OTS 121: Choose Wisely: Linking Motor Reflex Integration to Occupation
- Jayson Davies
- Apr 2, 2023
- 38 min read
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Welcome to the show notes for Episode 121 of the OT Schoolhouse Podcast.
Do you ever wonder how much our early reflexes impact our physical, cognitive, and emotional development? What about the importance of reflex integration and rhythmic movements in shaping these abilities?
In this episode, Sonia Story sheds light on these intriguing connections and explains why reflex integration is critical for a child's growth and development.
Get ready to rethink the role of reflexes and discover the fascinating world of neurological soft signs and sensory integration.
Listen now to learn the following objectives:
Learners will identify neurological soft signs and what happens when they are inhibited
Learners will identify how sensory integration and retained reflexes are connected
Learners will identify why reflex integration is such a fundamental foundational system of movements
Guest(s) Bio
Sonia Story earned a Bachelor of Science degree with a combined major in biology and psychology. She studied two bodywork systems—Orthobionomy and Hanna Somatics—which influenced her later application of neurodevelopmental movement tools.
Sonia extensively studied innate neurodevelopmental movements with Harald Blomberg, MD; Moira Dempsey; Svetlana Masgutova; Mary Kawar, OT; and other instructors.
While earning certifications to teach Rhythmic Movement Training (RMTi) and other movement courses, Sonia maintained a private practice effectively using these tools—first to overcome her own challenges with sensory issues and anxiety—then for helping individuals of all ages.
The majority of Sonia’s clients are school-age children. Sonia Story taught the RMTi curriculum for 10 years and has been teaching the Brain and Sensory Foundations curriculum since 2008.
Quotes
“The more you know about the stimulus and the motor response, the more you can see that reflexes could be hindering functional skills” -Sonia Story
“Reflex integration as a modality is basically trying to boost, innate development through, using the patterns and the ways that nature itself has designed human beings to develop” - Sonia Story
“There are very compelling studies showing that, when we give the tools for reflex integration, we boost function and occupational functions” Sonia Story
“It's also about going through the scientific steps to see if what we are doing is working with our clients. And… at the end of the plan, we are able to say, this created occupational outcomes, then we have created data for our program” Jayson Davies, M.A., OTR/L
“There is a sensory component that is stimulating the reflex” Jayson Davies, M.A., OTR/L
Resources (Affiliate links)
Brain & Sensory Foundation Course - Use discount code: OTSH30OFF by April 30, 2023
Episode Transcript
Expand to view the full episode transcript.
Jayson Davies
Hey there, and welcome to a very special episode and a unique episode of the OT Schoolhouse podcast, special because of the topic and unique because of how it was recorded. More on that in just a second. Today, I am sharing with you a conversation I had with Sonia Story from move playthrive.com Sonia is the creator and instructor of the brain and sensory foundations course, where she supports individuals and better understanding innate rhythmic movement and targeted reflex integration. Full disclosure, I am an affiliate for Sonia's course, meaning that I may earn a commission if you decide to take her course. But I want to let you know that that's not the reason I'm here today. I'm not here to convince you to take her course instead. Sonia and I are here today to address a very hot topic in the world of occupational therapy and reflex integration. We're here to talk about how to link reflex integration to occupational outcomes. If this sounds familiar to you, it's probably because AOTA has addressed this in a choosing wisely campaign where they stated, don't use reflex integration programs for individuals with delayed primary motor reflexes without clear length to occupational outcomes. Now unfortunately, this statement has led to some confusion and misunderstanding. Many therapists have read it and believed or thought to themselves, don't use reflex integration, but that's not what it says. There are two parts to this statement, so let's dive more into the statement and reflex integration as a whole with Sonia story. But before that, I almost forgot to tell you why this conversation is unique. Sonia and I actually recorded this interview live on YouTube, so you can actually listen to the edited version here, or you can use the links in the show notes to catch the full chat on YouTube. Either way, it's worth the listen, and there are several resources in the show notes for this episode. Sonia provided us with several links to give you several handouts that are very helpful, so be sure to check those out in the show notes at otschoolhouse com, slash episode 121, so let's go ahead Cue the intro, and when we come back, I will let Sonia actually introduce a little bit more about herself. We'll be right back.
Amazing Narrator
Hello and welcome to the otschoolhouse podcast, your source for school based occupational therapy, tips, interviews and professional development. Now, to get the conversation started, here is your host, Jayson Davies class is officially in session.
Jayson Davies
Welcome Sonya. How are you doing this evening?
Sonia Story
I'm very well. Thank you so much. It's super cold here too, but super delighted to be here with our virtual fires, sitting by our virtual fires. But I'm so thankful that ones are interested and looking forward to talking
Jayson Davies
absolutely and I, as you're talking, I can hear the rain starting to come down again. Here it comes. And you know what? Today we are here. Well, because you and I, we've we've had conversations together. You've been on the podcast before, but since you were on the podcast, actually something new came out back in 2021 and that was AOTAs collaboration with choosing wisely.org their campaign and within this campaign, aota asserted, don't use reflex integration programs for individuals with delayed primary motor reflexes without clear length to occupational outcomes. So that's what we're here to talk about today, and I'm excited to have you as we get started before we dive into that statement, why don't you just give us a quick background of your history within reflex integration and move playthrive.com.
