PT Corner: Function From the Inside Out

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[Source: HeartSpace PT]

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When I first became a pediatric PT we talked about primitive postural reflexes as part of the development of postural control.  We certainly didn’t have all the answers and there were many different perspectives, so these were lively conversations with lots of good clinical problem solving. But references to primitive reflexes had mostly disappeared from the discourse on postural control until fairly recently.

We used to think of development as a hierarchical process. But as our understanding of how the brain works has improved, we now understand it as a complex, dynamic, multi-systems process. So rather than primitive reflexes, I prefer to use the term developmental reflexes – stereotypical movement patterns triggered in response to a sensory stimulus representing our first developmental experiences with registering and responding to our position in space. Babies experience extension and flexion of their body (Moro), their relationship to the support surface (TLR), differentiation of left and right sides of their body (ATNR) as well as the dissociation of their upper body from their lower body (STNR) – all with reference to their head position.  As such, they lay down the early sensory and motor neurological wiring which supports the development of mature postural control.  And even when mature postural control is present, if the system is stressed or damaged, these patterns reappear to help out with stability.  One has only to watch me try to ski a beginner’s hill to view a classic ATNR!

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