Primitive Reflexes Research Articles

Sensory integration versus Masgutova neuro-sensorimotor reflex integration program on controlling primitive reflexes and gross motor abilities in children with diplegic cerebral palsy.

An abnormality in muscular tone, lack of postural control, and a lack of coordination are all linked to the retention of primitive and immature postural reflexes. The Purpose of this study aimed of detecting which therapeutic approach is more effective in integrating retained primitive reflexes, either Masgutova neuro-sensorimotor reflex integration or Sensory integration (SI) program. Forty children with spastic diplegic cerebral palsy (CP) (11 girls and 29 boys), involved in the current study and their ages ranged from 3 to 6years old. They were divided at random into two groups (A and B), patients in the study group (A) (n=20) were treated by Masgutova neuro-sensorimotor reflex integration program (MNRI) while those of study group (B) (n=20), were subjected to Sensory integration program (SIP), A standardized physical treatment regimen was provided to both groups (Stretching exercise, Strengthening exercise, and facilitation of developing motor milestones) All children were evaluated by using GMFM-88 and (PDMS-2) reflexes subtest before and after treatment that lasted for three successive months at a frequency of three sessions per week. There was a statistically substantial increase in GMFM scores and control of primitive reflexes post treatment in each group compared to those of the pretreatment mean values (p>0.05). There was also a statistically non-significance difference between group A and group B regarding post treatment results (p>0.05). SI and MNRI programs can equally be used in the treatment of children with spastic CP who suffer from retained primitive reflexes and delayed gross motor function.

PA25 Persistent and widespread infantile transient smooth muscle contraction of the skin: an atypical presentation of a rare condition.

Abstract Infantile transient smooth muscle contraction of the skin is a rare entity. Eleven cases have been described in the literature to date. Herein, we describe an unusual presentation, persistent and widespread in nature. A 2-year-old girl presented with asymptomatic bilateral transient textural change of the skin overlying the thighs. Textural changes were noted from birth, occurring a number of times each day. Episodes resolved spontaneously, sometimes within minutes, on occasion lasting up to 1 h. The child remained systemically well during episodes. Textural change progressed to involve the skin overlying the abdomen. Friction and temperature change did not provoke episodes. No other triggers were elicited. Background history included metatarsus adductus, which was under routine follow-up with orthopaedics. Full skin examination between episodes revealed no cutaneous abnormality. The areas affected were normal to palpate. Photographs and videos of episodes revealed marked textural change of the skin overlying both thighs and abdomen, with a striking stippled appearance. Laboratory investigations, including tryptase, lactate dehydrogenase, immunoglobulins and complement, were unremarkable. A case series first described nine cases of infantile transient smooth muscle contraction in 2013 (Torrelo A, Moreno S, Castro C et al. Infantile transient smooth muscle contraction of the skin. J Am Acad Dermatol 2013; 69:498–500). Textural skin changes occurred most frequently on the lower limbs. In eight of these cases, episodes resolved within 1 min. Episodes occurred both spontaneously and secondary to light friction from clothing, cool air and bathing. The majority of cases were noted from birth or in the first days of life. Skin biopsies taken from three of these patients revealed no abnormality. Episodes resolved by 2 years of age in all cases. It has been suggested that this transient phenomenon may be secondary to autonomic nervous system immaturity, primitive reflex phenomena or transient hypersensitivity of the smooth muscle. A more recent case has since been described in the literature (Theodosiou G, Belfrage E, Berggård K, Cristiansen J. Infantile transient smooth muscle contraction of the skin: a case report and literature review. Eur J Dermatol 2021; 31:260–1). We describe a persistent case of infantile transient smooth muscle contraction of the skin, in a child aged > 2 years, with prolonged episodes, progressing from lower limbs to truncal involvement. Recognition of this rare condition is important, to allow appropriate reassurance regarding its benign and self-limiting nature.

Stifling the sneeze in ACHOO syndrome-What the anesthesiologist should know.