Sonia Story
Sure. Well, I was somebody who got introduced to reflex integration, went to a reflex Integration Course. As a result of having done many courses within the brain gym curriculum, I took all the courses to become an instructor, and that's what I thought I was going to be doing. And I took those courses because I felt like I needed something for my own functioning I was a mother of two young children who both had challenges, not super severe challenges, but one was tended to be hypersensitive. One was hyperactive, and together, the two of them were it was like putting gasoline on a fire, because they kept triggering each other, but I felt like I wasn't the most steady, and I was really kind of scattered as a mom. So I when I had the chance, I took courses in brain gym, and I thought it was the most fun and engaging and remarkable set of tools, because you could make changes in things that were. Were very deep and profound, like things I'd been working on a long time, and I could make changes very quickly with movement, and so that was exciting to me, but then I learned about reflexes, and I couldn't believe it, because I have a background in biology, and that's what I took in undergrad. I had a combined major of biology and psychology. But I was so stunned to find out about these reflexes, because they have so much to do. I learned with how we function, and I also could tell, just by being in that one class that I had reflexes that weren't fully developed and integrated. And I thought, Oh my goodness. So then I did many, many courses. After that, I took over 50 courses from various mentors, and I realized about halfway through it, I was being taught by some of the best people in the world in this field. And it was such a joy. And I just, I kept using it for myself, my children. I started seeing private clients, and I am still, 17 years later, in awe of what these movements can do. And so here we are. That's how that's how I got started.
Jayson Davies
Awesome. And you know, we're going to be talking a lot about reflex integration. So before we get too far into the weeds. For anyone who's unfamiliar with Reflex integration as a modality to support individuals, can you share just a little bit about the premise behind it and what it looks like?
Sonia Story
Sure, well, it's a modality because it's needed part of development, but I want to, and there are various ways of approaching it. And they've been in use for a very long time, several decades. And they were first used for individuals with cerebral palsy, at least that I know of, at least going back in the literature. But then within the educational field or psychological field, they started to notice that children with learning challenges had remnants of these reflexes that were unintegrated. But basically, this is really, really what we're doing in a simple form. Is not any one modality, but it's an attempt to recreate development that was either missed or hindered, or somehow development that went awry later on due to trauma or something like that. So I guess reflex integration as a modality is basically trying to boost innate development through using the patterns and the ways that nature itself has designed human beings to develop.
Jayson Davies
Great thank you for sharing that. And as we go down that route, you were talking, you know, understanding the signs a little bit. You talked a little bit about how trauma could potentially be a reason for maybe something doesn't become integrated completely. There's a common term that is used alongside reflex integration, and that is neurological soft signs. That's something I hear a lot in relationship to maybe seeing a soft sign of a delayed, integrated, primitive reflex. So could you share what that means? Neurological soft sign.
Sonia Story
Sure. Well, yeah, and this is something that's well known by pediatricians, and they when they're giving infants exams, they look at these primitive reflexes to make sure that they're there and present, because they should be there as part of our proper development. But if they stay past the age of certain there's certain time frames when they should do their jobs, which means repeating over and over. So basically you have a certain stimulus, you have a motor response. So basically input a motor response, and that constitute, constitutes a primitive reflex. And there's all there's many different ones, all different kinds. They help us, in many, many ways, to develop the brain, the body and the sensory system. But they're supposed to do their jobs, and then, by virtue of that, the brain gets mature. And actually, it's not just reflexes. There are innate rhythmic movements that are working hand in hand with reflexes and development. So anyway, the whole if the whole thing is working together in healthy development the way it should, then there's a synergistic maturing that happens. And then the body, with its innate intelligence, and the brain knows to let go of that primitive reflex so that we can move on to more intentional, voluntary movement that's more refined. But if that does not happen, and the reflexes are retained, or they're still active, they haven't become dormant, and. Another word is that they're uninhibited. So if they're still in that stage where they're active, even though this individual is no longer an infant, then it causes problems. And the problems are neurological in nature, and that's why they're called neurological soft signs. So it means like, it's not actually like hard damage to the neurology, but there's definitely a soft meaning, a partial neurological abnormality going on. Yeah, and I put that in the slides also, if we want to look at some slides.
Jayson Davies
All right, yeah. And I think we'll get into those slides in just a bit as you, as you were speaking, there one thing that as OTs, we're very familiar with the term reflex integration, primitive reflexes, but you're also using the word innate rhythmic movements. I know this wasn't a question I had actually planned to ask you, but what is that word, innate rhythmic movement? What does that mean in comparison to the reflex integration?
Sonia Story
Yeah. So the way that I understand development is that there are groups or categories of innate movements. These are movements that all healthy babies do, as long as they're not stressed, as long as they have room to move, they will go through these very stereotypical movements, some of which are rhythmic in nature, some of which are reflexive in nature, and we're sucking is one that everyone's familiar With. Sucking is a rhythmic movement, and it obviously has purposes, because it calms ensues, and it's also necessary for survival and feeding. And another thing about the rhythmic movements is that they precede huge bursts and development. They precede bursts in speech, and they literally grow the brain, and they make connections within the brain, and they're very supportive and work hand in hand with primitive reflexes. So they're a whole category unto themselves, and they were studied in depth by Esther Thelen, who some of some people might recognize because she she wrote a lot about dynamical systems theory and movement. So she was a PT who did phenomenal work on what she called spontaneous rhythmic movements. And she her papers amazing, and she I really would love to get her original footage, because she studied healthy babies, and she documented what they were doing, and she described all these various rhythmic movements that they did. One that I'm sure everyone's familiar with is when a baby's on all fours and rocking on hands and knees. But these so other researchers have gone on, and they found out that when these rhythmic movements are hindered, just like reflexes, that it becomes problematic, like, Oh, we didn't get a big piece of development that we should have gotten, or something went awry, and the system didn't really get fully used the way it should have been. And that can result in brain immaturity, where the brain stem and the cerebellum are not as mature as would be optimal, and it can also result in the primitive reflexes not also being able to mature. So the two go hand in hand. And then the other category that everyone's familiar with would be developmental movements. So those are things like rolling writing and that the baby the whole trajectory from the baby being pretty helpless to being up and walking by the end of the.
