rachel and I together, along with our amazing Harkla team and customer service support team, graphic designer, but ultimately this course is for you because we want to help as many people as we can. Help all the children that we can.

Rachel: 1:00:01

Just a couple of really fun testimonials from our primitive reflex course. This is from, how you pronounce that, Leonel?"Primitive reflex digital course by Harkla that deserves to be considered as an official course to be included in anyone's resume. This person has a PE teacher with 32 years of experience, and they've been taking the online course before the pandemics era. Harkla's course is very concise versus other courses that are informative but too long and not going to the point. The OTs are fun, but always keep it on a serious level. If you've studied primitive reflexes before, this course helps to wrap up information and use it and it's so practical, but it also gives you a lot of information to backup. If you're new to primitive reflexes, you get to know what they are in a very, extremely easy and understandable way. I'm glad I took it and I think it's worth the price. Congratulations."

Jessica: 1:00:53

Thank you.

Another quick testimonial: 1:00:54

"I absolutely love this course. Highly recommended to my fellow OTs and parents. Format is very easy to follow. Fair cost, unlimited access, excellent videos, great ideas for treatment, handouts that are shareable, nice refresher for OTs who already know about reflexes or for beginners too."

Rachel: 1:01:14

And the last one is a parent who has a 20 year old son diagnosed with autism. "I heard about retained primitive reflexes for the first time last month from a different therapy group. When I googled it to see more about it, I saw the Harkla YouTube video. Ut was short, informative, well done, helpful. The course is reasonably priced and easy to understand. I did my second week of implementing the exercises for my son and I'm noticing more about his abilities. I asked a question in the course chat, and I got a quick response. I'm hoping at the end of the 30 days of doing these exercises, I will see improvements with my son."

Jessica: 1:01:46

That's a really cool one. I love that. If you decide to purchase the course, either the expert, master or AOTA CEU option. If you do that today, you do get a free video call with us. Now what that means is that you purchase it today, you go through the course. You go through the entire course, however long it takes you, know rush. Once you're finished, you can email us. Let us know that you went through the course, you purchased it the day of the free live webinar, and then we can set up a video call with you where we can brainstorm and chat and answer any questions you have.

Rachel: 1:02:25

Just why therapists are loving this course we're improving life by improving these by integrating the primitive reflexes. You can see all of these different areas that are improving with these reflexes when they are integrated and we just make learning fun. And we just feel like it's more impactful when the materials fun. And the material is very hands on and visual.

Jessica: 1:02:50

Also, because we really talk about the why. We want to understand why the child or the client is struggling and we want to make sure that we are addressing the underlying cause. Not just putting a bandaid on the problem and oftentimes these primitive reflexes are the underlying cause to specific challenges.

Rachel: 1:03:10

We don't want you to guess. We give you the clear demonstrations, clear videos, pictures, handouts, just so that way, you can easily flip to handout or a video and say, okay, this is what I'm working on right now. I need to make sure I'm doing it right.

Jessica: 1:03:23

Okay. So because you joined us for the live webinar, we are going to give you 15% off whichever course option you choose. If you choose to purchase, which means that if you decide to jump into the AOTA CEU version, you actually get it for $339 instead of $399. If you go with the Master, you get it for $169. If you go with the expert, just the most basic simple version, which still is really great, has lots of information, lots of great PDFs, you get it for $101.

Rachel: 1:03:59

We have not released this course to the public yet. So that means you have access to get it for 15% off through Monday when the course launches to the public. And once the course launches, you will not have that 15% off discount. So Thursday through Monday, you have time to think about it and decide if you want to move forward with it.

Jessica: 1:04:25

You also get the Harka Happiness Guarantee, which means that if you go all the way through the course, you're not satisfied, you do get your money back.

Rachel: 1:04:34

And we do have some of these free digital downloads that you are getting today. These will be emailed to you after the live webinar has happened and once it's all done, you get the integration timeline. We kind of broke down each of the reflexes and their integration timeline. This is just one quick PDF that you can reference. You get our primitive reflex 411, which just gives you a background on each of the five primitive reflexes that we talked about today. Then, you do get the potential causes for retained primitive reflexes handout as well. So just kind of some informations to put in your back pocket and save for later. These are also included in the course too.