Dear Editor, A 32-year-old male, a known patient of ocular amyloidosis, was posted for superficial keratectomy (removal of the corneal epithelium up to Bowman membrane) of the right eye under topical anesthesia. This patient had a history of photic sneeze reflex (PSR) since 12 years of age and was a diagnosed case of autosomal dominant compelling helio-ophthalmic outburst (ACHOO) syndrome. This condition is characterized by uncontrollable sneezing episodes on exposure to bright light or periocular injection including peribulbar block or eyelid infiltration. He suffered from continuous sneezing episodes lasting around 5 min even in response to slit-lamp examination. This was usually followed by a refractory period during which the ophthalmic examination was conducted. He had no other systemic illness. On the day of the procedure, he developed an irrepressible sneezing reflex after cleaning and draping of the right eye in the operating room. The ambient light had stimulated the PSR. The anesthesiologist was called for help. On clinical examination, the patient’s vitals were stable with a heart rate of 62/min, SpO2 98%, and blood pressure 100/70 mmHg. His sneezing fit had ceased but the patient was extremely anxious. An intravenous line was secured and he was administered midazolam 1 mg and fentanyl 50 μg intravenously. He became calm and allowed the gentle insertion of a wire speculum but still could not look at the light of the operating microscope though there were no more sneezing episodes. He was given another 50 μg fentanyl intravenously and reassured. The procedure was completed smoothly in 10 min. No further drugs were administered nor were there any sneezing episodes. A syringe filled with injection pheniramine maleate 22.75 mg was kept ready but was not required. Five days later, he was posted for superficial keratectomy of the other eye under monitored anesthesia care. The same anesthetic technique was followed and he was administered midazolam 1 mg and fentanyl 100 μg in small aliquots even before skin preparation. The procedure was completed uneventfully under topical anesthesia without a single sneezing episode. Sneezing fit after exposure to bright light or “sun sneezing” has been reported in about 25% of the population. These patients are also prone to a sternutatory reflex after local anesthetic injection under sedation.[1] Unexpected or sudden head movement during peribulbar block or eye surgery can cause globe perforation or vascular injury and retrobulbar hemorrhage.[2] PSR is a primitive brainstem reflex, sometimes considered a variant of the trigemino-cardiac reflex with the center in the trigeminal nucleus and adjacent reticular formation. The afferent arc is from the first (ophthalmic) and second (maxillary) division of the trigeminal nerve (VN) and the efferent is the vagus nerve. A cross-talk between the optic nerve (IIN) and VN has also been hypothesized.[3] No known treatment exists except avoidance. Few authors have found deep sedation, eyelid infiltration, midazolam, and propofol to increase the risk while opioids, dexmedetomidine, and antihistamines have been found to reduce the risk.[2,4] Some have even suggested PSR as an indication for general anesthesia in ophthalmic surgery.[5] It is important for anesthesiologists routinely caring for patients for ophthalmic surgery to be aware of this reflex as it can have severe sight-threatening consequences. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Prevalence of Active Primitive Reflexes and Craniosacral Blocks in Apparently Healthy Children and Relationships with Neurodevelopment Disturbances.

In healthy children, the frequency of the anomalous persistence of primitive reflexes (PRs) and craniosacral blocks (CBs) is unknown, as well as their impact on neurodevelopment, behaviour disorders and related consequences. We aim to know the prevalence of anomalous PRs and CBs in apparently healthy children and their relationships with behavior and neurodevelopment anomalies. Participants (n = 120) were evaluated via a physical examination to detect PRs and CBs and an ad hoc parent survey to collect perinatal events, and children's behavioral assessments were conducted by teachers using the Battelle score. PRs were present in 89.5%. Moro (70.8%), cervical asymmetric (78.3%) and cervical symmetric PRs (67.5%) were the most frequently observed PRs. CBs were found in 83.2%, and the most frequent CBs were dura mater (77.5%) and sphenoid bone (70%) blocks. Moro, cervical asymmetric and cervical symmetric active primitive reflexes were significantly associated with cranial blocks of dura mater, parietal zones and sphenoid bone sway. Gestational disorders or perinatal complications were associated with a higher frequency of PRs and CBs. The presence of PRs and CBs was associated with abnormal Battelle scores and neurobehavioral problems. The presence of PRs and CBs in children without diagnosed diseases is frequent and related to disturbances in childhood neurodevelopment.

