Why should Physiotherapists be interested in Primitive Reflexes and the neurodevelopmental process?

Pain is complex. Motor control is complex. It is quite helpful to understand the basics of primitive reflexes.

"It's so logical, it is ridiculous - if someone isn't moving well, 

go back to when they learned how to move in the first place and rehab that"!

Primitive reflexes are the reflexes we develop in utero. They do not automatically disappear as many of us were seemingly taught. They are inhibited by the higher centers of our frontal lobe as we develop. Therefore, things that interfere with the efficiency of the frontal lobe allow the reappearance of the primitive reflexes. Some examples include: psychiatric conditions, neurodevelopmental disorders (many of these may never have had their reflexes properly inhibited), coronary artery bypass surgery, concussion, and pain (with resultant changes in motor control).

When present in abundance it is well recognized that they influence motor control and neurocognitive function. Primitive reflex inhibition is easy to use. They are gentle and patient's find it easy to do them.

Movement Patterns and Motor Control
High amounts of primitive reflexes present in those who are clumsy and have poor motor skill learning. Primitive reflex inhibition provides a good rehabilitation option for this subgroup of people. It can also be used in good learners to speed up the normal rehabilitation process.
We have researched numerous aspects of motor control that have been helped by primitive reflexes. These include: abdominal hollowing, trunk flexion, trunk extension, deep neck flexors, cervical rotation, glenohumeral medial rotation, dorsiflexion, functional hallux limitus and postural stability.

Psychosocial Factors (Behavioral Factors)
We have to ask ourselves why do some people have these negative thoughts and beliefs? Although ACE (adverse childhood experiences) and chronic low grade systemic inflammation are now understood to be involved, there is a lesser known potential functional cause. An atypical birth history and early life experiences(with or without the development of a neurodevelopmental disorder) is very relevant. The nervous system is very fragile at this point and atypical exposures can influence the developing nervous system. So one avenue of rehab is to rehab the neurodevlopmental process prior to or concurrently with standard care.

Pain Mechanisms

• Central sensitization
• We believe the most common functional cause of central sensitization is chronic low grade sensitization, however inefficient sensory gating of pain is also present is some people. Although more targeted sensory retraining is indicated, there is a role for primitive reflex inhibition.
• Musculoskeletal body image pain 
• This is a type of central pain that results from extremely poor body image and is not caused by central sensitization.  Once identified is is much easier to treat than central sensitization. The rehab focuses on the neurodevelopmental process and the area that was lacking. A focused assessment identifies this

Neurological Rehab

Stroke, head injuries and neurological diseases have many primitive reflexes. Various forms of normal movement and postural responses / reflexes are commonly used with variable time frames. Primitive reflex inhibition can be done first and then followed with the standard therapy for a better result.

Pediatric Rehab
Similar to the above comments, Primitive Reflex inhibition is a great way to rehabilitate many pediatric conditions. As well as helping motor control, it helps neurocognitive and sensory motor function.

Concussion Rehab
Mild Traumatic Brain Injury is a neurological injury which usually has an orthopedic aspect to it. Primitive reflex inhibition provides an additional rehabilitation option to help neurocognitive function, movement and sensory motor function.

Vestibular Rehab
The vestibular system is the first sensory organ to develop (although there are conflicting reports with tactility) . Many primitive reflexes are stimulated by the vestibular system. Early neurodevelopemntal movements such as rolling and crawling stimulate the vestibular system. Inhibition of primitive reflexes improves postural stability as well.

Pelvic Floor Rehab 
Movement and motor control of the trunk are critical for pelvic floor rehab and primitive reflex inhibition helps this, as noted above. However certain primitive reflexes can specifically influence tone of the pelvic floor.

"If you treat movement and motor control, you should know about primitive reflexes"

Want to learn?
Ottawa, Canada: March 6-8, 2020 (Primitive Reflexes)
Barcelona, Spain: March 20-22, 2020 (Primitive Reflexes)
Toronto, Canada: May 2-3, 2020 (Body Image)
Warsaw, Poland: May  8-10 & 11-13, 2020 (Primitive Reflexes)
Montreal, Canada: June 5-7, 2020 (Body Image)

For more information email: stabilityphysio@gmail.com

The picture shows the early stage of the home exercise for the Spinal Galant reflex