Jayson Davies
gotcha. Yeah, and I don't know if this is one of them, but I as you're talking about rhythmic movements, I'm just thinking of my 11 month old shaking his hips every time we put music on. He says all the time he's shaking his hips.
Sonia Story
Isn't that fun. So and we are designed to function with rhythm, so we're, you know, that's how our bodies work the best. That's why we that sort of the end of the road in infant development is being up and walking, and ideally, the child is up and walking in a way that's aligned, free attention, without compensations, without, you know, imbalances in the muscle tone and things like that. So, yeah, we're meant to be rhythmic, and that's why we come with innate rhythmic movements. They're super important.
Jayson Davies
Awesome. Thanks for, thanks for adding on to that. Every time I go out there, man, he's he's always shaking his hips, so it's always fun to see. Now, yeah, now I know you're an aota approved provider, and when I'm an aota approved provider as well. And one thing that I know that that means is that you have to have research that supports everything that you're saying. And so I want to ask you just a little bit about what research is out there that showing retained primitive reflexes interfere with functions and occupation?
Sonia Story
Yeah, there's actually a lot, and I am right now in a master's program in Movement Science. And one of the wonderful things about it is I get to study what I'm really interested in. So I had to do a literature review last semester, and it was perfect timing, because I needed to address the choosing wisely initiative in my annual renewal to be an AOT provider aota. And so I got to do this literature review and really delve into what's out there. And I should say that there are a lot of recent studies, but there are studies going back decades and decades showing that retained, rhythmic, retained, primitive reflexes are connected with all kinds of dysfunction and in children, they're connected with, well, we already mentioned cerebral palsy, but learning challenges, things like dyspraxia, postural disorders, handwriting, that's more one of the more recent ones. ADHD is a big one. There's quite a bit of research connecting retained or unintegrated primitive reflexes with ADHD symptoms and sensory disorders, and even some researchers looked at how they were correlated with changes in gait. So there were anomalies in the PEL the way the pelvis is situated, which affects the gait. And then there were also recent research that was really well done, and it came out in 2020 where they connected retained primitive reflexes with emotional and behavioral challenges, which I thought was fascinating, because when you really got into the study, they were the authors of the study took into account things like past trauma that the child had and family upset, and things like the ACES score. And they took into account ADHD type symptoms and socio and economic factors, and still, even factoring in all those different things, they still found a predictive relationship between primitive reflexes and emotional behavioral disorders, and that kind of goes right along with what We see when we give children these any movements, we can actually pull them out of a more vulnerable state where they're they've got, like, a lot of sensory issues going on, a lot of emotional behavior challenges. And I think those stem a lot or are related with fighting, flight states, because, for example, that's what it's the same physiological response as what would be in a moral reflex. So once we can mature that and calm those fight and flight states, there isn't a need for the child to be disruptive and to have behavior challenges. And there's a lot more to it than just emotions and behavior, because we're actually really making the body much more comfortable and functional and so, so that's the idea behind that. But there, there's a lot of research connecting the retained primitive reflexes with dysfunction, and they've actually done research, not only in children, but in adults. And in adults, it's connected with things like schizophrenia, unfortunately, Parkinson's disease dementia, and even when they checked like some of the Oral Facial reflexes, they found that adults in nursing homes, when they have those retained, they weren't chewing well, and they were way more likely to suffer from malnutrition. So there's a lot.
Jayson Davies
Interesting that's, it's, it's amazing when you're able to just link a few things like that across the lifespan. And you talked about so many different populations, that was actually going to be my next question is to talk about some of about some of the different populations, but you already dove into that, so I'm going to skip that question. As we continue on, I will just say that in the chat I have just dropped a link a little while ago. Sonia all this information that she's sharing about evidence she has put so much of this into an E. Book, and you can grab that ebook. It's a free download that you can grab it talking about or showing how the primitive reflexes can link to occupation. So you can grab that. And as she mentioned, she had to really study this and document this for her aota approved provider application. And that's where this came from. She didn't just put this together for no reason. This is something that she put together, and it has gone to aota. And kind of, I don't want to say it's been approved by aota, because I know that's not the way that they use things, but it went through and it was approved by their approved Provider Program. So absolutely, check it out.
Sonia Story
Yeah, honestly, I don't know if they like officially approved this document, but the courses that I teach are aota approved, at least at this point, you know. And they have been since 2015 every year we get approved, and every year we show the evidence basis. So it wasn't, it was pretty much the same this year, except that I just did a whole lot more because of the choosing wisely initiative.
Jayson Davies
Yeah. And you know what I want to ask you one more question before we dive into that initiative, and that is the link between reflex integration and sensory integration that often, that often comes up. And so I just want to ask, from your standpoint, do these two frameworks and treatment models have similarities? Do they overlap? What do you think?
