Neurodevelopmental rehabilitation

What is it? How does it work? Who can it help?

In a nutshell, neurodevelopmental rehabilitation is a set of exercises designed to help children and adults with learning and behavioural issues. These include dyslexia, dyspraxia, ADHD, ADD and Asperger’s. But how does it do this? How does it work and what is its scientific validity?

Just after birth, infants are most happy curled up in a ball. When they turn, they do so in a block. There is no separation of head and body movement. They may, in response to a loud sound or sudden change in temperature, fling themselves open with a scream, but once settled, they return to their comfortable ball. This is entirely normal for the first week or two of life but the infant cannot stay this way. They need to progress into a walking, talking, reading, learning, adult. This is the role of the primitive reflex. 

The sudden opening out described above is one such reflex. It is called the Moro. Some refer to it as the Startle. A primitive reflex is an automatic movement elicited by a specific trigger. It is perfectly normal and is designed to shape the brain by laying down specific neurological pathways. We do this when we learn a new skill. Say we want to learn to play an instrument. When we start, we are not very good and probably quite annoying, but as we practice, we lay down the appropriate neurological pathways and get better and better. The primitive reflect is doing the same thing for the child. The difference is that once the pathways are laid down the child no longer needs the reflex. We, however, probably still need to practice. The reflex is put away into the lower cupboards of the brain. The brain can get it out again after injury or age-related cerebral deterioration but that is another story.

Another primitive reflex is the Atonic Neck Reflex (ATNR) or fencer pose. This reflex lays down pathways in the brain to do with sight. It works like this. The baby turns the head to the right. In response the reflex dictates that right arm and right leg are flung out, straight, like a fencer. The opposite happens if the baby looks to the left. As the arm is flung out the baby sees the hand. Immediately pathways in the brain associated with hand-eye co-ordination, accommodation and horizontal eye tracking are laid down. The baby repeats this reflex movement again and again and the appropriate brain pathways are reinforced.

Another example is the Tonic Labyrinthine Reflex, TLR. This ensures that as the infant’s head moves up the whole body extends out. As the infant’s head goes down the opposite happens and the body becomes a tight ball. Again, this reflex has implications for sight. As the baby’s head moves up the eyes follow. As the baby’s head is moves down, again, the eyes follow. As a consequence, pathways in the brain are laid down that are associated with vertical eye tracking.

Now, horizontal and vertical eye tracking along with accommodation are important for reading and writing. A child, and here’s the vital message, that cannot move their head at this critical early stage of their development lays down different brain pathways that may interfere with normal eye tracking and accommodation and, by inference, reading and writing. These difficulties are akin to dyslexia.

In this example the child presents with a learning difficulty associated with the lack of development of one or two of the primitive reflexes purely because of a simple head restriction. Other presentations, such as behavioural issues similar to ADHD, ADD may have their origins in the retention of a primitive reflex, i.e. one that has not been integrated properly. As mentioned above, all primitive reflexes should arise, stay for a time - to help laydown the appropriate brain pathways - and then be integrated or, in layman’s terms, put away in the shed. There is a primitive reflex called the Galant. In the Galant stroking the babies side produces an upward flick of the hip. This should be integrated within the first few weeks of life but what do you think happens when it is not? Do you think children with a retained Galant can sit still? Often, they can’t and it may be assumed that they have ADHD or ADD. At the beginning of this article we mentioned the Moro reflex. What do you think a person might be like who still has this reflex? Jumpy, nervous, exhausted and worn out from the adrenaline produced? Another picture similar to ADHD or ADD.  

So why might primitive reflexes not emerge or be retained? Mentioned above was the fact that the emergence of the ATNR or fencer can be prevented simply by an inability to turn the head. This, and other musculoskeletal restrictions, can occur for many reasons. Most are related to the position of the infant in the womb or the labour. Low pelvic presentations, common for second and third babies, the pelvis being looser, and breech positions in which the bottom or feet are down and the head develops squashed up against the rib cage, are just two restrictive intrauterine arrangements. With respect to labour, musculoskeletal restrictions can arise following: forceps; ventouse; cord round the neck; long labours; quick labours; caesarean sections; asynclitism (head tipped to one side) - the list goes on. Whatever the cause, the important thing is to recognise is that musculoskeletal restrictions can interfer with the emergence and/or integration of the primitive reflexes and so ‘normal’ or optimal neurological development.

Fortunately, if the child’s learning difficulty and/or behavioural presentation has its origins in the primitive reflex, there is a straight forward, tried and tested solution, Neurodevelopmental rehabilitation, (https://www.inpp.org.uk/research-publications/research/). Neurodevelopmental rehabilitation is a series of exercises, developed by research foundations such as the Institute of Neuro Physiological Psychology, that, if executed slowly and precisely over a number of days or weeks, encourages the emergence or inhibition of the problematic primitive reflexes. As this happens new pathways are laid down in the brain and the symptoms of dyslexia, dyspraxia, problematic behaviour tend to settle. This is brain retraining, a second chance. Of course, as with any presenting compliant there can be many potential causes. If, however, the primary driver is the primitive reflexes then it may be that neurodevelopmental rehabilitation can help.