Jessica: 1:05:13

Okay, so if you decide that you want to go ahead and purchase one of the course options, the discount code is PRWebinar23, and that gets you 15% off whichever version you choose. We're going to put the link to the course in the chat box and then we'll do our q&a session.

Rachel: 1:05:35

Yeah, let's do it.

Jessica: 1:05:36

Okay.

Rachel: 1:05:36

Okay. So here is the link. Go back here, we're going to put it in the chat box.

Jessica: 1:05:47

And then the discount code is PRWebinar23. There you go. So the link to the course options where you can kind of look at all the details of the different course options, is in the chat box, the discount code is in the chat box, and that discount code gives you 15% off through Monday.

Rachel: 1:06:11

Okay, so we're gonna pop back on this one. I can do this the right way.

Jessica: 1:06:18

And then we'll answer your question.

Rachel: 1:06:19

We'll get to your questions. Sorry, we went over our hour.

Jessica: 1:06:23

We always do. We always do. We're going to try to answer as there's a lot of questions in the q&a box. You guys are awesome. We're gonna get to as many as we can, but it is after five o'clock right now. My son is down in the sensory room at the office waiting for me to get done. So we're gonna answer as many as we can in the next like, what? 10-15 minutes?

Rachel: 1:06:47

Yeah.

Jessica: 1:06:47

Okay.

Rachel: 1:06:48

Let's do it. Okay, so.

Jessica: 1:06:54

Alright, first question, why only five years old and older? What about the younger kids? Because for specific integration exercises, most children under that age don't have the coordination yet to complete the specific integration exercises. So for younger children, we focus on developmental milestones. We focus on climbi,ng, crawling and those normal play activities. Lots of sensory activities. Because until they get five and up, they probably don't have the coordination to complete the exercises.

Rachel: 1:07:30

Okay, Sue said, I've taken a lot of courses over the years in this area, how do I become certified? We took a specific course from Karen Pryor that included those certification credentials,. We had to meet with her and chat with her. So it was a very specific program that we did in order to become certified primitive reflux specialists.

Jessica: 1:07:50

You could probably find it by going to PESI and searching for Karen Pryors' courses.

Rachel: 1:07:57

Yep. All right. Kiko. I feel like I've talked to you before.

Jessica: 1:08:00

Well, we get this question a lot.

Rachel: 1:08:02

Yeah, I know, but I feel like I've chatted with her before. I might be the same person. Maybe. Okay, if a child has a sensory seeker and has some retained reflexes, should sensory diets focus primarily on reflex integration first, or meeting the thresholds? Yes, both ideally, but so many hours after school. Okay, so if a child has sensory seeker and has some retain reflexes, I would say primarily focusing on meeting the sensory threshold first, and then once their nervous system is a little bit more regulated, then you can participate in a primitive reflex integration activity or exercise.

Jessica: 1:08:39

I agree.

Rachel: 1:08:40

Yay.

Jessica: 1:08:42

We'll use some this info to us? Yes, you're going to receive an email after we hop off here and you're going to receive the recorded version of the webinar as well as the PDFs.

Rachel: 1:08:53

And the link to the chorus and the discount.

Jessica: 1:08:55

Yes, yes.

Rachel: 1:08:56

All right, Rebecca said I'm working with a three year old and tested his supine flexion he has head lag and cannot lift his head against gravity without a lot of help. He seems to not be flexing his neck, could this be low tone and or weak core muscles or poor body awareness or primitive reflexes?

Jessica: 1:09:12

All of the above.

Rachel: 1:09:13

It's like what came first the chicken or the egg? Is it weak core causing the reflexes not to integrate? Is it the primitive reflexes not integrating, therefore, the neck cannot flex. Likely all connected. So that's why we want to work on those primitive reflexes as well as the strength during play.

