Primitive Reflexes and Vision

What are Primitive Reflexes?

  • Primitive reflexes are “tools” that all infants are born with – these reflexes are designed to provide safety immediately after birth. 
  • They are “automatic, stereotyped movements, directed from the brain stem and executed without cortical involvement.” (Goddard)
  • Primitive reflexes are the foundation, for higher-level learning and thinking, planning, and movement. 
  • Each reflex has its own life span and once it is integrated (“goes away”), the child will develop more mature movement patterns that are voluntary and controlled. 
  • Primitive reflexes are not meant to remain in the body forever. 
  • Once they integrate, more mature and voluntary movements appear. 
  • Primitive reflexes typically integrate naturally – through movement, or what we now call “developmental milestones.” 
  • Developing head control, tummy time, rolling, crawling, etc. – these are all examples of natural movement that will assist in natural primitive reflex integration. 
  • If a primitive reflex does not integrate naturally, this is an indication of structural weakness or immaturity within the CNS (central nervous system). 
  • Retained (not integrated) primitive reflexes can interfere with the development of more mature, voluntary movement patterns including:
    • Postural reflexes – balance, ability to move safely through environment. 
    • Bilateral coordination – ability to coordinate arms and legs. 
  • Instead of mature, voluntary movement patterns, a child with retained primitive reflexes may develop abnormal movement patterns which can result in clumsiness. This can affect a child’s ability to participate in social activities such as recess and sports. 
  • Because primitive reflexes are the foundation for higher-level learning, if one or more is retained, potential challenges can occur in:
    • Learning – challenges sitting and attending in class; challenges with ocular motor skills which affects reading and writing; challenges with establishing a hand dominance. 
    • Social skills – high anxiety and decreased self-confidence; decreased language and communication skills. 

What Causes Primitive Reflexes To Be Retained?

There is no definitive answer to WHY a primitive reflex may not integrate naturally.

However, there may be contributing factors.

During pregnancy:

  • Hyperemesis or severe morning sickness
  • Severe viral infection during the first 12 weeks or between 26-30 weeks
  • Alcohol / drug use / smoking
  • Radiation
  • Severe stress

During the birthing process:

  • Prolonged labor
  • Placenta previa
  • Use of forceps or “vacuum”
  • Breech
  • Cesarean
  • Cord wrapped around infant’s neck
  • Fetal distress
  • Premature / post-mature (2 weeks early or late)

In newborns and infants:

  • Low birth weight (under 5 pounds)
  • Incubation
  • Prolonged jaundice
  • “Blue baby”
  • Feeding challenges in the first 6 months
  • High fever, delirium, or convulsions in the first 18 months
  • Adverse reactions to any of the inoculations
  • Delayed walking or talking (later than 18 months

Reflexes that are integrated may become reactivated later due to trauma, injury, illness, or stress.

It is important to address these missing developmental stages when primitive reflexes are not integrated.

Vision Therapy and Primitive Reflexes

Although there are many primitive reflexes, vision therapy programs focus on five reflexes that affect he development of the visual system. 

Moro Reflex

Moro reflex is the earliest primitive reflex. It affects vestibular, ocular, motor and visual perceptual skills.

Symptoms include:

  • Exaggerated startle reflex
  • Motion sickness
  • Eye movement and visual processing problems
  • Poor coordination
  • Poor balance
  • Light sensitivity
  • Frequent infections
  • Inner ear problems
  • Allergies
  • Poor stamina
  • Difficulty with black print on white paper
  • Tense muscle tone
  • Poor auditory discrimination
  • Biochemical and nutritional imbalances
  • Often in “Fight or Flight” mode
  • Hyperactivity
  • Low self-esteem

Tonic Labyrinthine Reflex (TLR)

TLR affects ocular, motor, balance, muscle tone and auditory discrimination.

Symptoms include:

  • Poor posture and/or stooping
  • Weak muscle tone
  • Stiff or jerky movements
  • Toe walking
  • Dislike of sports
  • Eye movement, spatial and visual perceptual problems
  • Motion sickness
  • Poor balance
  • Poor organization skills
  • Poor sequencing skills
  • Poor coordination
  • Poor sense of time
  • Fear of heights

Symmetrical Tonic Neck Reflex (STNR)

STNR affects fixation, focusing from far to near and crossing midline.