Effect of a psychoeducational intervention on motor and perceptual-visual development through the inhibition of primitive reflexes in schoolchildren aged 4 to 7 years old

The efficacy of the Assessing Neuromotor Readiness for Learning (Blythe, 2012) on primitive reflex inhibition is described. The sample consisted of 25 girls and 21 boys aged 4–7 years (M = 4.84, SD = 1.10). For the sake of evaluating the efficacy of the intervention, the Developmental Screening by the Chester Institute of Neurophysiological Psychology, INPP (Blythe, 2012), was used by means of a pretest-posttest design with a control group. The statistical analyses performed were ANCOVA and factorial ANOVA—depending on the fulfilment of the assumptions. The main findings refer to the existence of active primitive reflexes in the sample, and how these primitive reflexes are sensitive to the psychoeducational intervention of reflex inhibition through movement. Besides, the involvement of primitive reflex inhibition in the improvement of motor development—but not in perceptual-visual development—has been proved.

Efecto de una intervención psicoeducativa en el desarrollo motor y perceptivo-visual a través de la inhibición de los reflejos primitivos en escolares de 4 a 7 años

The efficacy of the Assessing Neuromotor Readiness for Learning program (Blythe, 2012) on inhibition of primitive reflexes is presented. The sample is made up of 25 girls and 21 boys aged four to seven years old (M=4.84, SD=1.10). The Developmental Screening of the Institute of Neurophysiological Psychology of Chester, INPP (Blythe, 2012) has been used to evaluate the efficacy of the intervention through a pretest-postest design with control group. ANCOVA and Factorial ANOVA have been used for statistical analysis, depending on the fulfillment of assumptions. The main findings of this study refers to the existence of active primitive reflexes in a sample of schoolchildren and how these primitive reflexes are sensitive to psychoeducational intervention on reflex inhibition through a movement program. In addition, the involvement of inhibition of primitive reflexes in improving motor development has been highlighted but except for visual perception skills.

Are Immature Neuromotor Skills Significant Factors in Educational Under-achievement and Special Educational Needs? Literature review of the role of Primitive Reflexes as Indicators and Measures of Neuromotor Immaturity

An overview of research carried out in the last eighteen years investigating the incidence of immature neuromotor skills in children of pre-school and school age; the impact of immature neuromotor status on educational achievement and the influence of daily movement programmes on neuromotor status. Based on published material and independently commissioned reports, the literature indicates that persistence of primitive reflexes is associated with a range of presenting difficulties which include: educational under-achievement; attention deficit hyperactive disorder (ADHD); developmental language disorder; emotional and behavioural issues; visual perception and poverty related differences in physical literacy.Evaluation of intervention programmes indicated that specific developmental movement programmes can help to reduce signs of neuromotor immaturity improving the physical basis for motor related aspects of classroom learning and poverty related differences in physical literacy skills.

Teaching Neuro Images : FDG-PET in progressive supranuclear palsy

A 74-year-old man presented with falls, dysphagia, and personality change. Examination showed axial parkinsonism (without response to levodopa), low pitched dysarthria, supranuclear vertical gaze palsy, decreased blinking, square-wave jerks, primitive reflexes, apathy, and decreased verbal fluency

Effects of TSB Levels above 5mg/dl on Primitive Reflex Responses and Righting Reactions in Preterm Newborns

Effects of TSB Levels above 5mg/dl on Primitive Reflex Responses and Righting Reactions in Preterm Newborns

Comparative Cough Suppression of Chitosan Crab Extract of Uca tangeri and Dihydrocodeine