Sonia Story
All right, so Well, I want to just first tell a story. You know, when I was first starting out learning about reflexes, I was so fascinated and just dumbstruck, because I really couldn't remember talking about them much in college, I remember I had one physiology professor saying, well, the baby's born, and the baby knows how to suck, and the baby has a rooting reflex to find nourishment. And that's all I could remember. And I don't think it was much more than that, but then when I find out much later in life how impactful these were with our functioning, for our functioning, I was so hooked on that. And I just thought that, you know, we've got to get the word out about this, because I can clearly see them inhibiting the function. And I can clearly see them needing to be addressed, and I can clearly see when we address them, we see huge gains in functioning. So it was really OTs, who came back and said to me and parents, they said, This is the best thing we found for sensory processing issues. And they were specifically talking about the rhythmic movements in combination with the reflex integration. But I can tell you that I've had so many students who are OTS who have taken the brain and sensory foundations training, and that's why sensory is in the title, but they've taken it and said, You know, I'm trained in sips and, you know, high level sensory integration, and this is definitely a missing piece of it. And so if you think about it, our primitive reflexes are all stimulated by sensory input. They're all they've all got sensory, some kind of sensory stimulus that triggers the motor response. And so you can't really separate sensory from reflex integration, and that's what I came to learn. And then now that there's, there's research showing that when children have reflexes that are retained. They have sensory disorders, all kinds of different ones. Sometimes it's dyspraxia, sometimes it's postural disorders, sometimes it's ocular motor disorders, many different things. So you can't really separate the two, and I think it's a missing piece in terms of how to get the sensory system to be mature and calm and organized. So hopefully that's helpful.
Jayson Davies
Yeah, yeah, absolutely. I, I like Especially that last part that you mentioned, right, that there is a sensory component that is stimulating the reflex. And so I think when you think of it that way, they're very closely linked. So yeah, absolutely.
Sonia Story
Can I say just a couple other things about this? First of all, one of the things that Dr Blomberg, he's a psychiatrist, he was one of my mentors, and he used these movements quite a lot with children, and helped them overcome ADHD symptoms and learning challenges all kinds of things. And he said that what you're really doing with rhythmic movements and reflexes is you're maturing the brainstem and cerebellum. We. What is normal and natural in our development. But when you start maturing the brainstem, especially, it has one of its the functions of the brainstem is to filter sensory input. That's one of its jobs. It can't do its job unless it's mature. So you've got to have these movements to mature the brainstem so that your sensory functioning can be calm, mature and organized and integrated. So hopefully, that's another piece that makes sense to everybody. And then yet another piece, which is also something I learned from Dr Blomberg, is that you cannot fully help somebody get to an optimal sensory integration place until you deal with the moral reflex, which is the startle. So the startle, we know, if that is retained, it really should be inhibited or dormant, unless there's some kind of emergency, it should be dormant at the age of about two months, four months, probably at the most. And if that continues on, then sensory input, like a vestibular input or a sudden tactile input, a sudden movement, a sudden visual stimulus that can trigger a sudden loud noise, something like that can trigger this startle response. And instead of it just being a normal startle, which wouldn't trigger the fight or flight, it triggers the Moro startle, which is adrenaline, cortisol, the whole fight in flight, you know you have. The breathing rate goes up, the heart rate goes up, the blood goes to the limbs, just it's the exact same physiological response. And when that happens over time, because the adrenaline and cortisol are there, that makes us more sensitive, which would be good in an emergency, because you want to be hyper vigilant. You want to know where's the threat coming. Do I need to fight or flee? What do I need to do? But in a normal, everyday circumstance, when you have that much adrenaline, you're making yourself more sensitive over time, because that's the nature of the way our bodies are wired and so calming that fight or flight through maturing of the reflexes is is super important. So hopefully that's another piece for sensory specifically.
Jayson Davies
Yeah, I mean, you talk about the the old brain, as they often call it, that brain stem, and how that's where you know everything originally originated from, and everything beyond that, you have to kind of things have to mature in that old, old brain before you can start to use the rest of the brain. And so yeah, all right. Now, I know we titled this right Choose wisely, talking about the linking of reflex integration to occupation, and that's we're going to dive into for the rest of the evening, and I just want to read that verbatim. Aota, choose wisely. Campaign really quickly. And then as I do that, I'm going to ask Sonia what her first thoughts were, but I also want to ask everyone listening what your first thoughts were. And go ahead, either, just think about it in your head, type it in the chat, do whatever, but this is what they said, don't use reflex integration programs for individuals with delayed primary motor reflexes without clear links to occupational outcomes. So I would love to hear Sonia, what your first thoughts were when this came through your email or you read this online, what were some of your first thoughts?
