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Everything You Need To Know About Neuro-Developmental Delay, Primitive Reflexes & The Vestibular System

Let's journey together to learn about these brain and body systems and how they impact development and everyday functioning. 

In this post, you will find everything you need to know about Neuro-Developmental Delay, primitive reflexes, and the vestibular system. 

 

 

This is fascinating stuff! Let's get started! 

Neuro-Developmental Delay

What is Neuro-Developmental Delay?

Neuro-Developmental Delay (NDD) is a term used to describe an immature and underdeveloped nervous and reflex system that has caused interruptions in early development stages. The immature reflexes interfere with subsequent motor development, visual functioning, hand-eye coordination, and perceptual skills of the child.

What Can Cause Neuro-Developmental Delay?

Below is a list of factors that could be contributing factors to the cause of NDD this is not an all-inclusive list

  • Stress in Mother throughout pregnancy

  • Complications throughout pregnancy

  • Exposure to toxins in utero

  • Premature birth

  • Post-mature birth

  • Complications with the birthing process

  • Birthing interventions such as forceps, vacuum-assisted birth, C-section birth

  • Precipitous birth (very quick labor)

  • Prolonged birth

  • Separation from Mother at birth

  • Stress in Mothor or baby during or following birth

  • Trauma in infancy

  • Lack of experiences as a baby (lack of movement, interaction etc..)

  • Medical conditions contributing to neuro-developmental delay

Learn more about Neuro-Developmental Delay Check out these blogs:  

 

Developmental Delay What Caused it? Quick Guide

Are Reflexes Good or Bad?

Moro Reflex

Moro Reflex At Birth

The Moro reflex should be present in a full-term, healthy baby. In the early months of life, the Moro reflex is there as a form of protection, especially in a young infant whose movements are purely reflexive. The Moro reflex is thought to be closely linked to our survival. If a traumatic event occurs during the birthing or early infancy period, it is thought that this could contribute to a retained Moro reflex. The Moro reflex should inhibit around 4 months of age. 

What Does the Moro Reflex Look Like In A Baby?
  1. The arms open out and extend (abduct)

  2. The legs abduct (not as big as a response as the arms)

  3. The baby has a sudden intake of breath (inhale)

  4. The baby "freezes" in this position for a moment

  5. The arms flex back in close to the body into a "fetal" position

  6. Typically the baby will start to cry

May help initiate the first breath of life

Moro Reflex- the "startle reflex"​   

Moro Reflex Fight or Flight
What Triggers The Moro Reflex? 
  • Moro is most sensitive to vestibular stimulation in infants (movement, change in position)

  • Can be activated by any form of sensory stimulation

  • Loud sound

  • Hypersensitive to events or situations that might trigger the Moro reaction 

  • Invasive thoughts, memory

Long-Term Effects of a Retained Moro Reflex
  • Vestibular Related Problems

    • Motion sickness​

    • Poor balance

    • Poor coordination

  • Physical Timidity

    • Cautious with movement

    • Fearful of feet leaving the ground​​​

  • Oculo-Motor and Visual Perceptual Problems

    • Skips lines while reading

    • Poor handwriting legibility

    • Poor visual organization

    • Gets overwhelmed in a busy environment

  • Poor Impulse Control

  • Stimulus Bound Effect

    • Poor attention

    • Attention is drawn to the slightest movement or disturbance

  • Auditory Overload / Confusion

    • Overreacts to sounds

    • Avoids noisy environments

    • Can't focus with background noise

  • Low Self-Esteem

    • Poor self-image

    • Hard on one's self

  • Poor Adaptability

    • Difficulty with transitions

    • Afraid to try new things

    • Sensory defensiveness

  • Anxiety

    • Fearful of new situations

    • Worrying about daily tasks

    • Impairing daily functioning

  • Immune Issues

    • Easily prone to sickness 

  • Sensory Deficits

    • Sensory defensiveness

    • Sensory seeking

    • Sensory avoiding

    • Sensory thresholds are out of the norm

Learn More About The Moro Reflex

ATNR Reflex

The ATNR (Asymmetric Tonic Neck Reflex) should be present in utero and in a full-term, healthy baby. The ATNR response is due to the rotation of the head which causes the body to respond. When the head rotates, the arm and leg on the same side extend, and the opposite side limbs flex. 