Cough is an inmate primitive reflex and acts as a part of the body's immune system to protect against foreign materials from the respiratory tract. This study was done to investigate the cough suppression potential of Uca tangeri. A day before the test, guinea pigs were placed individually in a transparent chamber (60 × 36 × 60 cm) for 5 minutes before cough was induced by exposure to 15% citric acid, delivered using an Omron compressor nebulizer (rate of 0.4 ml/minutes and particle size 5?m) for 10 minutes. The animals were then monitored visually within this exposure time for cough; the latency and counts, of which, were taken as the basal values. The animals exhibiting 10 - 20 bouts of cough were selected for the study and fasted overnight but with access to water. The selected animals were randomly allotted to 5 groups (n=5 per group). The animals were treated orally thus: Group 1 was the control group and received 2 ml/kg of normal saline; group 2 received 25 mg/kg dihydrocodeine; Group 3 received 150 mg/kg extract; group 4 received 300 mg/kg extract and group 5 received 600 mg/kg of the extract. An hour after administration, they were re-exposed to citric acid aerosol (as earlier described) and the latency of cough and cough count were recorded. The procedure was repeated at hours 2 and 3 after treatment. Antitussive activity was then evaluated in each guinea-pig as the percentage reduction in the number of coughs also known as percentage suppression of cough and percentage increase in latency of cough. The results revealed that Uca tangeri exhibited a dose dependent percentage increase in cough latency period as well as percentage increase in suppression of cough which was inferior to dihydrocodeine, but significantly greater than normal saline and basal levels.

Balance functions and primitive reflexes in dyslexic children

Background Dyslexia is considered a neurodevelopmental disorder accordingly; investigating primitive reflexes – which considered as indicator for neuromotor maturation – possibly be of clinical value for evaluating dyslexic children. Objectives To assess balance functions and primitive reflexes in dyslexic children. Material and methods The study was conducted on 60 children divided into two groups. Control group consists of 20 normal children and study group consists of 40 children with dyslexia (diagnosed by Arabic Reading Screening test (ARST) and Modified Arabic Dyslexia Screening Test (MADST). Both study and control groups aged from 6 6/12 to 9 years old. They were subjected to clinical diagnostic tests for primitive reflexes and balance function tests (office tests, computerized dynamic posturography (CDP), sensory organization test (SOT)). Results Dyslexic children have poorer balance functions compared to control group. Sixty seven percent of the study group has retained primitive reflexes. Conclusions Dyslexic children have poorer balance functions in challenging situations and have retained primitive reflexes indicating delayed neural maturation. Dyslexia is a medical complex that needs assessment and management of balance functions and primitive reflexes for better quality of life.

The Correlation between Residual Primitive Reflexes and Clock Reading Difficulties in School-Aged Children-A Pilot Study.

The aim of the pilot project was to research relationships between the occurrence and level of intensity of primitive reflexes in primary school children, the ability to read an analogue clock and to tell the time. A group of 28 children (14 girls and 14 boys) who attended Montessori Primary School was examined. In the first stage, participants were assessed for the presence of five primitive reflexes (PR): the asymmetrical tonic neck reflex (ATNR), symmetrical tonic neck reflex (STNR), spinal Galant reflex, tonic labyrinthine reflex (TLR) and Palmar grasp reflex. Romberg's test was employed to identify signs of difficulties with control of balance and/or proprioception. In the second stage, pupils underwent tests that challenged their ability to read a clock and calculate passing time. After summing up points obtained for all tests, a correlation coefficient was made from which the results were derived. There is a negative correlation between the ability to read an analogue clock and the continued presence of some primitive reflexes. Lower neuromotor maturity (higher points of PR) correlates with lower ability to read a clock. The highest correlations between difficulty with telling the time were found with persistence of the STNR, ATNR and Romberg's test.

Plantar Grasp sign as a screening tool for Orthostatic Tremor (OT)

IntroductionOrthostatic tremor (OT) is a rare neurological disorder characterized by a sensation of instability while standing. Very few clinical signs have been described for OT to date. Finding other symptoms and signs could prove valuable for this hard-to-recognized disease. MethodsThis protocol is part of the University of Nebraska Medical Center Orthostatic Tremor longitudinal study. It was noted that OT patients flex their toes and sometimes the foot arch while standing (Plantar Grasp). They reported doing this to “grab” the floor and improve stability. This paper analyses the diagnostic test characteristics of the patient-self-reported Plantar Grasp, a new sign in OT. ResultsThere were 34 OT patients (88% females), and 20 controls (65% females). Eighty-eight percent of patients with OT reported the plantar grasp sign and none of the controls. The Plantar Grasp Sign was found to be very sensitive (88%), and extremely specific (100%) in our cohort. Non-weighted Negative Likelihood Ratio (NLR) was 0.12. And the 3% prevalence-weighted NLR was so low that the negative post-test probability was close to zero. ConclusionDue to its high sensitivity, specificity, and ideal likelihood ratio, we propose that the Plantar Grasp sign could be considered to screen patients with possible OT. Further studies are needed to determine the specificity of this sign in OT versus other balance disorders.

