Introduction The Moro Reflex and the Palmar Reflex

1. IntroductionThe Moro Reflex and the Palmar Reflex Part 1 Do not use or distribute without written permission.

2. Survival • Baby is born equipped with a set of reflexes designed to support the adaptive response to environmental / relational triggers • Automatic • Stereotypical • Brainstem – subconscious brain, not cortical, conscious brain • Provide crude training for voluntary motor skills that should still develop • Limited life span – needs to be integrated, though always be available in times of trauma – brain injury or emotional trauma • If reflexes remain active beyond initial time span – sign of CNS weakness Do not use or distribute without written permission.

3. Sally Goddard “Neural Development – not chronological age – determines at what time each reflex emerges and at what time it becomes inhibited (integrated). Thus the presence or absence of reflexes at key stages in development may be used as diagnostic signposts of central nervous system (CNS) maturity” • “A reflex is a nervous system reaction caused by stimulation of receptors of skin, tendons, muscles, mucous membrane, and pupil receptors” (I.M. Setchenov, 1947,1980,1995) Do not use or distribute without written permission.

4. Rhythmic Movement Training (RMT) • Originated in Stockholm in the 1970’s with Kerstin Linde • Mid 1980’s, Dr. Harold Blomberg used with great success with clients in psychiatry • Moira Dempsey first studied with Svetlana Masgututova and met Dr. Blomberg in Poland • Rhythmic Movements are done on the floor and mimic in many ways the developmental movements that babies and infants naturally make as they grow. Do not use or distribute without written permission.

5. Vygotsky (MNRI) • Stressed the understanding of nervous system development • Transfer first unconscious infant responses into inner control • Allow for development in controlled and selected perception, focusing, memorizing, and thinking • Identified 3 phases of infant brain and motor development (1984): • Cerebral cortex immaturity and superiority of pallidar system (hippocampus-basal ganglia-thalamus) – non-myelinated • The Striopallidar period: growth of the striatum (dopamine center) – primary mechanisms of orientation and synergies for sitting, standing, and grasping • Third phase dependent upon maturation of cerebral cortex – higher nervous system, complex conditioned reflexes, transition to intentional movement patterns to enable conscious control of motor activity Do not use or distribute without written permission.

6. Exact Movements • Rhythmical • Smooth • Effortless • Easy • Coordinated • Symmetrical • Jerky and uncoordinated movements can indicate dysfunction in the cerebellum and the presence of active primitive reflexes Do not use or distribute without written permission.

7. Anatomical Position • Interaction of 3 systems • The bones • Linking together at the joints • Moved by the actions of muscles • Follow these conventions: • Consider each joint in isolation • Three perpendicular planes • “Anatomical position” – body standing upright, feet parallel, arms hanging by the sides, palms and face directed forward Do not use or distribute without written permission.

8. Median (Midsagittal) Plane • Divides the body into symmetrical right and left halves • Any plane parallel to the median plane is called a sagittal plane • Movement in this plane which takes the body forward = Flexion • Examples: hip flexion, should flexion, knee flexion, dorsiflexion of ankle • Movement in this plane taking a part of the body backward = Extension • Examples: arms extended backward, neck arched back, extension (plantar flexion) of the ankle Do not use or distribute without written permission.

9. Frontal (Coronal) Plane • Any vertical plane perpendicular to the median plane • Divides the body into anterior and posterior parts • When body part is moving towards the median plane = adduction • Movement away from the median plane – abduction • Trunk or neck movement away from median = lateral flexion or side bending • For fingers or toes – reference is the axis of the hand = middle finger or second toe Do not use or distribute without written permission.

10. Transverse (Horizontal) Plane • Divides body into superior and inferior (upper and lower) parts • Movement which takes body outward = lateral rotation • Example: external (lateral) rotation of hip (ballerina stance) • Movement which takes the body inward = medial (internal)rotation • Example: medial rotation of the shoulder • Pronation of forearm, palm of hands faces backward • Supination of forearm, palm faces forward • For trunk or neck = right or left rotation Do not use or distribute without written permission.