Jessica: 1:09:32

So since he's three, you're gonna want to work on those fun play based activities that address developmental milestones strength and primitive reflex.

Rachel: 1:09:41

Some three year olds are able to participate in the functional activities.

Jessica: 1:09:45

Yeah, absolutely.

Rachel: 1:09:46

But generally not like the very specific integration exercise.

Jessica: 1:09:51

Does retain primitive reflexes impact ocular motor skills as well? In our experience, Yes, absolutely.

Rachel: 1:09:59

If there are developmental or emotional struggles, how do we know if the non integrated primitive reflexes are the cause or even if they are interfering at all? Maybe it's all another cause?

Jessica: 1:10:09

It could be. Yeah, it could be a variety of factors. We always want to look at the child as a whole. So we want to talk to the family, the caregivers find out what's going on in the home Do intake paperwork to figure out what the child's background is like. But ultimately, the way we find out is by testing the reflexes, which we teach in the full course.

Rachel: 1:10:28

What is the average time it takes to help a child with

Jessica: 1:10:28

During the functional activities, if you try it with the child, and they're not able to do it is that an indicator integrating reflexes assuming clarity of which reflexes are that the reflex is retained? Potentially. What you want to do retained? Generally, we focus on one reflex at a time, not to is, if the child has never done this functional activity ever overwhelm the nervous system, and once a child is able to complete the exercises with good form, quality, good form accuracy, that is when we can see it integrate in potentially before in their life, it's going to be hard at first. So you want 30 days. So we want to do the exercises for 30 days with that good form accuracy. Obviously, that can take longer and obviously it does take longer for most of our clients. But in generally 30 days for one reflex. to do it a few times with them and if they're able to catch on and master that functional activity fairly quickly, maybe you still probably want to test that reflex. But if they're doing the functional activity, and they just can't get it even with repetition over multiple trials, it could potentially indicate that reflex might be retained.

Rachel: 1:11:42

What is a good proprioceptive activity to follow the integration exercise? So this is specific to the Moro reflex with the supine over the therapy ball. What I would do is after they've gone upside down over the therapy ball, lay them on the ground, and have them lay on their tummy, and then steamroll them with that therapy ball over their backs. You can have them tell you you want me to push harder or softer, and they can direct how much proprioception they need. Good question.

Jessica: 1:12:08

These are all good questions. How do you prevent the child from rolling over when doing the supine activity over the therapy ball. I would provide more support. So in the video, you saw me supporting Rachel at her knees. But for a younger child or child who struggles with this, you're going to need to maybe support them more through their hips or even their trunk. I've worked with kids where I'm literally in front of them holding their entire length of their body while they go upside down to help keep them on the ball.

Rachel: 1:12:34

And like I've mentioned using the ball to your advantage to help them activate that core. So if you pull them all the way forward, then the ball kind of rolls them up so that way they can activate their core and sit up. How would you recommend implementing primitive reflex integration exercises into for school based OT? I would get the entire class involved with simple functional activities, like crawling around the room and turning their head side to side or laying on their tummy to do their handwriting activities during the day. So I would incorporate, I would teach the teacher the impact of these reflexes, teach them how impactful these reflexes can be for academic skills, and I would get the entire class to participate in some of the activities.

Jessica: 1:13:21

Now if you're doing individual treatments, you have like 30 minutes a week with a student and you want to focus on primitive reflexes. The functional activities are great, or if you know which reflexes are impacting the student you can do the specific integration exercises with them. Even if they're not doing able to do it at home if you're doing it with them once a week, it's still potentially going to have a positive impact, definitely. For infants who missed their integration timelines, do you recommend early intervention to help integrate, find a therapist. I have a 10 month old baby who still struggles with the Moro in his sleep. But most resources I've seen for integrating are for older children? I would definitely if you're concerned about his ability to get through his day, if he's struggling with emotion regulation at this young age, he can't self soothe, if you're noticing motor delays in his development, definitely seek out early intervention. We prefer to rule it out versus wait and see. We don't like the wait and see method. So if you are concerned definitely seek out services.