Motor rehabilitation of aphasic stroke patient: the possibility of Rood's approach.

Motor rehabilitation of aphasic stroke patient: the possibility of Rood's approach.

Primitive Reflex Integration and Reading Achievement in the Classroom

Primitive Reflex Integration and Reading Achievement in the Classroom

"You are Never Too Old to Overcome ADHD” - Case Report

Case study about a 57-year-old head of publishing house, who suffered from ADHD with much impulsivity and mood changes, depression and eating disorders as well as persisting primitive reflexes, that worked as catalyst to the above-mentioned symptoms. This case report shows, how it was able to overcome all these conditions in 13 months of combined treatment with LDX in decreasing dosage, Neurofeedback (z-score training) and Reflex Integration Program (RIP®), that have been developed and published in 2021. Treatment results have been continually monitored with the OPATUS CPTa, a test measuring attention, impulsivity, and hyperactivity. Two q-EEGs have been performed, one at baseline and other after conclusion of NFB and several clinical appointments monitoring neurological improvement and psychiatric evaluations in order to continue the decreasing dosage of medication, which was stopped after 10 months of the initial assessment. This case report represents uniquity, because such a quick improvement was not expected in this short time, which would be normal, when treating children with equal conditions.

Acute Bilirubin Encephalopathy: A Propos of 151 Cases Collected during a Multicentric Study in Senegal

Introduction: Bilirubin encephalopathy is a debilitating complication of severe neonatal unconjugated bilirubin jaundice. The aim of this study was to determine the frequency of occurrence of this complication and to describe the diagnostic and prognostic aspects in Senegal. Materials and Methods: This was a multicenter, descriptive and analytical study conducted in 32 neonatal units of various levels, with retrospective (January to December 2020) and prospective (January to August 2021) collection. All neonates hospitalized for acute bilirubin encephalopathy were included. The diagnostic criteria were the presence of jaundice associated with neurological signs (muscle tone disorders, abnormal movements, convulsions, etc.), with no other obvious etiology found. The data were entered and analyzed using SPSS version 23 software. The significance threshold was retained for a p-value Results: We registered 151 patients. The mean age was 6 days and the sex ratio was 2.5 (clear male predominance). The majority of newborns were from Dakar (51%). Twenty-two (22%) were premature and 32% had low birth weight. Half of the newborns (50%) came from home and 87% were exclusively breastfed. The average time to consult was 3 days. Neurological signs were dominated by decreased primitive reflexes (74%), abnormal movements (59%) and lethargy (50%). Dehydration (30%) and anemia (26%) were often associated. The mean bilirubin level was 416 umol/l. Neonatal infections (19%) and Rhesus (16.7%) and ABO (8.7) incompatibility were the main causes. One third (33%) of patients had received intensive phototherapy and only 2% had received exchange blood transfusion. The case fatality was 48.9%. Conclusion: Bilirubin encephalopathy remains a major concern in Senegal. It is associated with high mortality and numerous neurological sequelae. Progress in terms of early detection and appropriate management is urgently needed on a national scale.

Associations between maternal phthalate exposure and neonatal neurobehaviors: The Taiwan maternal and infant cohort study (TMICS)