ATNR Quick Facts
  • Emerges at 18 weeks gestation

  • Often coincides with when mother begins to feel fetal movement

  • First form of hand-eye training

  • Should be present in a full-term, healthy baby

  • Should integrate at 6 months of age

  • Known as the "academic" reflex

  • If not integrated causes significant problems in coordination, reading, and writing

ATNR The "Academic" Reflex

 

The ATNR (Asymmetric Tonic Neck Reflex) is also known as the “academic reflex”. If a person has a residual ATNR, it can have a big impact on their ability to read and write. Many parents do not know this reflex is retained until their child becomes school-aged. 

Symptoms of a Retained ATNR

  • Reading difficulties​

  • Difficulty crossing midline

  • Hand-eye coordination problems

  • Poor bilateral integration (using two hands together)

  • Immature handwriting

  • Difficulty in school

  • Difficulty separating head, hand & eye movement

  • Poor balance

  • Difficulty in sports

It is important to have your child tested when you suspect a retained ATNR. They may struggle in school and become very fatigued with reading and writing. Many kids resist performing pencil/paper tasks. 

Learn More About The ATNR And Other Primitive Reflexes 

TLR (Tonic Labyrinthine Reflex)

The TLR (Tonic Labyrinthine Reflex) is an interesting reflex! There are many components to the TLR that impact other brain and body systems. Let's check it out! 

TLR Quick Facts
  • Observed to be present in infants as early as 30 weeks gestation

  • TLR is a reaction of the body in response to head movement

  • TLR has a direct connection to balance, posture, and muscle tone

  • TLR is observed in both flexion and extension (see below)

  • TLR can impact visual processing

  • TLR should integrate at 3 yrs 6 months

TLR In Flexion

Just a reminder, the TLR (Tonic Labyrinthine Reflex) is triggered by head movement in both flexion (looking down) and extension (looking up). Let's talk about the TLR in Flexion. In a baby, when the chin is brought to the chest (flexion) the arms and legs respond to this head movement by also flexing. 

TLR in Flexion in Utero

The "fetal position" of the baby in the womb is an expression of the TLR in flexion. This serves several purposes: 

  • The baby is growing and takes up less space when it is "tucked in"

  • The pressure of the head on the cervix helps with dilation

  • With the head flexed, the baby can enter the birth canal

  • This position allows cranial bones to compress 

  • The hard, bony part of the skull is what is taking the force of contractions, or the head hitting the Mother's pubic bone.

TLR in Flexion In Baby

The "fetal position" of the baby looks very similar to that in the womb.  This is how the TLR in flexion looks and changes as the baby ages:

  • ​Increased muscle tone primarily at the hips and knees is observed

  • Gravity is now working on this baby outside of the womb

  • TLR in the "crude" form is only visible in the first few weeks of life

  • As the baby ages, head control develops

  • When head control improves, it helps to gradually break up the effects of the TLR

  • TLR has until the age of 3 1/2 yrs to integrate naturally

What Does A Retained TLR In Flexion Look Like In An Older Child?

Kids with a retained TLR in flexion tend to be "floppy" and have low muscle tone. They need to prop or lean on people or objects. When sitting on the floor they may "W" sit due to their low muscle tone and weak core. Kids can also demonstrate a "slumped" posture while sitting at their desk, or the dinner table. The reason for this is that when the head looks down, the body responds by also "flexing" or "slumping". 

These kids typically are not fans of playing organized sports. They fatigue quickly and lack the postural stability to coordinate movements efficiently. They might struggle with sitting upright on bleachers, or during circle time with no back support. 