Rachel: 1:14:22

We do have another course called improving infant and develop. No. Improving, how we say that?

Jessica: 1:14:28

Infant and toddler sensory development.

Rachel: 1:14:30

Thank you. So it's it's geared towards the irth to Three population.

Jessica: 1:14:34

Three and four.

Rachel: 1:14:35

And we talk about sensory activities, sensory integration, and primitive reflex activities that aren't specific activities but more of that functional implication of participating in activities that can integrate those reflexes. So that might be a better option to look at right now, since you do have a 10 month old.

Jessica: 1:14:55

What kind of activities would you try with kiddos who have limited volitional movement or more physically restricted to participate in those functional tasks? We have a full module in the course on this specific challenge. Children with limited physical control, cerebral palsy, high muscle tone, and how to modify the different activities for them.

Rachel: 1:15:18

So with the TLR, when the child has constantly running into you and things, how do you address?

Jessica: 1:15:24

Okay. So like they're not able to like, they're just bumping into things their clumsy.

Rachel: 1:15:29

We work on integrating that reflex and that can potentially help for sure.

Jessica: 1:15:33

Obstacle courses are a great option for them to learn how to control their body through obstacles as well.

Rachel: 1:15:38

We talk a lot about the casting of the name of it. We talked about the pyramid and we talk about how important it is for these strong foundational skills to develop and acquire.

Jessica: 1:15:49

Pyramid of learning.

Rachel: 1:15:50

Pyramid of learning. Thank you, oh, my gosh, like I said this.

Jessica: 1:15:53

I was blanking on it too.

Rachel: 1:15:54

And, in order for those higher level academic skills to acquire and develop, we have to have that strong foundation. So we talk about making sure that we're meeting the sensory needs. We're meeting those reflexes, we're integrating those reflexes, and then we lay the foundation for those higher level skills.

Jessica: 1:16:13

All of these seem like they're for bigger kids. Is there alternative activities for younger kids? My son is one has CP and all of its reflexes are so bad, especially ATNR. Yeah and I would imagine that he probably had higher muscle tone. So this is impacting him as well. Yeah, our course is designed for older children.

Rachel: 1:16:31

Like four plus.

Jessica: 1:16:32

Yeah, our infant toddler sensory development course could be an option. I think for him, in-person therapy is honestly going to be like the best option for sure.

Rachel: 1:16:45

Yep. Is bear walking crawling a probability of ATNR with an almost two year old? So if the two year old is just playing on the ground and bear crawling, I would say it's just for fun and just playful. But if the child bear crawled as an infant, and that was the only way that they crawl, I would say that could be a potential for maybe a retained STNR, or possibly a ATNR to TLR.

Jessica: 1:17:12

You mentioned how much it's retained. So there are obviously variances and severity of response. Just curious if you've ever seen a rating scale for documentation purposes to put a number on the improvement? We actually created one.

Rachel: 1:17:23

Yeah, so we're gonna have a rating scale inside the course. We have zero to four and that is like the rating scale, like how severely it is retained. And that way you can document when you're going back and retesting the reflexes, and you can see oh, my gosh, this was definitely a four when we initially tested it, and now it's a two. So we've really seen those improvements with the integration.

Jessica: 1:17:47

I liked hearing about when these reflexes are developed, and why. Where can you find this information? I graduated in 82. So this was not in any of my training. It wasn't in our training nine years ago, 10 years ago, either. It's crazy. I think we linked most of our references in the slide show.

Rachel: 1:18:06

Yes, it is live show. We also have our timeline handout as part of the course as well. It's also the freebie that you'll get. But all the references are linked inside that course as well.

Jessica: 1:18:18

How do you assess and do these activities with noncompliant preschoolers, who you think you have retained primitive reflexes? We have a module all about this in the full course. But really, it's about making it fun and engaging. Because if you tell the preschooler, hey, we have to do this. They're not going to want to do it. So you have to figure out how to engage and motivate them.