Symptoms include:

  • Poor posture
  • Difficulty catching and/or tracking a ball
  • Poor depth perception and balance
  • Difficulty swimming
  • Poor hand-eye coordination
  • Messy eating
  • Difficulties with adjusting focus from far to near
  • Poor swimming skills
  • Learning problems
  • Difficulty aligning numbers for math problems
  • Difficulty recognizing social cues
  • ADD/ADHD characteristics
  • Anchors feet behind chair while sitting
  • “W” position when sitting on the floor

Asymmetrical Tonic Neck Reflex (ATNR)

ATNR affects midline issues, eye tracking, balance, handwriting and laterality.

Symptoms include:

  • Poor balance when moving head side to side
  • Focusing problems (especially when switching from near to distance)
  • Difficulty keeping place when copying
  • Difficulty learning to ride a bicycle
  • Difficulty crossing the midline
  • Poor pursuits (smooth eye movements)
  • Mixed laterality (uses right foot, left hand or uses right or left hand interchangeably)
  • Poor expression of ideas on paper
  • Difficulty catching a ball
  • Poor handwriting
  • ADD/ADHD characteristics

Spinal Galant Reflex

Spinal Galant reflex affects the ability to sit still, short-term memory, concentration problems and can lead to bedwetting.

Symptoms include:

  • Bedwetting
  • Fidgety or wiggly (especially when sitting)
  • Sensory issues with food texture or tags or waistbands in clothing
  • Poor short-term memory
  • Poor concentration
  • ADHD characteristics

How Does Integration Therapy Help?

An Integration Therapy Program provides exercises to address primitive reflexes. By using rhythmic movement training techniques that imitate the movements of an infant in development, patients can integrate these retained reflexes. These repetitive motions develop the reflexes and gradually help develop the front and visual cortex of the brain.

Once these reflexes are integrated by the body, many behavioral issues affected by retained primitive reflexes show improvement and at times are resolved. Since, vision is directly linked with the brain and is affected when our brains do not develop correctly, it is important to address primitive reflexes along with the visual concerns.

To learn more about Primitive Reflexes, feel free to contact our office.

The Role of Neuro-Optometry in the Recovery of Brain Injury and Trauma

What is Neuro-Optometry? 

Neuro-Optometry can play a significant role in the path to recovery from a traumatic brain injury. Doctors that specialize in Neuro-Optometry have had additional training that focuses on how the eyes work as a team and process information to bring meaning to what you are seeing. Neuro-Optometrists also are trained and give attention to how the visual system integrates with the other sensory systems and how they balance and function together for the person to be able to navigate and perform at their best. 

What is Neuro-Optometric Rehabilitation? 

Neuro-Optometric Rehabilitation focuses on strengthening the visual skills needed to perform daily activities for increased independence and improved quality of life after a traumatic brain injury. As well as, rehabilitate cognitive function and integration of other sensory systems with the visual system for a whole body approach. 

Below is a  list of the common ocular conditions that can emerge post brain injury,  trauma or concussion. These include:

  • Vestibular Dysfunction – imbalance of the vestibular system and how it integrates with the visual system can commonly be  associated with motion sickness and at times even vertigo. 
  • Acquired Strabismus – also known as “crossed-eyes.” This occurs when there is a misalignment with the eyes. 
  • Convergence  insufficiency – Difficulty paying attention or focusing on near or far objects for long periods of time. Convergence insufficiency is a very common symptom people experience. 
  • Visual-spatial dysfunction/visual processing disorder – a disrupted sense of where objects are in space and where your body is in relation to other objects. This can cause someone to feel disoriented in busy areas or get overwhelmed when they are in busy rooms/areas. 
  • Oculomotor Dysfunction – hard time tracking and following objects, making it difficult to read or sustain concentration on near tasks. Words or sentences seem to move on the page or loose track when reading. 
  • Nystagmus – a condition where the eyes repeatedly make uncontrolled movements. This can result in problems with balance, visual acuity, and depth perception.
  • BINOCULAR VISION DYSFUNCTION: This is the inability to use the two eyes together, and contributes to dizziness, headaches, and the inability to sustain focus. Undiagnosed, mis-diagnosed, or untreated binocular vision dysfunction conditions can impede progress in rehabilitative therapies with both occupational and physical therapists.
  • Hemianopsia/Visual Neglect—losing part of your visual field or unable to process the information that is coming from that field of vision. 

Early diagnosis and treatment of these vision conditions is a critical component of overall recovery and lingering vision conditions impede rehabilitation therapies (physical therapy, occupational therapy, speech therapy, etc) as well as prolong the return to normal daily activities.

If you have any questions, please feel free to complete our Adult/TBI screening form to see if you are experiencing any visual symptoms secondary to a Brain Injury.