Reflexes, Muscle Tone and Learning: Tonic Labyrinthine Reflex
Let me tell you the story of Billy. He was a sweet boy and was referred to therapy because he hid under the desk at school and struggled with academics, especially writing. He had a history of melting down, crying or refusing to write at school.
His body seemed soft. It’s not that he was over-weight. He had average proportions but his muscles had a limp-quality, especially in his arms and trunk.
In therapy-language this is called “low tone.” One OT instructor once taught me that to make a general assessment of muscle tone, you can squeeze a child’s arm and feel the quality of the muscle. High tone would feel firm and stiff. Low tone feels soft. The tissue then gives little resistance when squeezed.
Billy’s muscle tension was imbalanced. His arm muscles were soft and poorly supporting his joints. His calves had very high tone and his neck muscles were tight, indicating high tone as well.
There are in fact many Billys out there. I can recognize these kids even if I work with them only in the online environment. I see them slouch when sitting: they seem to melt at the table; they rest their head on the table after a few minutes of tabletop work; their arms do not provide a solid foundation for writing.
When muscles have low-tone, they require more energy to shorten. Maintaining an upright sitting posture takes a substantial amount of energy.
No wonder why school is so difficult for them!
The reflex that affects Billy and many other children is the Tonic Labyrinthine Reflex (TLR). This reflex will be the focus of this blog. But first, let’s have a little review of what reflexes are!
In child development, reflexes set up the foundation in the body for patterns of movement and other behaviors to be then used throughout their life.
But what happens if a reflex is never fully activated? What if the reflex does not move to the background at the right time? The result is an “unintegrated” reflex.
Causes of unintegrated reflexes include:
- Lack of exposure to age-typical activities (such as not getting enough tummy time or time to crawl)
- Physical or emotional trauma
- Neurological diseases
- Stress (even adults can develop unintegrated reflexes due constant exposure to stress)
Coming back to Billy and the other kids I have seen with abnormal muscle tone, the tell-tale signs of an unintegrated Tonic Labyrinthine Reflex (TLR) have been:
– Weak core muscles and slouched body posture
– Abnormal muscle tone, which can be both too high and too low in various areas
– Tiring easily when sitting at the table
– Vestibular system (sense of balance) not functioning well, indicated by poor balance
The TLR is responsible for changes in muscle tone depending on the position of the head. This reflex is informed by the inner ear receptors that sense movement (vestibular system) and it plays a role in the development of body stability.
There are two components to this reflex: flexion and extension.
Flexion can be observed when a child is lying with stomach to the floor. Head moving down causes the body to assume a flexion pattern: spine rounding and limbs bent.
Extension can be observed when a child is lying with its back on the floor. Head tilted back causes the body to react in an extension pattern: causing spine arching and leg extension. (Masgutova S., Masgutov D., 2015). The arms may assume a “surrender” position, meaning hands raised up to the side of the head (Besekar, 2013). This helps a baby straighten out after birth.
These responses are seen up to four months of age.
When the TLR is not integrated or functioning appropriately, a child may be constantly working against patterns of flexion and extension when moving their head up and down.
The good news is that it is possible to influence the functioning of reflexes. Billy is now more comfortable with writing. He is no longer running away or hiding from schoolwork. Although he still has some difficulties with doing longer assignments, he has indeed come a long way from hiding under tables. We have achieved this success by working on his TLR reflex as an integral part of our therapy plan.
I have a few kids on my caseload working on this reflex and I am finding that balance is rapidly improving for them. One girl went from an average one-leg standing balance of 3 seconds to 15 seconds within 2 months. Another little boy is now balancing much better on a moving swing without losing balance in just his fourth session. This makes sense, as the TLR is tied into the inner ears and connects with the flexion and extension patterns of the body.
Note to my colleague therapists: ensuring that the TLR is integrated first will help with integrating the other tonic neck reflexes, such as the more widely known Asymmetric Tonic neck Reflex ATNR and Symmetric Tonic Neck Reflex STNR.
Personally I am learning that reflex integration is an art that takes time. Be patient with yourselves and know that there is more information and support available for you.
(The co-founder of the MNRI reflex integration program will be giving a live free 2 hour lecture on reflexes via Zoom to our group in March . Learn more about the event Here)
TLR- Inspired Activities
Tips :
– make the activity fun and get dramatic, especially for younger kids
– sneak in small pieces of the activity throughout the week
– be mindful of the specific needs of your child and don’t hesitate to get a professional evaluation from someone near you
– consider starting with flexion. Infants arrive in a flexed state and start to open as time passes. Bringing children back to a state of flexion before demanding other movement patterns can help with filling in developmental gaps.
“Hide From The Giant” game with the “invisibility pose”
- Prone flexion: Have the child start in flexion with face to the floor. I tell the children that they have to get invisible by tucking into a ball. This is similar to the child’s pose in yoga except with arms bent. Then, make loud stomping sounds by slamming your feet or hands on the ground and pretend to be a giant that is sniffing for them. The kids in my practice love it when I pretend that I can’t see them! They also love when I elaborate on the story by having the giant’s family members stop by to also look for the child.
*Play Hide and Seek if the Giant idea is too terrifying!
*Each of these activities should be followed by a relaxation phase for extension. Make sure to take deep breaths here. See picture below.
- Supine flexion: If the child can perform prone flexion easily, then I have them do this activity on their back: supine flexion pose. I will often help them assume this position with my arms holding their head and legs while having someone else pretend to be the giant and stomp their feet. Just this week I had a kid complain how hard this was for his neck. Therefore, it’s best if you can support them and only start off with a few seconds of this activity when beginning.
Functional games for flexion:
– Rocking on back: hold arms and legs together and rock back and forth. Kids can roll and jump up after getting enough momentum.
– Flips on a bar: using a bar at the park to flip – be sure to spot them! In the picture I used a bolster swing.
– Tuck and roll/ summersaults: helping children tuck into roll while crashing into pillows and crashpads (put pillows on a bed or soft mats and make sure there are enough to support rough and tumble play)
Big Ball Bounce- One of the kids I saw this week made up a great game of holding an udder ball (ball with handles) and bouncing it on a trampoline. This is a great standing activity for extension. Before bouncing demonstrate the extension pose with your arms up and knees soft.
I hope you have fun with these activities!
There are more activities that I would love to share though if you are starting off with reflexes I highly recommend attending the event coming up:
The co-founder of the MNRI reflex integration program will be giving a live free 2 hour lecture on reflexes via Zoom to our group in March . Learn more about the event Here
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References:
Besekar, Apeksha, (2013) Primitive and Tonic Reflexes [Powerpoint presentation]
Masgutova S., Masgutov D. (2015) Parents’ Guide to MNRI Masgutova Neurosensorimotor Reflex Integration (second edition) Orlando, FL, USA: SMEI