Sonia Story
Oh gosh. All right, so if I'm going to be really honest, I was very upset. I'm continue to be upset, but I'm I'm really upset by it. I think it is misleading. I do understand that as an occupational therapist, there needs to be a connection to occupations. But the way, you know, reflux integration is, is development. It's a part of development. And so I was shocked when I read it. I was really upset. I was sad. I was, gosh, frustrated, I think anger got in there. I was just like, Wow, are you kidding me? I couldn't believe it, and I I didn't, I still don't understand what the motivation is behind it. But you know, when I really dug deep into, like I have the whole aota Choosing Wisely thing here in front of me, and it lists the sources for that initiative. They list only two sources, and the one I read thoroughly, many, many times, and it's, it's they're citing. Research erroneously. I actually put it toward my one of my research professors going to school right now, and I said, Am I interpreting this correctly? And he writes back and says, As far as I can see, yes, you're interpreting it correctly. I said, because they're not saying the same thing in this article. And so I felt like, Okay, I'm just gonna stick with what I know and what the research actually says, and I'm gonna continue forward, and I'm gonna, you know, I've read over 1500 case studies. I'm pretty sure it's closer to 1600 or more, and they're so these are case studies that are written by students of the brain and sensory foundations. Course, they're remarkably consistent, remarkably positive and remarkably showing transformation and showing that they're making an impact that's really hugely positive. And so at some point. You know, we know that case studies are anecdotal, but when you've read 1500 of them, I mean, they become data. And actually, I would like to analyze the data. It's just a lot of work, and I'm not sure exactly how to do it yet, but I'd like to figure out how to do that and put it together into like a qualitative study. But, but the thing is, is that if the thing that upset me about it is that if you are a new OT, then you could read that initiative, and you could think, Oh, well, reflex integration, I don't have to worry about that, but you wouldn't know how important it is for sensory processing. You wouldn't know how important it is to help a child out of flight, fight or flight. You wouldn't know how important it is to help a child with handwriting or with reading or with walking even, or with sleeping or with all these occupations that are so important, with playing, socializing, it's really such a fundamental, foundational system of movements, because it comes from development, that it it should not be cast there should be no casting of doubt on it, and there should be more exploration, In my opinion, there should be more funding for research. In my opinion, it's a tough thing to research, absolutely, because there are so many factors, and it's really hard and standard research to to, you know, take, what's the word I'm looking at when you have all these different Yeah, like, it's hard to control for the variables. So research is not easy, but if we're well funded, we could do so much. It's also hard to standardize assessments, because everybody has their individual ways in which they compensate for reflexes. And so it's challenging, but I tell you, I have heard from so many occupational therapists over the years, hundreds and hundreds who have all said, we learn what a primitive reflex is. We learn how to test for them. We learn that they're soft neurological signs, but we don't learn what to do about them and that whole thing, if we had more of an emphasis on that, we could help so many children with their occupations, as we've seen over and over and over again, so you know. And I talked to some really seasoned OTS who have said that they were really upset by it. They said, Wow, this makes us so frustrated, because young OTs, who don't know, you know what we know, would just tend to write this off. And so to me, that's a problem, because we're writing off a chunk of development, or possibly writing it off. So I appreciate you like taking this head on, Jason, when you know, and talking about it. You know, we should be having conversations about this, and we should be, we should be talking about it and diving into what literature there is, you know, I do wish there was more. I do wish we had funding and proper more studies. But there are very compelling studies showing that when we give the tools for reflex integration, we boost function and occupational functions. So that is out there. It's just, I wish we had more of it.
Jayson Davies
Yeah, and I'm going to just chime in here with what Melinda said in the chat. She says it reminds me of a time when history, or in history, when people were not as accepting of sensory integration because we didn't have the research to back it up. And it's, in a way, it's similar, and because it takes funding now, something that has, well, we've been talking. A lot about it on the podcast recently, is creating your own evidence, and I think that that is something that we do. As far as evidence based practice, evidence based practice, it's not just about going out and finding the research. It's also about going through the scientific steps to see if what we are doing is working with our clients, and if what we do, if we assess our our student, our client, we put a plan in place, we follow that plan, and at the end of the plan, we are able to say, this created occupational outcomes, then we have created data for our program. Now, again, just like everything else in the world, what works with one student may not work with another student, but that doesn't mean that it's maybe not worth trying, and especially if you are doing an assessment to figure that out, and that kind of leads into where I wanted to go next, which is asking you about that assessment tool you just mentioned. There's no standardized assessment tool, per se. But how might you assess to see okay, this student is having difficulty with an occupational task, such as you've already talked a little bit about functional mobility, walking, or maybe they're having difficulty with writing. Maybe they're having difficulty with unzipping, unzipping their backpack, whatever it might be, how do you go about assessing that and then linking it back to a specific, retained reflex.
Sonia Story
Right, okay, so that's a great question. And what I would say about that is, it really helps to know what the stimulus is and the motor response and where in the body the reflex expresses and one of the huge eye openers for me was when Dr Blomberg explained that when reflexes are retained, it not only ties body parts together, but it interferes with the function of the muscles in that region or possibly interferes. So, for example, when the reflexes of the hands are not integrated, we see, oftentimes children with really weak hands or immature grasp, and you know, the children who have the dagger grasp and things like that. And when we start to integrate reflexes, then we help the muscles of the hand to develop, and then the child is able to have a tripod grasp. They're able to do writing that's way more comfortable, it looks nicer, it's more legible. And they say things like, Oh, my hands aren't getting as tired, and things like that. You know, the asymmetrical tonic neck reflex is probably involved quite a bit in handwriting, also when that's retained. But yes, you know, the more you know about the stimulus and the motor response, the more you can see that reflexes could be hindering functional skills.
Jayson Davies
Okay, so I have a question then, kind of going off of that, because as occupational therapy practitioners, we're taught to start with the big picture and work our way down, and so we really have to start with this student is not able to functionally write out a sentence. Let's just go with that one, and then we kind of work backwards to determine if it's a fine motor skill, if it's sensory motor processing, whatever it might be that leads us there. Now, if you're seeing and we can kind of even maybe walk through this a little bit, but if you're seeing a student that has difficulty with handwriting, you mentioned some of those. You know reflexes within the hand. Do you just kind of say, I see difficulties with handwriting? Immediately you're going to go to those more hand reflexes, or are you going to look at several reflexes? How are you going to determine which reflexes to work on, per se? Does that make sense?