11. Other Anatomical Terms • Medial = closer to the median plane • Lateral = further from the median plane • Anterior = facing forward or located at the front • Posterior = facing toward or located at the back • Superior = facing toward or located at the top (closer to head) • Inferior = facing toward or located at the bottom (further from the head) • Superficial = on or near external surface of the body • Deep = internal, deeper within • Proximal = closer to the trunk or major joint • Distal = further from the trunk, or major point • Supine = on the back • Prone = on the stomach Do not use or distribute without written permission.

12. The Triune Brain • First layer: Basal Ganglia – Controlling postural reflexes, inhibiting primitive reflexes, regulates level of activity • Second layer: Limbic System – Emotions, memory, learning and the ability to play • Third layer: Neo-cortex – Processing of the senses, pre-frontal cortex – essential for our judgment, attention, and power of initiative and control of impulses Do not use or distribute without written permission.

13. Effects of Rhythmic Movement on the Brain • Develop nerve nets of the brainstem, cerebellum, basal ganglia and neo-cortex • Improve attention and concentration • Decrease hyperactivity and impulsivity • Improve body posture, breathing and endurance • Improve attention and concentration • Regulate activity Do not use or distribute without written permission.

14. The Neural Chassis • The Brainstem (medulla oblongata, pons) – fully developed at birth for survival • The midbrain (mesencephalon) • Cerebellum • Spinal Cord • Rhythmic baby movements help to program the proprioceptive and kinesthetic senses in order to be able to direct the motor abilities Do not use or distribute without written permission.

15. Brainstem • Central part is Reticular Activating System (RAS) • Receives signals from visual, auditory, vestibular, proprioceptive, and tactile • Information is transmitted to the cortex • Action is to arouse the cortex, which is necessary for maintaining attention and alertness Do not use or distribute without written permission.

16. Movements of the Neural Chassis • Passive stimulation from the feet • Passive stimulation from the knees • Passive stimulation from the hip – fetal rocking • Passive stimulation from the chest – ribcage rock • Passive rolling from the bottom • Rotation of the head from side to side Do not use or distribute without written permission.

17. Video 1

18. Reflex Testing – Sally Goddard • 0 = No abnormality detected, no evidence of a primitive reflex or postural reflex fully developed • 1 = evidence of primitive reflex to 25%; partial absence of a postural reflex to 25% • 2 = residual presence of a primitive reflex to 50%; Underdeveloped postural reflex to 50% • 3 = Virtually retained primitive reflex to 75%; virtual absence of postural reflex to 75% • 4 = retained primitive reflex, 100% present, complete absence of postural reflexes Do not use or distribute without written permission.

19. The Fear Paralysis Reflex (FPR) • Low tolerance to stress • Oversensitivity to sensory stimulation • Strong vestibular sensitivity – tendency for motion sickness • May feel dizzy and sick when doing rhythmic movements involving the head • Linked to gut issues, environmental toxicity • Adults: • Panic syndromes, social phobias • Blood pressure problems • Muscle tension in neck and shoulder area Do not use or distribute without written permission.

20. Walking Test – Moira Dempsey (RMT) • Stand on opposite side of room from the client • Tell him you are going to walk towards him and he has to tell you when he is ready. He can tell you to stop when he wants to. • Look him in the eye as you walk towards him Do not use or distribute without written permission.

21. Video 2

22. Some Responses You May See • Inability to make or maintain eye contact • Stares without blinking • Holding breath • Tension up the whole body • Clenching fists • Swaying • Toes curling • Note how long it takes for him to give permission to start walking • How close you can walk to the client before he tells you to stop • Reverse the walk and have client walk towards you Do not use or distribute without written permission.

23. Children May Show: • Withdrawal • Elective mutism or excessive shyness • Others may act out • Autistic like symptoms • Poor adaptability and inflexibility • Obsessive compulsive symptoms • Decreased eye contact • May stare intensely without blinking Do not use or distribute without written permission.

24. Intervention Ideas • Pre-Birth movements by Clare Hocking – all in supine position • Swinging legs with knees bent • Crawling up the side one leg against the other hip abducted • Frog legs – straight legs, then abduct hips and bring knees out together while abducting hips and back (think breast stroke in swimming) • Up down legs – legs straight, curl up to chest and back • Cross over legs one side to the other • Standing Position • Over head arm stretch • Chest to ears • Forearm lift • Up and down arms • In and out arms • Cross over arms • Head bob • Head Side to side Do not use or distribute without written permission.

