Wednesday, 23 May 2012

Timing of sensory integration and reflex integration/inhibition

Continuing our discussions about retained reflexes and overall development, here are some observations and questions from Deb and Nick related to the work they have been doing with their son through RDI and through the BIRD programme.


Your discussions on the blog have been very interesting and have come at a time when we have been trying to assimilate our thoughts on the relationship between interventions to address retained reflexes, Sensory Integration Therapy and the RDI approach.

In October 2008 our son completed a course of sensory integration therapy. Through this we learnt how different types and amounts of movements can stimulate his different sensory systems and affect his level of functioning and behaviour in a given situation. We came to better understand what types of movement and sensation  we need to 'feed' our son 'in the moment' to help him with his sensory processing and integration to help him in terms of  his concentration / attention, posture, physical regulation, gross and fine motor skills etc. We see short lived improvements in these areas – enough to make a positive difference so that he can more fully participate or be more competent in an activity at that time - but this does not result in him being able to sustain these improvements over time without further/ regular feeding.

In April 2011 we commenced Reflexive Rehabilitation Development programme under the direction of B.I.R.D. The initial assessment concluded that our son (who was 7yrs 4 months at that time) had retained all of the primitive reflexes that they test for i.e.  babinski, asymmetrical tonic neck reflex, spinal gallant and the symmetrical tonic neck reflex. A year on, May 2012, at his latest assessment it was found that the asymmetrical tonic neck reflex and the spinal gallant reflex are now inhibited completely. The babinski reflex is residual in the left foot only, and we are commencing new exercises to work on inhibiting the symmetrical tonic neck reflex.

In January 2012 we commenced RDI programme and have just completed the initial education module.

Like Kimberley we too have considered the importance of timing, and this has led us to conclude that to get the best outcomes from an RDI approach, the work on retained reflexes has to happen first or be happening, if at all possible, doesn't it?  And what about sensory integration difficulties  - exercises to address these difficulties -  they need to be part and parcel of everyday life don't they.?

We are wondering what the relationship is between retained reflexes and sensory integration difficulties. They must be inextricably linked / interwoven. Can you possibly have one without the other? We are assuming you can't, and that work on retained reflexes and work on sensory integration difficulties have to go together.

But they are different aren't they?  Why do some therapists advocate sensory integration therapy and not do any work on retained reflexes, and other therapists lead with work on the retained reflexes and don't mention sensory integration therapy? How can this be?

Finally, for now anyhow, do you think our sons sensory integration and processing will improve and be more sustained, with the need for less 'feeding', once all his retained reflexes have been inhibited?

from Deb and Nick

The question about the difference between sensory integration and reflex integration and inhibition is one that I too have been pondering since this discussion started.  I'm hoping that Claire  and others can give us the benefit of their wisdom on that one!

1 comment:

  1. Gosh – not sure where to start! Think your questions pretty much embrace motor, sensory, cognitive, social and emotional development. And, of course, they are all intimately interwoven so it is always hard to unravel them to try and make sense of them developmentally. Will try and explain the bits I understand from my perspective as someone who has trained to provide a reflex stimulation and inhibition progamme (INPP) and also as the mum of a son who is autistic who had a sensory integration programme when he was younger. Others please chip in.

    As you say if you were to put SIT, a reflex programme and RDI in developmental order – you would start with reflexes then sensory therapy then RDI. Of course this is overly simplistic. Failure of primitivereflexes to be stimulated and inhibitied and postural reflexes to be established will result in sensory integration problems (as well as other stuff, like emotional problems, postural problems, behavioural difficulties, gross and fine motor issues etc). Though sensory integration problems may be caused by issues other than reflexes, eg damage to developing brain.

    What I was taught at INPP was that if you use sensory integration therapies (which complement reflex programmes) before addressing problems with early primitive reflexes – moro, ATNR, TLR particularly – the child doesn’t hold on to gains made during sensory integration therapy. This was certainly my experience with my son and left me wondering what comes before sensory development as it was clear we were working in the right area for him. I think if a person has problems only with the emergence of postural reflexes (which are developmentally later) sensory integration programmes have been successful and gains do hold.

    . And it is actually movement that proceeds sensory development. Movement that initially occurs automatically through reflexes . If a child can’t use movement to explore its world (going right back in utero as the fetus explores its body within the womb) it can’t create an physical image of either its own body, the world it can reach out and touch, and later the world it can see beyond the reach of its hand. An early crude experiment with 2 new born kittens illustrate this point. The kittens were kept together but only 1 was allowed to move its legs, the other was not. The second kitten did not develop vision. Deprived of its ability to touch the world it was impossible for its brain to make sense of th e images of light that its intact retinas passed to its brain.

    RDI addresses issues further on developmentally (though you can actually see the problems from the moment a baby is born sometimes). Clearly if an infant is unable to build up an image of its own physical self (eg where my body ends and the rest of the world starts/ my hand is attached to my arm etc) he/she is not going to be able to co-regulate with an adult as he/she will not have fully grasped the concept of them being 2 separate physical entities.