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By Suzanne Day
 The neurodevelopmental approach to learning remediation has been for me one of the most important aspects of my practice in the past ten years. This therapy attempts to address the learning inefficiencies at a lower level of development before aiming at the higher centres in the brain. It considers which functions of the Central Nervous System (CNS) should be in place from birth to grade two in order to be an efficient learner. It looks at the “input” of information coming from the visual, auditory, and tactile domains in order to yield an “output” in the manual, language, and mobility areas. I will share here about some reflexes which are in place from conception and how they should be inhibited to give place to more mature neurological functions in order to produce learning efficiency. When these reflexes are not inhibited, they yield inefficiencies in motor control, eye-hand coordination, sensory perception, emotional behaviour, attention, and/or higher cognitive abilities. Note: The four pictures on this page illustrate some of the favorite positions characteristic of people (children, teens and even adults) with immature reflexes.
Neurodevelopmental Reflexes or Primitive Reflexes
 The term ‘stimulus-response arc’, or what is more commonly refered to as a reflex can be described as being a stereotyped response of the CNS to a specific stimulus on an individual. It is generally assumed that the nervous system’s organization moves from the lowest levels, in the spinal cord and brain stem, through the midbrain, to the highest level in the cortex. This neurological organization develops through movement patterns in stages from conception to the toddler. These reflexes are called primitive reflexes.
The primitive reflexes present from conception are organized in a hierarchy. These reflexes allow the baby to make body movements. When these movements are done in the right proportion and the proper sequence, they contribute to inhibit these primitive reflexes and give place to higher neurological organizations called ‘functions’. The higher functions of the CNS relate to learning (memory, ability to categorize, logic) and to attention span (arousal and inhibition).
Let me give you an analogy. Lets pretend that the brain is a building with a phone relay in its center (thalamus). Over the years as the electric connections are used, they are being replaced by newer ones. However, if certain connections are not removed because they have not been used enough, the phone relay from 2005 may still have connections from 1950 which makes the whole system inefficient. When the primitive reflexes are not inhibited we find their manifestations in children who struggle with different forms of learning.
Sally Goddard from the Institute of Neuro-physiological Psychology has done an amazing work in this area of primitive reflexes. Let us look at the most commonly active reflexes found in children with learning and attention inefficiencies.
The Moro Reflex
The Moro reflex, one of the most basic and important reflexes to influence learning, emerges at nine weeks in utero and is fully present at birth. It should be inhibited by four months after birth. The Moro reflex manifests itself in a sudden movement of the arms extended with opening of the fingers and with legs folded, with a momentary freeze before the coming back of the arms and legs in a closed position. This reflex allows the CNS to react automatically to sudden pain, change in temperature, noise, or change in the visual field. Children or even adults who retain this reflex will be hypersensitive to sudden change in their surroundings and be constantly in a state of alert. The individual may withdraw or become aggressive trying to control the environment with hyper-activity.
The Tonic Labyrinthine Reflex
 The tonic labyrinthine reflex (TLR) emerges in utero, is present at birth, and is also inhibited approximately four months after birth. As the head moves away from the spine, the arms and the legs extend (when the head moves backward) and will curl when the head moves forward. It deals with the head control which will greatly impact the sense of balance, proprioception (perception of different parts of the body in space, at rest or in motion) vision perception, and the muscle tone. The importance of balance in learning is better understood by the influence of a gravity-free environment on astronauts who start writing from right to left.
The Asymmetrical Tonic Neck Reflex
The asymmetrical tonic neck reflex (ATNR) emerges at eighteen weeks in utero, is present at birth, and should be inhibited at six months. When the baby’s head moves to one side the arm and leg of the same side extend while the limbs of the other side bend. If this reflex is not inhibited it leads to difficulty in crossing the midline of the body. Handwriting later on in life will be impaired. When the child moves his head to read or write, his arm and fingers will tend to stretch. He will constantly have to readjust this innate movement using energy that is not yielding the proper results
The Symmetrical Tonic Neck Reflex
 The symmetrical tonic neck reflex (STNR) emerges at six to nine months of life and should be inhibited by eleven months. It manifests itself in crawling, or often called “army crawl,” and in creeping which are movements of the baby on his knees. It allows the baby to defy gravity as it synchronizes different systems to work together: the vestibular system (balance), the visual system (vertical tracking of the eyes), and the proprioception system (the feeling of the torso and limbs). It may be seen as a stage of the labyrinthe reflex because of the crucial involvement of the vestibular system. Bender (1976) estimated that 75% of learning disabled children have retained STNR. The retention of this reflex greatly impacts on eye-hand coordination (not loosing his place when reading), the sitting position, attention span, and the use of written language (writing on the line and in straight columns).
In conclusion, this article has summarized some of the reflexes which, when active in a child, are part of the root causes of neurological based labels such as Learning Disability, Dyslexia, Attention Deficit Disorder and others. It is possible to give a “second chance” to the brain in providing the right movement patterns in the proper sequence: that is what neurodevelopmental therapy is all about. I would be glad to help you and your children in evaluating not only the surface manifestations of their neurodevelopment but especially to equip you, as parents, with a program of activities to work with your child in inhibiting these reflexes and to promote more efficient learning functions.
Copyright 2005 Suzanne Day, Neuropsychologist member of l’Ordre des psychologues du Québec
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