Previous studies have shown associations between prenatal phthalate exposure and neurobehavioral changes in children. However, few studies have focused on neonatal neurobehavioral development. This study aimed to examine the associations between prenatal phthalate exposure and neonatal neurobehavioral development in the early days of life after birth.This cohort study included 283 mother-infant pairs who participated in the Taiwan Mother Infant Cohort Study during 2012–2015. Each mother was interviewed, and urine samples were collected during the third trimester of pregnancy (weeks 29–40). Eleven common phthalate metabolites in maternal urine were analyzed. The Chinese version of the Neonatal Neurobehavioral Examination was used to evaluate early infant neurobehavioral development within five days of birth. We performed multiple linear regressions to explore the associations between phthalate exposure and neonatal neurobehavioral development. Sex differences in the association between phthalate metabolites and neonatal neurobehaviors were noted. Among girls, tertiles of phthalate metabolite concentrations were associated with worse behavioral responses and tone and motor patterns in the high-molecular-weight phthalate (HMW) and low-molecular-weight phthalate (LMW) groups. Girls in the highest tertile of di-2-ethylhexyl phthalate (DEHP) and mono-isobutyl phthalate (MiBP) had a negative association with tone and motor patterns. Girls in the highest tertile of mono-n-butyl phthalate (MnBP) and MiBP showed a negative association with behavioral responses. In contrast, tertiles of phthalate metabolite exposure were associated with improved neurobehaviors in mono-methyl phthalate (MMP) among boys. The highest tertile of MMP was positively associated with behavioral responses, primitive reflexes, and tone and motor patterns. Our findings suggest that maternal phthalate exposure affects neonatal neurobehavioral development in a sex-specific manner. Despite the relatively small sample size, our findings add to the existing research linking maternal phthalate exposure to neonatal neurobehavioral development. Additional research is needed to determine the potential long-term effects of prenatal phthalate exposure on children.

Apert Syndrome with Agenesis of the Corpus Collosum - Case Report

Abstract Apert syndrome (Acrocephalosyndactylia type 1) belongs to the group of extremely rare congenital dysmorphic syndromes. It is characterized by craniostenosis with very early fusion of the skull and / or cranial base sutures, facial hypoplasia, symmetrical syndactyly of the fingers and toes and other systemic malformations. Multiple CNS abnormalities are common, but simultaneous occurrence of Apert syndrome and agenesis of corpus callosum is estimated about 10%. We present a male patient born after first, normal and controlled pregnancy and term, naturally birth, in which the Apert syndrome was diagnosed, based on the clinical presentation of the skull and face and syndactyly of fingers and toes. Neurological examination established generalized hypotonia and aggravated provocation of the primitive reflexes. Neurosonography showed complete agenesis of the corpus callosum, which makes this case a rare form of this syndrome. The head X-rays showed turricephalic skull shape and suture’s synostoses, which is demonstrated in more detail at computed tomography finding. The hands and feet X-rays showed bone synostosis of fingers and toes. The video-electroencephalogram recorded intermittent depression of electrocortical activity. There was conducted the multidisciplinary examination in order to examine the possibility of reconstructive and plastic surgical correction of the anomalies. The neurodevelopmental disorders in patients with Apert syndrome can be manifested by a variety of congenital malformations, but considering its rare occurrence, the significance of these abnormalities remains unknown.

From the origins to the stream of consciousness and its neural correlates.

There are now dozens of very different theories of consciousness, each somehow contributing to our understanding of its nature. The science of consciousness needs therefore not new theories but a general framework integrating insights from those, yet not making it a still-born "Frankenstein" theory. First, the framework must operate explicitly on the stream of consciousness, not on its static description. Second, this dynamical account must also be put on the evolutionary timeline to explain the origins of consciousness. The Cognitive Evolution Theory (CET), outlined here, proposes such a framework. This starts with the assumption that brains have primarily evolved as volitional subsystems of organisms, inherited from primitive (fast and random) reflexes of simplest neural networks, only then resembling error-minimizing prediction machines. CET adopts the tools of critical dynamics to account for metastability, scale-free avalanches, and self-organization which are all intrinsic to brain dynamics. This formalizes the stream of consciousness as a discrete (transitive, irreflexive) chain of momentary states derived from critical brain dynamics at points of phase transitions and mapped then onto a state space as neural correlates of a particular conscious state. The continuous/discrete dichotomy appears naturally between the brain dynamics at the causal level and conscious states at the phenomenal level, each volitionally triggered from arousal centers of the brainstem and cognitively modulated by thalamocortical systems. Their objective observables can be entropy-based complexity measures, reflecting the transient level or quantity of consciousness at that moment.