25. Moro Reflex • Emerges: 8th week in utero, appears as extension of the fingers • Fully available by 30th week in utero • 32nd week – extending and abducting the upper limbs along with fingers opening • Birth: fully present • Integrated: 3 to 4 months of life and replaced by an adult startle reflex or Strauss reflex. Do not use or distribute without written permission.

26. 9 Reflexes of the Baby https://www.youtube.com/watch?v=1EGyR-NqXco Do not use or distribute without written permission.

27. Triggers • Sudden, unexpected occurrence of any kind • Change in head position (vestibular) • Noise (auditory) • Sudden movement or change of light in the visual field (visual) • Pain, temperature change, or being handled too roughly (tactile) • Earliest form of fight and flight Do not use or distribute without written permission.

28. Emotional Challenges • Withdraw and shut off external sensory impressions that they cannot handle • Lacking confident contact with children their own age • Lack inner security to be flexible • May need to be bossy and dominate play mates • Oversensitivity patterns • Early fatigue, sensitive to feeling overwhelmed • Usually activated in cases of burnout and chronic fatigue syndrome in adults Do not use or distribute without written permission.

29. Video 3

30. Test Position • Supine, arms flexed and hands resting on the floor • Shoulders raised with small cushion • Child’s head supported in tester’s hands • Head elevated approx. 2 inches above the spine • Let client know you are going to drop the head • Ask client to clasp hands together across chest once they feel the drop Do not use or distribute without written permission.

31. Scoring • 0 = immediate hand clasp, no adverse reaction • 1 = slight delay in reaction • 2 = delayed reaction, incomplete hand / arm movement or breath holding • 3 = no arm movement, alteration in breathing, visible dislike of procedure • 4 = movement of the arms outward away from the body, leg extension or distress • Can also note any reddening of the skin or pallor immediately after testing Do not use or distribute without written permission.

32. Erect Test • Stands with feet together • Arms bent , held 45 degrees from body • Hands flexed at the wrists • Tester stands behind client • Ask client to put head back, look at ceiling and close eyes • Once stabilized, give instruction to remain still and fall backwards at a given sound • Tester be prepared to catch the full weight of the client Do not use or distribute without written permission.

33. Scoring • 0 = client falls back with no alteration of arm position • 1 = reddening of skin or slight but quickly controlled movement of arms and hands outwards • 2 = inability to drop back, movement of the arms and hands outwards, dislike of procedure • 3 = movement of the arms accompanied by “freezing” momentarily in this position, gasp of breath, reddening of the skin or pallor • 4 = complete abduction of the arms and hands outward accompanied by gasp, freeze and possible cry. Visible dislike or distress Do not use or distribute without written permission.

34. Physical Responses • Instant arousal (sympathetic) • Rapid inhalation, momentary “freeze” or “startle” – followed by expiration – often accompanied by a cry • Activation of fight/flight response resulting in: • Release of adrenalin and cortisol into the system (stress hormones) • Increase in breathing rate (especially upper lobes) - hyperventilation • Increase in heart rate • Rise in blood pressure • Reddening of the skin • Possible outburst, e.g. anger or tears Do not use or distribute without written permission.

35. RMT Test Suggestion • Client in supine – self initiate the pattern of open and close • In supine – tilt head 30 degrees backwards • Supine – pull legs out at feet in order to straighten the legs • Supine – make a sound by hitting the floor 10 to 15 cm from client’s ear • Have arms crossed over chest – tap suddenly on both upper arms • Wave hand or flashlight in front of eyes • For each suggestion, check muscle tension. Do not use or distribute without written permission.

36. Long Term Response – Poor CO2 reflexSally Goddard The CO2 reflex causes spontaneous inhalation of the upper and lower part of the lungs. When the CO2 levels become too high in the blood, chemical changes take place in the medulla, which will open the arteries to increase blood supply to the brain and at the same time stimulate deep breathing. Do not use or distribute without written permission.