Symptoms of a Retained TLR in Flexion
  • Insecure Balance

    • May become upset if bumped​

    • Clumsy

    • Uncoordinated

  • Poor Posture

    • Slumped over​

    • Slouchy

  • Low Muscle Tone

    • Poor endurance​

    • "Floppy"

  • Vestibular-related problems

    • Fear of feet leaving the ground

    • Difficulty with playground equipment

    • Fear of looking through the holes in playground equipment

    • Fear of going up or down unfamiliar stairs 

    • Motion sickness

    • Vertigo

  • Visual Problems Such As

    • Figure-ground effect

    • Being overwhelmed by a visually "busy" worksheet

    • Overwhelmed in a visually "busy" environment

    • Poor near-point convergence

    • Eyes become easily fatigued with school work

  • Vestibular-Cerebellar Problems

    • Problems with sequencing

    • Poor timing

TLR In Extension

Just a reminder, the TLR (Tonic Labyrinthine Reflex) is triggered by head movement in both flexion (looking down) and extension (looking up). Let's talk about the TLR in extension. In an infant, when the head is significantly tipped back, the arms and legs respond to this head movement by extending, or "straightening". The purest form of this reflex should only be seen for a few short weeks in infancy. 

TLR in extension in utero
TLR in Extension During Birth

The TLR in extension isn't used in-utero until the birthing process. As the baby's head is delivered, it will rotate a quarter turn to be in line with the body. The head will then extend back causing the TLR in extension to activate. The arms and legs respond along with uterine contractions to deliver the baby. 

What Does A Retained TLR In Extension Look Like In An Older Child?

Remember, it can be normal for traces of the TLR to be present until age 3 yrs. 6mo. Kids with a retained TLR in extension tend to have high muscle tone. Some of these kids can have a "tongue thrust" when the tongue protrudes through the lips. This can be observed when the child is focused on performing an activity, or when they are using their hands for play, or writing etc... The TLR in extension can also cause some kids to toe walk. It is also common for these kids to run with their arms behind them. 

Writing with tongue out TLR in extension
Toe walking TLR in extension
Symptoms of a Retained TLR in Extension
  • Insecure Balance

    • May become upset if bumped​

    • Clumsy

    • Uncoordinated

  • Poor Posture

  • High Muscle Tone

    • Extensor tone when the head is tipped back

  • Vestibular-related problems

    • Fear of feet leaving the ground

    • Difficulty with playground equipment

    • Fear of looking through the holes in playground equipment

    • Fear of going up or down unfamiliar stairs 

    • Motion sickness

    • Vertigo

  • Toe Walking

  • Articulation Problems

    • With or Without Tongue Protrusion

  • Visual Problems Such As

    • Figure-ground effect

    • Being overwhelmed by a visually "busy" worksheet

    • Overwhelmed in a visually "busy" environment

    • Poor near-point convergence

    • Eyes become easily fatigued with school work

  • Vestibular-Cerebellar Problems​

    • Problems with sequencing

    • Poor timing

Learn More! Check Out These Resources 

STNR (Symmetrical Tonic Neck Reflex)

STNR baby pushes up on tummy

The STNR  (Symmetric Tonic Neck Reflex) is known as "the crawling reflex." It is responsible for getting the baby off its tummy and onto the hands and knees position so that when they are ready, they can take off and crawl!  

STNR Quick Facts
  • Present for a short period at birth, plays a part in the newborn "breast crawl" Amazing, Right?
  • STNR recedes shortly after birth and reappears at 6-8 months
  • STNR helps the baby to push up off their belly onto their hands and knees for the first time
  • STNR should integrate before the baby begins to crawl
  • STNR also helps baby pull up from hands and knees to standing
  • STNR helps to train baby's visual skills to shift focus from near to far, and a far distance to a near distance
  • STNR helps integrate and inhibit the TLR (Tonic Labyrinthine Reflex)
  • STNR should integrate around 11 months
  • A retained STNR contributes to poor posture 
STNR baby
STNR in flexion-min.png

STNR In Flexion

STNR in flexion while standing pnk-min.png

The STNR (Symmetrical Tonic Labyrinthine Reflex) is triggered by head movement in both flexion (looking down) and extension (looking up). Let's talk about the STNR in Flexion. In a baby, when the head looks down (flexion) the arms bend (flex), the bottom pushes up all while the hips and knees straighten (extend). Whew! That is a lot to think about happening all at once! Let's explore further....

STNR flexion real kid -min.png

Head Flexes

Arms Bend

Legs Straighten

STNR In Extension

STNR in extension-min.png

The information, including but not limited to, text, graphics, images, and other material contained on this website is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, or diagnosis.

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