Changing Movement Patterns and Specific Motor Control: Clinical Reasoning Using Primitive Reflexes

There are three main uses for the use of primitive reflexes in clinical practice. It is very helpful, but not necessary, to have a good understanding of normal movement and the factors that limit it.

(1): Patients that cannot learn specific motor control exercise:

We use the Motor Control Abilities Questionnaire to predict this, however you could use the rule of three (if they haven't learned in three sessions with compliance and proper teaching they have less than a 2% of learning if you continue). If a child has developmental coordination disorder or a learning difficulty they don't automatically get better when they leave school. They carry these into adulthood. Further, the exposures to a western diet, environmental chemicals, illnesses and numerous other factors combined with genetic variability lead to neuro-immune-sympathetic endocrine dysregulation and can create neurocognitive deficits.  Of course multiple minor injuries with associated sensory motor deficits appear to have an additive effect in some people and other traumas such as concussion can lead to poor motor learning.

It is a clinical priority to use primitive and postural reflexes to facilitate normal movement in mechanical pain when someone does not learn. Primitive reflex inhibition improves neurocognitive function and movement in a variety of different patient populations (clinical trial and prospective cohort level of evidence).

Neurodevelopmental (recommended) or Local approach

Neurodevelopmental Approach

Look at the normal time frames of development of the reflex and rehabilitate each reflex in their natural order. This will generally lead to imitating a postural or functional movement (e.g. crawling, rolling, reaching, walking). We provide you with the tables of the normal time frames of the reflexes to facilitate your clinical reasoning.

Local Approach

Here you would only rehabilitate the reflexes that have a direct influence on that region. Care is needed because many reflexes influence the whole body.

e.g. Neck pain with poor movement of the cervical spine.

What reflexes influence the cervical spine? Asymmetrical tonic neck reflex, Symmetrical tonic neck reflex, Sucking reflex, Landau, Moro etc

(2): Make normal rehab better

A simple way to look at this is to ask yourself what you already to do improve movement or motor control?

(e.g. Muscle energy techniques, Myofascial trigger point release)

You can use Primitive Reflex inhibition in place of, or in conjunction with these techniques. If you are trying to change muscle tone and movement, it is more appropriate to do a technique that is higher in the central nervous system first.

Primitive Reflex Inhibition to reduce muscle tone

(1) Identify which muscle you would like to target

(2) Identify which reflexes would aim to increase tone in that muscle

(3) Inhibit the reflex

Gastrocnemius

What reflexes produce plantar flexion? (Foot Tendon Guard family)

Rectus abdominus

What reflexes flex the trunk? (Moro, STNR, ATNR, Abdominal...)

Quadratus lumborum

What reflexes side flex the trunk? (Abdominal, Spinal Galant, Spinal Perez...)

Primitive Reflex Inhibition to Improve Movement

There are two things to consider here. (1) Is the movement limited by a restriction (same as above with just a little different perspective) or is there just (2) poor movement

Primitive Reflex Inhibition to Improve Movement limited by a myofascial restriction

You want to increase upper cervical flexion

What reflexes produce upper cervical extension? (STNR, Moro, Landau...)

You want to improve lumbar flexion

What reflexes produce trunk extension? (STNR, Moro, Landau...)

Isn't it interesting that these reflexes also influence hamstring tone!

Primitive Reflex Inhibition to Improve Poor Movement and Motor Control

You want to improve abdominal hollowing with a transversus bias

What primitive reflexes influence the anterior abdominals?

You want to improve translation control of the glenohumeral joint

What primitive reflexes influence upper limb function?

You want to improve the lumbar - hip ratio during trunk flexion

What reflexes produce trunk flexion?

Note: Postural reflexes are generally more effective when there is no restriction, but should be treated concurrently

(3) Central Pain Management

Primitive and postural reflexes are key for the rehabilitating Body Image Pain, however there are two uses for using primitive reflexes for central sensitization. Please keep in mind the most common mechanism of central sensitization is systemic inflammation due to neuro-immune-sympathetic-dysregulation, however there are other causes (e.g. poor sensory motor gating of pain).

(1) Primitive reflexes are stimulated by the sensory system (e.g. Babinski is tactile). You can use these tactile points distal / remote from the main areas of the pain if that is possible and appropriate

(2) In an effort to start introducing normal input to the central nervous system (CNS) and teaching it normal input is, primitive reflexes once again can be used. Obviously they would be gentle and done within the concepts of graded exercise therapy. This achieves a few goals: it introduces normal sensory input into the CNS and starts activating whole body movements and influencing abnormal muscle tone.

For those not familiar with Primitive Reflexes. Primitive reflexes (PR) are brain stem-mediated, complex automatic movement patterns that commence in utero. If PR persist beyond their average lifespan they may begin to interfere with proper CNS development, normal movement and could indicate neurological impairment. They present in conditions such as learning difficulties or movement disorders in children and adults. PR can also reappear due to altered sensory input into the CNS (musculoskeletal injury) or altered processing (i.e. concussion). The presence of PR will influence motor control and can interfere with normal rehabilitation. 

Want to Learn?