Rachel: 1:18:35

A big part of primitive reflex integration starts with just connecting and helping the child feel safe. And before you can even participate in any of these reflex integration activities, that should be your first goal is to build rapport, build that connection, and make the child feel safe and comfortable. And then you can participate in some of those really modified activities. Do we have any lower level TLR activities? Yes, we do. Yep. What is your opinion when there is fluid in the ear and ear infections? We see a connection with like vestibular challenges, potentially vestibular seeking or avoiding. Oftentimes, kids with tubes in their ears will have sensory processing challenges and potentially retained reflexes. I haven't seen any articles, this is all just our clinical experience. So I'm not saying like, if your child has these things, this will happen. This is just observations.

Jessica: 1:19:29

Should all OTs know thi? Absolutely.

Rachel: 1:19:31

But don't feel bad if you don't know this, because we did not get hardly any training in school. This was all initially learned in the clinic setting.

Jessica: 1:19:41

We had a really amazing mentor and then we went on and started doing our own learning in our traditional continuing education. But ideally, it would be awesome if all therapists knew about this. Is there a registry that you know of that has a list of OTs who are trained? So I actually just looked it up. We were certified through Evergreen Certifications when we went through Karen Pryor's course through PESI, and they do have like a directory of certified professionals. So you can go to EvergreenCertifications.com and look up their registry of providers.

Rachel: 1:20:16

I'm creating one of these on sensational brain too. So, hopefully, it will be ready soon, because I feel like that's a really important part.

Jessica: 1:20:23

How do we know we found an OT with this knowledge, if we're looking for an OT for children? Ask

Rachel: 1:20:27

Yes. We also have a YouTube video that talks about finding the right OT.

Jessica: 1:20:32

Would yoga be a great functional activity as well? Absolutely. Do you have any tips for things I can do at home for a child still bed wetting at eight? Address the spinal galant reflex. Are you offering CEUs for OTs? Yes, we are.

Rachel: 1:20:46

1.05 AOTA CEUs or 10.5 contact hours.

Jessica: 1:20:51

All right, we're gonna end this at 5:30, so we have three more minutes to answer as many questions as we can. I have to go you guys. I'm so sorry.

Rachel: 1:21:00

Okay.

Jessica: 1:21:01

Can you reshare the slide of symptoms of a potentially retained STNR? You will be emailed a recording of this webinar so you can rewatch it and pause where you need to pause.

Rachel: 1:21:11

I'm an OT student recently, when I was going over primitive reflexes, one of my OT professors said recent studies say that they will never truly get integrated, but rather inhibited when the child learns to override the reflex. This has caused me some confusion with kiddos I currently work with as a PT in the school. Do you agree with what she said or do you think that was bad information?

Jessica: 1:21:31

I'd like to see the studies.

Rachel: 1:21:33

I would be curious to see where your professor is getting the information from. I have seen reflexes get integrated and really, in the grand scheme of things, I would say does it matter if it's integrated or inhibited? Or is it you know, tomato tomahto? I feel like really the goal is function and that's what we should be looking at rather than all of these specific logistics. If the child has improved function, that's the goal here.

Jessica: 1:22:02

Okay, we already answered that. So can you have issues with reflexes as you age, specifically seniors? Absolutely. There are studies out there that show that a lot of the elderly population have reflexes come back.

Rachel: 1:22:14

Yeah, I think it would be cool for OTS who work with geriatrics and that senior population to do specific reflex integration in that population. So if you are in that population, you should.

Jessica: 1:22:25

Will reflexes show up consistently each time? I worked with a kiddo who would be in four points, so on hands and knees, and sometimes when he looked up his lower extremities will collapse and he seemed perplexed about it. Yeah, it might not be consistent every single time it can be dependent on what he's doing and where his focus is.

Rachel: 1:22:44

Is the fear paralysis reflex and Moro reflex tested the same way? No, and they are not integrated in the same way, either. The fear paralysis, we don't talk specifically about the fear process,. We bring it up. We mentioned that we have some information about it. But we don't go into specifics just because it's generally integrated and they're really specific cases with that fear paralysis reflex. So a good book to look at for the fear paralysis is the symphony of reflexes, and they talk a lot about the fear paralysis in that book, which I thought was super interesting.