Sonia Story
Yeah it does. So what I personally do and what I actually teach students, because after years of experience, I realized, like, wow, and I talked to many other therapists and they were seeing the same thing was that we actually have a lot easier time integrating reflexes if we begin with the rhythmic movements. And that's true with almost everybody. So that I kind of, after a lot of experience, that came to be sort of a general rule, like, let's start here, because they're so calming and organizing. And when a child has unintegrated reflexes, they unconsciously are compensating for the underlying muscle weakness and or the body parts being tied together and or different ways of holding tension, or different compensations that they've held. And. For a long time, since infancy. So I actually start with the rhythmic movements, because then when you go to stimulate the primitive reflexes, there's a more stable foundation, and you're not dysregulating the child as much, because when you go right in and stimulate reflexes, it can be uncomfortable for a lot of children, especially the tactile reflexes. They're uncomfortable because the nervous system is in like a less mature, more raw, more vulnerable state, and so having that foundation of rhythmic movements makes things so much easier and and faster also, and deeper. So faster, easier, deeper. And I'm like, let's go with this. It works way better. And kids are getting huge benefits just from the rhythmic movements where they're sleeping better. They're calmer. Their emotional regulation is better. They they even start, some of them even, will start having much better reading fluency and speech even before we get to reflexes. So we see that quite a lot. And so that would be my first thing. And then, you know, I like to look at, okay, what area, what? What areas this child having the most challenge with and then I look for reflexes that might be related. So for example, if it's anxiety, well, you know, the rhythmic movements impact that quite a bit. But then I would think, okay, possibly more. And fear paralysis reflex could be really helpful. And then if it's something like handwriting, then we talked about the hand reflexes and asymmetrical tonic neck. If it's balance issues, I always go for tonic labyrinthine reflex, because that seems to be very good for helping with balance. That and more motion sickness, those kinds of things would be rhythmic movements, Moro, tonic, labyrinthine reflex. Sometimes kids have a big challenge with the spinal gallant reflex, where they're they're just fidgety all the time, and clothes are uncomfortable, and they're constantly squirming. So that can be helpful for that. And then, if you have things like ADHD or an inability to focus, you know, usually any kind of functional thing that you see, there are several reflexes involved. And also, you know, there's research about if a child has a rhythmic impairment and they can't produce a smooth rhythmic movement from within that is associated with ADHD, dyslexia, speech and language challenges and something now, so I can't remember the other one, but it's in the literature, and I have slides too. I should share
Jayson Davies
this. You can go ahead and share the slides.
Sonia Story
I mean, I just hot. Well, we don't have too much time left, but let me show us one or two that works. Sure, I'll find that on the slides so well, okay, so let me just go to the the research that I was just talking about.
Jayson Davies
Yeah, and as you do that, I'm going to go ahead and post in the comments one more time that link to where they can get the ebook on supporting evidence for the brain and sensory foundations, course. And then one thing as you bring that up that I was thinking about too, is you also have a chart. Because you really, I think right there you dove into exactly what I was trying to get was like, what reflexes might you focus on when you see this? And that reminded me that you also have a chart, and I think I'm going to put that in the in the chat as well, because you have a chart that shows kind of what reflexes may lead to long term difficulties, right?
Sonia Story
Yes, for sure, and that's actually a really good guide, because, like I said, the children are so different in how they present, because they've all their bodies have sort of found these individual ways of compensating, and so it's very helpful to have the chart to see where there might be gaps in development.
Jayson Davies
Did you want to bring up the slides or,
Sonia Story
I mean, I have, oh wait, I got a screen share, right? Let me put
Jayson Davies
them up really quickly. There you go. Now everyone should be able to There we go. Now everyone can see them.
Sonia Story
Okay, great. So this is the research I was referring to, where they they took a group of children and found out if they had a rhythmic impairment, that it was associated with all these different things that you see. So I had three out of the four. The other one was Developmental Coordination Disorder, which is related to dyspraxia. So yeah, so there, there's so many things I could share. You know that you guys already know about the a lot of these things we talked about, the neurological. Yeah, but here's a one that I really love to share, and I've shared it before because it's so illustrative of the fact that a lot of the functional challenges we see in children are related to what did or did not happen in infancy, and so all of these kinds of skills that we want to see our children have, which is proper alignment, posture, core strength, our integrated sensory development, focus, speech, social emotional skills, executive function type things, they're all related, and they all depend on infant movements, and we can't fully develop our brain, our body and our sensory systems without them. So that's just a way of showing that what else can here's a related research about how retained reflexes are related to sensory issues. We see the difference between a healthy baby and compromised baby with in terms of core strength, and that's related as like that's definitely associated with autism later on. I like this one because you can see like, these changes don't go away when we get older. So here's a seven year old boy who had scoliosis, and he was unable to fully lay prone on the floor, and after doing the spinal gallant reflex and rhythmic movements, he was able to, within a few months, able to maintain prone position comfortably. So this is the these are different challenges that are all associated with retained, primitive reflex, reflexes and peer reviewed research. So you guys can get the evidence book that Jason's putting the link up. So you asked about sensory and one thing we didn't talk about Jason was how they're linked, how retained reflexes are linked with sensory issues, but then sensory issues and sensory processing disorders are linked with anxiety, which I think is really an important connection, because so many Children are suffering from anxiety these days. Anyway, I can send you the link to the slides if people want them, but I think it's really important to make this connection. We talked about this already and and basically what we're doing is we're using these movements to boost development. And, oh, here's a case study. I know. I know that that was going to be the next question too. Are we? I can't I don't want to take up too much of time going on and on.
