Just this last month I got the sweetest Valentine’s card from a girl in the 4th grade. Let’s call her Liz. She had just graduated from occupational therapy.
When we started working together, Liz had already done the Astronaut program (a vestibular program) with another therapist. The quarantine had just started and she was moving onto my caseload for tele-therapy.
Liz was very sweet and obliging but she had low confidence and poor performance of fine motor activities such as cutting and writing. I remember asking her to cut out an outline of her hand and she said “I’m not good at cutting.” Indeed, she had difficulty with the task and took a long time while using all of her effort to cut along curves to produce a scrappy result.
When I asked her to write, she had difficulty with recalling certain letters although she did have a mature pencil grasp. When she copied the letters, the writing was large and poorly placed.
When I tested her reflexes, the main unintegrated reflex for her was the Asymmetrical Tonic Neck Reflex (ATNR). She also had a mild hyperactive STNR and foot tendon guard which will be the topic of other blogs.
If you read blog #4 on reflexes, you will recall that reflexes are like the original software code that is the basis for all movement patterns and behaviors. This code will behave differently when tested, depending on the age of a child. Most reflexes should move to the background of the child’s system by the time they become a toddler.
The ATNR motor pattern is often called the “fencing pose”. When an infant turns its head to one side, the result is a straightening of the arm and leg on the side that the head is turned to. The knee and elbow of the opposing side flexes.
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This reflex can be triggered by auditory and visual stimuli. For example, a loud toy or voice that is causing the child’s head to turn and the body to fall into this “fencing position”. The reflex helps to develop eye-hand coordination.
I used to only think of the presence of the ATNR in testing as a problem (not realizing that reflexes are always functioning in the background of our operating systems.)
The ATNR can give the body a sense of stability so that a child can attend to and interact with their environment.
Now I know that the reflex has many benefits. Some children may even need to be assisted to learn this reflex pattern so that they can improve object manipulation skills and attention.
Improper development of this reflex however, can interfere with the child’s ability to cross the midline of their bodies. (Imagine a line running down the nose dividing the body to left and right sides – this is often referred to as the body ‘midline.’)
This may occur when a child is no longer moving to more mature patterns of movement.
You may notice an avoidance of bringing the limbs across the midline. Some children will even switch the hand they are using to hold a pencil or crayon when drawing across this line.
Other signs that this reflex may not have developed properly or integrated is in the eye movements. Just as it may be more difficult to bring the limbs across the midline, it can also be more difficult for children to look from left to right sides of their body. The result is left to right movements of the pupils are not smooth. Instead, there is a “jerky” quality when crossing midline.
It is common in my experience to see children experiencing difficulties with ATNR integration to struggle with catching or dribbling a ball between their left and right sides. I often use ball skills to quantify progress.
Note that ball skills involve visual convergence and divergence, which is the ability to see an object as it approaches. This is tied to other reflexes such as the TLR and the STNR.
It is also common to see the body positioned in an ATNR pattern when seated at the table. Look for one side of the child’s body extended and the other side flexed.
The ATNR is linked to a state of alertness and auditory memory (Masgutova & Masgutov 2015). A child will most likely be attending to and reaching for items in an active and alert state. Therefore, it is recommended to work this reflex with a child to encourage a state of alertness.
I have incorporated the ATNR pattern into my morning yoga flow. When I assign ATNR activities, I recommend parents work this reflex in the morning with their children and even helping them into this position, should they have difficulty waking.
Several studies have found significant connections between the abnormal expression of reflexes and the diagnosis of learning disabilities and reduced math and language grades (Oliver& Grand, 2020).
One study of 683 children found that the ATNR was associated significantly with reduced reading, spelling and mathematics. ATNR was attributed to a 13% difference in reading scores (Jordan-Black, 2005).
The good news is that it is possible to influence the functioning of reflexes.
I love to hear when the students I work with meet grade level for reading or when their parent’s say that their child has now taken interest in writing.Several studies have found significant connections between the abnormal expression of reflexes and the diagnosis of Learning disabilities land reduced math and language grades (Oliver& Grand, 2020).
One study of 683 children found that the ATNR was associated significantly with reduced reading, spelling and mathematics. ATNR was attributed to a 13% difference in reading scores (Jordan-Black, 2005).
The good news is that it is possible to influence the functioning of reflexes.
I love to hear when the students I work with meet grade level for reading or when their parent’s say that their child has now taken interest in writing.
I believe this to be closely linked to the work we are doing on reflex integration as I usually devote devote less than 10 minutes of my OT sessions to writing. I will share my techniques to help kids with writing in another blog.
Important considerations before participating in reflex-inspired activities:
– Be mindful of the specific needs of each individual child and get a professional evaluation for an individualized treatment plan.
– Some children are unable to participate in ATNR integration when they have other reflexes that are unintegrated such as the TLR and Spinal Galant.
ATNR-Inspired Activities:
Wall lean:
Inspired by teachings of Julia Harper, OT
- Assume position in picture.
- Stretch and hold for 3 sets of 7 seconds on each side (hold for longer such as 21 seconds if a child has poor attention span to be able to switch sides)
- Use a stool, chair or therapy ball, as needed, for balancing the leg opposite to the wall.
- To go into the reflex pattern look to the wall; to go out of the reflex look to the hand.
- This posture can also be assumed with a child lying on their back or stomach.
- You can use yourself with speech or song to draw attention to the side the head is rotated .
One arm catch
- Hold a folder or toy between arm and body
- Catch ball with the other hand
- Bounce the ball to them so it is easier to catch
Looking for toys while crawling
This is a great activity to help eyes cross midline. Crawling and turning the head left and right such as looking for toys is a wonderful way of separating the movements of the head from the arms.
- Hide toys in various areas within eyesight and have the child look for it.
- They can pretend to be a dog or puppy looking for treats.
Thread the needle:
Great activity for crossing midline with eyes and arms.
- Place toys on one side of the body and bowls/boxes to the other side.
- Demonstrate going under arm to get the objects.
Swing activities:
Sitting and pulling
I like having children pull on ropes when on the swing.
I might stand to one side and encourage them to look towards one side with a where they throw an object to a target.
Prone:
Another OT said that she has a child lie prone or belly down on a swing with hands on the ground making the swing move.
They collect puzzle pieces or beanbags scattered on the floor.
Cupid Hops:
Ninja bow and arrow:
- Some therapists have said that they put an actual target up and have children shoot arrows at the target with toy bows.
This is from a dice game that if you missed just let me know via email jasmine@thebigpicturetherapy.com and I will send you a copy.
References:
Jordan‐Black, Julie‐Anne. (2005). The effects of the Primary Movement programme on the academic performance of children attending ordinary primary school. Journal of Research in Special Educational Needs. 5. 101 – 111. 10.1111/j.1471-3802.2005.00049.x.
Masgutova S., Masgutov D. (2015) Parents’ Guide to MNRI Masgutova Neurosensorimotor Reflex Integration (second edition) Orlando, FL, USA: SMEI
Oliver, Janet L. Grand (2020) Canyon University, ProQuest Dissertations Publishing. 27833410.
Photo credits
By Samuel Finlayson – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=64033530
Brantigan, Otto C., Public domain, via Wikimedia Commons