Jessica: 1:23:18

Okay, we have time for one more question and I kinda want to do this.

Rachel: 1:23:21

Let's do these two. Is the workbook included in the middle option? No, it is only included in the AOTA version. We haven't decided yet if we're going to have it separate to purchase, but email us and let us know if this is something that you're interested in. So we can we can put. Yep. Okay. Last one.

Jessica: 1:23:38

So you guys have so many great questions. Last one. Is it ever too late to work on integrating primitive reflexes? One more?

Rachel: 1:23:45

Expert level. Does the parent version includes the yoga My daughter suffered a TBI at age five, she's now 20. I'm very curious to know if it's too late for OT intervention for her. I would say you could look and see if you could find an OT who sequences and sensory diet? Yeah, yeah. Okay.

Jessica: 1:23:56

And you can find all that information on the sales would work with her, but that's definitely never too late. Right? We know that neuroplasticity is a thing. Our brains are constantly changing and learning and we can always change our brain, which is where our primitive reflexes live. So if she has retained primitive reflexes from that TBI, you can absolutely work on integrating them and be successful with it. page on the website. It does include details of what's within each course.

Rachel: 1:24:36

Okay, just to be clear, I can purchase the course on Monday and get the 15% off discount?

Jessica: 1:24:40

Monday at midnight is when it expires, and we're mountain time.

Rachel: 1:24:44

Yes. Okay. There's more, but we do have to go.

Jessica: 1:24:47

So good. I'm so sorry.

Rachel: 1:24:49

If a baby skips crawling and walks first and eventually crawls, would that be a concern for retain primitive reflexes? Yes, possibly. Yes.

Jessica: 1:24:56

I'm sorry Rachel.

Rachel: 1:24:58

I just want to answer more.

Jessica: 1:24:59

I know. I want to too. But we have to go. If you have more questions, you can always reach out on Instagram. We're at Harkla_family, you can send us a message there. You can send us a message at our podcast Instagram at All Things Sensory Podcast. We're always in DMs there answering any questions you have.

Rachel: 1:25:18

And if you do purchase the course, and you have more of these specific questions that we didn't get to today, put them in the course. Because other people will most likely have the same questions and these are all great questions.

Jessica: 1:25:30

You guys were so great.

Rachel: 1:25:31

Hit us up on Instagram. Shoot us a DM. Thank you so much for being here. If you're watching the recording, thank you so much for watching the recording. We hope it was helpful, and we cannot wait to see you inside of the course and we hope you love it as much as we do.

Jessica: 1:25:45

Okay, bye.

Rachel: 1:25:45

Bye, guys. Thank you so much for listening to All Things Sensory by Harkla.

Jessica: 1:25:51

If you want more information on anything mentioned in the show, head over to Harkla.co/podcast to get the show notes.

Rachel: 1:25:59

If you have any follow up questions, the best place to ask those is in the comments, on the show notes, or message us on our Instagram account, which is at Harkla_family or at all things sensory podcast. If you just search Harkla, you'll find us there.

Jessica: 1:26:14

Like we mentioned before our podcast listeners get Head to Harkla.co/sensory to use that discount code right now. 10% off their first order at Hakrla. Whether it's for one of We are so excited to work together to help create confident kids all over the world. While we make every our digital courses or one of our sensory swings, the discount code sensory will get you 10% off. effort to share correct information, we're still learning.

Rachel: 1:26:48

We will double check all of our facts but realize that medicine is a constantly changing science and art.

Jessica: 1:26:54

One doctor or therapist may have a different way of doing things from another.

Rachel: 1:26:58

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: 1:27:09

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: 1:27:18

Consult your child's pediatrician or therapist for any medical issues that he or she may be having.

Jessica: 1:27:24

This entire disclaimer also applies to any guests or contributors to the podcast.

Rachel: 1:27:29

Thanks so much for listening.