Reflex Integration in the Schools



While performing the BOT-2, I ask a child to stand in tandem on my tape line. As the child attempts this skill, I immediately notice her arms internally rotating as her feet are internally rotating. She seems unable to move her legs without her arms following suit. I’ll do a little more testing, but that one thing sends up a red-flag warning—there’s an unintegrated Moro reflex.

Does it matter? Should I focus on it? Do I even mention it? Is it a school-based issue?

Let me look at this child a bit more: intelligent, emotional, impulsive, self-directed and strong-willed. Having difficulty with outbursts in school. The Moro reflex acts as a baby’s primitive fight/flight reaction and is typically replaced by the adult startle reflex by four months old. If a child experiences a retained Moro reflex beyond 4 months, she may become over sensitive and over reactive to sensory stimulus resulting in poor impulse control, sensory overload, anxiety and emotions and social immaturity. Some additional signs of a retained Moro reflex are motion sickness, poor balance, poor coordination, easily distracted, unable to adapt well to change, and mood swings.

So yes, it does appear this is impacting education. I’ve evaluated children who literally fall out of their seat in class due to an unintegrated Moro. A retained STNR (Symmetrical Tonic Neck Reflex) will impact a child’s ability to work in a desk, remaining seated while looking at the board and then down at the paper (i.e., copying information).  On the other hand, ask a roomful of adults to perform the starfish exercise (the exercise to integrate the Moro). Many will not be able to do it, which indicates that they are not fully integrated. Yet they are fully-functioning adults. Therefore, the presence of a retained reflex may not always impact education.

Assuming it is determined that the reflex is impacting education, the next issue is how to implement a reflex-integration program. Evidence shows that with daily performance of the exercises, reflexes can be integrated in about 6 weeks. However, caseloads and schedules don’t allow for a daily program, which requires creative thinking. Often I reach out to parents, have them come in, and teach them the exercises. Ideally, the program is done at home with homework. We all know it’s not an ideal world.

However, it makes no sense to me to pull a child for a 30-minute session and do integration exercises for at least half of the session, especially when the efficacy of doing the exercises one to two times a week is questionable. What else can we do? How can we help with this? Is there evidence to support these program?

To continue the discussion about retained reflexes, check out Janine Wiskind’s

Reflex Integration: Is it Relevant to my School-Based Practice

at the Eighteenth Annual Therapies in the School Conference.

~Kathryn Biel, PT, DPT