37. What does it look like? First Dynamic Phase: • The person opens the core of the body, extend arms and fingers to the periphery, takes a deep breath and holds it. • Core is opened, limbs extended • Causes body disorientation, loses grounding and stability, adrenalin rush, fight or flight Second Dynamic Phase: • Movement goes from body periphery to the center • Limbs are flexed and the core is closed • Response for centering • Also core withdrawal similar to fetal position • Attempt escape stimulus, creates a loss of point of reference in space, protection • Also can be described: When triggered, causes a sudden symmetrical movement of the arms upward – away – from the body – with opening of the hands, momentary freeze and then gradual return of the arms across the body in a clasping posture • Abduction is accompanied by a sudden intake of breath • Adduction facilitates the release of that breath Do not use or distribute without written permission.

38. Influence on Development • Function is to assist in opening and closing of the body. • Assists infant in first breathing cycle and extending for birth process • Vestibular based reflex – affects semicircular canals with change in head position • Triggers Up Down Motor Coordination System (Superior-Inferior Body Planes) • Center to upper and lower body parts • Causes holding of the breath as a result of hyperactivity • Suppresses grounding, stability and gravity responses • Sympathetic Storm (hyper activation) • Can become automatic, uncontrolled reaction to external stimuli • Over-activate brainstem, frontal inhibited Do not use or distribute without written permission.

39. Hypersensitivity May be Outcome • In one or several sensory channels, causing over-reaction • Constant alert and heightened state of awareness • Vicious circle where reflex activity stimulates the production of adrenaline and cortisol – stress hormones • Personality affected: acutely sensitive, perceptive and imaginative, though immature and over-reactive as well • May cope by being the fearful child who withdraws from situations, difficulty socializing, not accepting or demonstrating affection easily • Or copy by being the over-active aggressive child, highly excitable, cannot read body language, needing to dominate situations • Both coping strategies will act manipulative in order to remain in control Do not use or distribute without written permission.

40. Immune System • Adrenaline and cortisol are instrumental as two of the body’s chief defenses • If continuously diverted from their important function, it may lead to not supporting against potential allergens • Picking up on colds easily and over-reacting to certain medication • Sensitive to foods or food additives, affecting behavior and concentration • Tend to burn up blood sugar quicker impacting on mood and behavior swings Do not use or distribute without written permission.

41. Long Term Effects • Vestibular related problems such as motion sickness, poor balance, coordination • Physical timidity • Oculo-motor and visual perceptual problems • Poor pupillary reaction to light, photosensitivity, difficulty with black print on white paper • Auditory confusion • Allergies and lowered immunity, adverse reaction to drugs • Poor stamina • Dislike of change – poor adaptability • Poor CO2 reflex • Reactive hypoglycemia Do not use or distribute without written permission.

42. Possible Psychological Symptoms • Free floating anxiety • Excessive reaction to simuli • Mood swings • Tense muscle tone • Difficult to accept criticism • Cycle of hyperactivity followed by excessive fatigue • Difficulty making decisions • Weak ego, low self-esteem • Insecurity, dependency • Need for control, may manipulate Do not use or distribute without written permission.

43. Clinical Observations • High guard posture during walking / moving • Holding breath during physical activity • Hand flapping • Jumping up and down • Can become “hooked on” sympathetic over arousal Do not use or distribute without written permission.

44. Moro Exercise: The Starfish https://www.youtube.com/watch?v=K6k0FKrbRhg Do not use or distribute without written permission.

45. Intervention Ideas • Vestibular training • Tactile stimulation / massage • Sound therapy • Nutrition / Drinking water / sleep patterns • Slowly repeating the reflex pattern 5 to 6 times per day (Peter Blythe), include breathing in and out • Therapist can provide resistance against the pattern • Breathing exercises • You want to teach children the exhale first: • Working towards breathing in and out of the nose unless otherwise specified Do not use or distribute without written permission.

46. Maude Le Roux, OTR/L, SIPT, IMC Websites https://maudeleroux.com/ Facebook https://www.facebook.com/ATAMaudeLerouxOT/ LinkedIn https://www.linkedin.com/company/a-total-approach Blog http://www.maude-leroux.com/ Do not use or distribute without written permission.