Jayson Davies
No, that actually was going to be exactly where I was going with next. So I'm going to let you share the case study, but also, as you go into that for everyone out there watching, listening, go ahead and drop any questions you might have. We have about 10 minutes left. So after she shares this case study, we can dive into some questions that you might want to ask. So I'll keep an eye on the chat while Sonia goes ahead and shares the case study.
Sonia Story
Okay, great. Thanks, Jason. So I like this case study. I love this case study because this mom who is also a occupation, comcupational therapy assistant, she documented how much they were doing of these movements, and actually they're so the movements are so powerful and our brain recognizes them and takes them in, like super food, and then really can work with them. And so even a small amount, such as they did one to 15 minutes per day, three to five times a week, and they got phenomenal results. So the first thing they did was, for a couple months, they did just the rhythmic movements, and they found that instead of being fearful in public places, she was able to go at a public restaurant, able to go visit the restroom on her own, which was a huge thing for this girl. She was 12 at the age of this case study, and at the time, she was also struggling with balance, skipping, hopping and toe walking. And after they did a combination of rhythmic movements and reflexes, she was much less clumsy and even had improved gait and stronger heel strikes. She had much better writing fluency. She scored a on a math test for the first time, and she had been in speech therapy since the age of three, and she was dismissed after they started doing these movements at the age of 12, and then she just was able to study more on her own, and started getting all A's and B's on her report card. So she. She graduated right out of her IEP and her speech therapy. So, yeah, I and, you know, that that's really, I think, showing a clear connection to to functional outcomes and being able to participate in what's meaningful. And that's the, you know, that's the heart of OT is to be able to participate in meaningful activities.
Jayson Davies
Absolutely. Um, I really like, how on that slide, you put them side by side, you know, the before and after, and then you also show down in the corner, kind of what it took to get there. And As occupational therapists, we're, if we're not using reflex, we're doing the same thing, right? We're evaluating the students, seeing where they are. We're implementing a program, and then we are taking data to see where where the student eventually gets to. Now we have a few questions coming in, and as I continue to kind of gather them up, why don't you just go ahead and share a little bit about the brain and sensory course. And then we'll dive into these questions.
Sonia Story
Sure, well the course is doing. So what my goal was with this course was to give somebody as complete and comprehensive set of activities that are child friendly, first of all, and that really work. And so I really synthesized a lot of different training into one package of what I found were the best of the best, most useful tools. And what I really wanted to do is I wanted to go deep, and I also wanted to go broad, because with the broad, you're getting more components of development. So we included things like the rhythmic movements, developmental movements, play and games, and very targeted, specific reflex integration. And also i There were some processes and things that I learned in my initial brain gym courses that I found were very helpful, specifically for taking stress out of goals. Because we know that, like a child who's been struggling with reading, for example, every time they open a book, that stress pattern comes up, and then, like their their nervous system learns like, this is super uncomfortable, super stressful. And so that becomes, like a ingrained nervous system response if they're really nervous about reading. And so I use some of the processes that don't necessarily come from development, but they're very effective for taking the stress out of goals specifically, and I wove those in to help children reach their goals. And adults, it works for adults, too, to reach their goals with more enjoyment and much less stress. And we could also use that process to help reflexes integrate more quickly. So it's a it's a very good combination, and I'm just super thankful for how well it's working. And that's, I think that's it in a nutshell.
Jayson Davies
And we're going to go ahead and post a link right now, just in the chat for anyone who might be interested.
Sonia Story
I stopped sharing my slides.
Jayson Davies
I've already moved it on to you, so we are good to go. I did go ahead and just put in a link in the chat for anyone who wants to learn more about the course. This is an affiliate link, meaning that if you do decide to purchase the course at no additional cost to you. Sonia's is super grateful, and she actually provides a slight compensation to myself for hosting this conversation and bringing us all together tonight. So with that, there are a few questions, and I want to start with Kristen, she asks, and I'm going to go ahead and put this on the screen. Do you have advice for using reflex integration or rhythmic movements in school based practice where we are at most, seen a child one time a week for 30 minutes.