This course is being offered in:

Calgary, Canada Sept 8-10, 2017 for pelvic floor therapists

Harrogate, UK Sept 23-24, 2017

Ottawa, Canada Oct 14-15, 2017

For further information please email: [email protected]

Related posts

https://www.dhirubhai.net/pulse/you-rehabilitate-movement-should-know-primitive-reflex-sean-gibbons

https://www.dhirubhai.net/pulse/understanding-movement-why-does-replicating-reflex-inhibit-gibbons

https://www.dhirubhai.net/pulse/symmetrical-tonic-neck-reflex-new-look-old-exercise-sean-gibbons

https://www.dhirubhai.net/pulse/primitive-reflex-inhibition-improves-body-image-two-point-gibbons

https://www.dhirubhai.net/pulse/functional-hallux-limitis-sign-primitive-reflex-sean-gibbons

https://www.dhirubhai.net/pulse/muscle-tone-part-1-what-bleep-sean-gibbons

References

Parfrey K, Gibbons SGT, Drinkwater EJ, Behm DG 2014 Head and limb position influence superficial EMG of abdominals during an abdominal hollowing exercise. BMC Musculoskeletal Disorders. 15:52. DOI: 10.1186/1471-2474-15-52 (Highly accessed)

Gibbons SGT 2011 Neurocognitive and sensorimotor deficits represent an important sub-classification for musculoskeletal disorders – Central Nervous System Coordination. Journal of the Icelandic Physical Therapy Association. 38 (1): 10-12

Gibbons SGT 2011 Neurocognitive and sensorimotor deficits represent an important sub-group for whiplash associated disorders. Fifth International Whiplash Trauma Congress. Aug 24-28; Lund, Sweden. J Rehabil Med 2011; Suppl 50: 23

Gibbons SGT 2009 Cognitive learning and sensorimotor function provide a protective effect from disability in low back pain. Manual Therapy. 14 (S1): S30

Gibbons SGT 2009 Neurological soft signs are present more often and to a greater extent in adults with chronic low back pain with cognitive learning deficits. Manual Therapy. 14 (S1): S20

Gibbons SGT 2008 Retraining of asymmetry in recruitment of transversus abdominis. Orthopaedic Division Review. March/April: 29-34

Testimonial

“I can't recommend Sean Gibbons and Smarterehab courses enough. I have found the sub-classification system to be easy to use and revolutionary in removing a lot of the guesswork in my patient management. The primitive reflex course has been transformative in my practice in that it has wide applicability across a spectrum of conditions that would normally constitute ‘difficult’ patients. I can't recommend these courses highly enough!

Chris Barber MCSP BSc (Hons) Musculoskeletal & Sports Physiotherapist, Director: Advanced Physiotherapy Centres Ltd.

As a clinic owner and have seen a trend in Canadian physiotherapy towards spinal manipulation and needling techniques. While these techniques are valuable, the transformative learning that takes place in a SmarteRehab course is the direction I am dedicated to bringing our profession. As Physiotherapists, if we wish to distinguish ourselves from chiropractors, massage therapists, athletic therapists, osteopaths etc., we need to move away from technique based therapy. Sean is masterful at explaining the complex relationship between Central Sensitization, Central Pain, Sensori-Motor Function and how it relates to Motor Control dysfunction and pain. No other approach I have seen, heard of, or even read about does such a complete job of integrating neurological rehabilitation techniques and orthopaedic treatment. I now have junior therapists who are able to reason their way through the most complex of chronic pain cases and can formulate treatment plans that are effective and get results. Most importantly they can explain to these patients the nature of their problem in a way that they can understand. It is so rewarding to see patients, empowered with this knowledge, resolve problems that have sometimes existed for decades. Equally as rewarding is watching a junior Physio quickly solve an orthopaedic complaint by identifying the underlying movement dysfunction and easily explaining it’s cause. Thank you Sean for what you have done and continue to do for our Profession.

Dave Holmes Owner and Physiotherapist at Tower Physiotherapy & Sports Medicine

The courses that I have taken with Sean have completely changed my pelvic floor practice and the way I practice as a physical therapist! Taking his courses is a must in order to help a variety of clientele and especially those who do not respond to conventional treatments! This is especially true when it comes to patients that can't learn or retain specific motor control exercises or those who have atypical pain. The techniques learned and applied literally make magic! The first key to make that magic happen is to know how to properly sub-classify your patients.

So when my patients are amazed by the results of the treatment and say "Wowww it is like magic" I am proud to reply "No, it is physiotherapy"! Applying the principles learned from Sean Gibbons courses just make me experience every day the power and beauty of the human brain! The best part is that it is all evidence based practice! Thank you Sean!

Erica Lafontant, pht, B. Sc, M.Sc.A. Rééducation périnéale et pelvienne, PhysioActif

If you find yourself stuck and frustrated with chronic, generalized, weird pain patients who don't respond to usual treatments, this is what this course is all about. Sean's courses are truly unique and bring practical, evidence based guidelines that are untouched by other institutions. Places are limited.

Jean-Michel Cormier, Physiotherapist Max Health Institute, Shediac, NB, Canada

Facilitator

Sean Gibbons graduated from Manchester University in 1995. He has been rehabilitating movement patterns for over 20 years. He researched and developed numerous advances to the cognitive control of movement including which postural and primitive reflexes influence movement and key aspects of the neurodevelopmental history. His PhD was on the development of a prescriptive clinical prediction rule for specific motor control exercises in low back pain. Key new sub-classifications were identified: neurocognitive, sensory motor function which is related to extremely poor movement and the ability to learn to coordination exercises; central body image pain and neuro-immune-endocrine dys-regulation. His current work follows this and aims to further sub-classify pain mechanisms and understand the mechanisms of non mechanical pain. His dissection and research into psoas major, gluteus maximus and other muscles has led to the development of new rehabilitation options. He has presented his research at national and international conferences and has several journal publications and book chapters on related topics. He is an Assistant Clinical Professor (Adjunct) at McMaster's Advanced Orthopaedic Musculoskeletal / Manipulative Physiotherapy specialization.