Sonia Story
Yeah. You know what I would love to see happen is that all the children in the classroom get these movements that would be ideal somehow. And what I would say is, within these limitations, that these movements are incredibly powerful, so if you only have limited time in from my perspective and my experience, it's important to really use them so that you can boost function and promote those skills that you're looking for. And I'll give you a little story that an OTS actually an OT assistant. And she said in their school district, there was a teacher who said, Look, my kids really need this. Can you help me? And between her and another OT, they had 96 kids, and she said there was no way we. Could get to them all. And so she said what we did was we gave them each I have to check back with her, it was either five minutes a day or 10 minutes a day of rhythmic movement. And she said we couldn't even specifically address their ot goal. She said, I'm kind of embarrassed to say this, because it's not the way we're supposed to do things as an OT she said, but we had such a big caseload, she goes. But you know what happened when they got those rhythmic movements even just a tiny amount on a daily basis? She said, they made progress on all their ot goals. And so that's the kind of thing where, you know, after all these years of hearing these things, I'm not I'm not surprised at all, but I just wish that somehow we could, we could get this out there to more children, and they're really delightful. Most children really love, especially the rhythmic movements. And, you know, somebody wrote a comment about play and leisure, which being an occupation, I think that's really important. It really needs to be fun for children and and having that connection and fun, you know, is really ideal. So that's a part of integration. It's a part of development. But anyway, I know it's hard when you're limited to once a week. And the other thing I would say would be to if you can is try to teach the parents. Ask the parent to come in, give them some rhythmic movement. Get training first, because there there are specific things, because some children respond uncomfortably to them. You have to know what to do, even though most children love them and will ask for more. But some children don't what their their system is way too underdeveloped to to take the stimulus in comfortably. But anyway, if you can get the parents to experience them and then do them even for three to five minutes on a daily basis, you're going to be doing some huge help with that. And also, if you cannot get the parents to do it, try to teach the child himself or herself how to do it. And if you can get them to a place where they can produce a smooth, rhythmic movement and do this on their own, you can say, hey, this is good for whenever you feel like you need a little break, or a little wake up, or a little thing to calm down, or something that just makes you feel better. You know, you can go and do this. So if you can plant that seed for them, even though you can't, you know, maybe see them multiple times a week. But we have seen OTs, who do apply this. They apply the rhythmic movements and the reflexes, and they just see kids once a week for 30 minutes, and they see measurable progress. So So I would still encourage you to do it even within limitations, yeah.
Jayson Davies
Absolutely. Thank you. And yeah, we did have Holly. I put it up on the screen. She said that she was able to get a teacher assistant and parents on board to work on reflex integration daily. So, yeah, you know, I think we come across this issue with everything, I mean, from handwriting to sensory to reflex integration, right? Like we talk about, we could spend 30 minutes working on a student's grasp, working on the letter formation, their sizing, whatever it might be, and then they go back to the classroom, and for the next week they do it all wrong until they come back to our class. And so that's the same type of thing, right? We have this problem across the board. It's not specific to reflex integration. Wouldn't it be great if every morning a student could get five minutes of handwriting instruction? That's what we would love to so, you know, it's it really does take time. Anything takes that concerted effort, that daily practice, if you will. You know, to make changes. So absolutely, there was another question here from Jeanette. And Jeanette wants to a fairly, you know, a short, short question that might have a not so short answer. How long does it take to see results on average? And let's just assume that we're going with, you know that that student who maybe is getting the three to five times a week.
Sonia Story
Yeah, so it's so variable, you know, development is so complex, and then when development has gaps in it, everybody seems to be different in terms of how much of a foundation they got versus, you know, how, how compromised was the foundation, you know, if you're talking about a child with something like severe autism or severe cerebral palsy, you know, it may take longer, but in general, what we usually see is that Within a month, almost everybody is showing positive, noticeable changes. I'm not saying you're done in a month, by any means, but you're seeing things going in the right direction within a month, some people see changes right away, like they'll see children. They get the rhythmic movements and they they're much calmer. They're. Much more present they can then focus on, you know, a tabletop activity or something like that. So sometimes you'll see changes right there in one session. And that's not uncommon, but to see really substantial changes in the foundation and substantial changes in how that child or individual actually functions throughout the day, usually about a month. It's very rare to see it taking longer than that to see things going in a positive direction, but sometimes that happens. But yeah, everybody's really different, but hopefully that helps. Yeah, absolutely. I just want to say, you know, this is a process. Development is a process. You have a baby developing that entire time in the womb, which is nine months, and ideally, they're getting a lot of good movement in the womb, with the mother moving a lot. Mothers tend to be more sedentary in this day and age, and that that leaves the baby less developed, but you've got the whole womb life, and you've got the whole entire infancy. Well, the birth is important too, but the birth and the infancy through toddlerhood, that's a long time to be developing. And so when there are gaps in development, you have to take into account that this may take some time, and we want to be in it for the long haul, and really give children a broad and deep and you know, foundation of the movements from development.
Jayson Davies
Absolutely All right. Well, Sonia, thank you so much for coming on today, I apologize for my production muting airs, but I'm glad that we were able to talk about reflex integration. And again, I posted some links in the comments for anyone who wants to learn more. Sonia is so nice and that she is offering a few different freebies. So you can use those links to grab those freebies. And of course, there is no pressure to take a course on reflex, on reflex integration with Sonia, but if it is something that you're interested in, be sure to also use the link that we posted as well. If you want to. Maybe you caught the second half of this, but not the first half. We'll be sending out a replay tomorrow morning in an email, so you all have the replay to this. So come back, watch it when you have the time and catch all the good things that we talked about. So one more time, Sonia, thank you so much for being here. I really appreciate it, and be sure to check her out at move playthrive.com and learn all about it. So thank you so much, Sonia.
Sonia Story
Thank you Jayson, and thanks to everyone listening.
Jayson Davies
Take care.
Sonia Story
Take care.
Jayson Davies
All right. Thank you so much for listening to this episode of the otschoolhouse podcast. Again. You can catch all the show notes, all the resources that we shared at otschoolhouse com, slash episode 121, there are many resources there. You can also catch the live unedited YouTube chat, if you'd like over there. And yeah, I just want to really quickly say thank you to Sonia one more time for coming on the show. If you would like to learn more about her courses. The links are in the show notes. And yeah, I hope this episode just got you thinking a little bit more about reflex integration and occupational outcomes. Take care. Have a great rest of your week, and I will see you next time bye bye.
Amazing Narrator
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