Reflex Integration Exercises

Zion Dixon
PEP 498 Project

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 Table of Contents
ATNR………………………………………………………….…………………3
Babinski Reflex…………………………………………………………..4-5
Babkin Palmomental Reflex……………………………………..…..6
Bauer Crawling………………………………………………………..…7-8
Bonding Reflex………………………………………………………….….9
Foot Grasp………………………………………………………………10-11
Foot Tendon Guard…………………………………………………12-13
Hand Pulling……………………………………………………….….14-15
Hands Supporting…………………………………………………..16-17
Landau Reflex……………………………………………………………..18
Moro Embrace Reflex…………………………………………….19-20
Robinson Hand Grasp………………………………………………….21
Spinal Galant Reflex…………………………………………………….22
Spinal Perez Reflex……………………………………………………...23
STNR……………………………………………………………….………24-25
TLR………………………………………………………………………….26-27
Trunk Extension Reflex……………………………………………28-29
Bibliography.………………………………..………………………..30-31

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 ATNR
History/Background
ATNR or Asymmetrical Tonic Neck Reflex is a
reflex that we, as humans, are born with. ATNR helps
fetuses develop muscle tone and vestibular
stimulation. It “first emerges at 18 weeks in utero, is
fully present at birth, and should be integrated when
the baby is approximately 6 months old” (Assymetrical
Tonic Neck Reflex (ATNR), n.d.). This Reflex aids in
helping us get ourselves out of the birth canal when
being born and it is crucial in ensuring a delivery
without complications.

What is it?
ATNR is a reflex that “manifests when the
baby’s head is turned to one side. The infant’s arm and
leg on the side to which the head is turned will extend
and the opposite limbs will flex so that the child appears to be in what has been called a
‘fencer’s pose’” (Assymetrical Tonic Neck Reflex (ATNR), n.d.). ATNR is one of the most
important reflexes for survival and integration of this reflex is key in toddlers and infants
beginning to crawl. Infants who stand or walk, without crawling first, may retain ATNR, which
can lead to complications (Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova
Neurosensorimotor Reflex Integration, 2015).

Purpose
Without ATNR fully integrating, complications can arise. Some of the complications
include: Poor smooth eye movements, poor handwriting, ADD/ADHD, learning problems,
difficulty throwing and catching a ball, and poor balance when moving head side to side
(Assymetrical Tonic Neck Reflex (ATNR), n.d.). These are just some of the problems. In pediatric,
OT by performing the reflex exercise, which involves the child laying on their belly, turning their
head side to side and extending the limbs each way the head is turned, and flexing the limbs
opposite of the way the head is turned (Masgutova & Masgutov, Parent's Guide to MRNI:
Masgustova Neurosensorimotor Reflex Integration, 2015). By performing this exercise, children
and the OT can help integrate ATNR.

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 Babinski Reflex
History/Background
The Babinski Reflex was first described in 1899
by a neurologist named Joseph Babinski. This reflex is
often used for neurological examination because it is
usually easy to elicit without sophisticated equipment. It
also widely used because it does not require much
patient participation, so it can be done even on patients
who are unwilling to participate (Acharya & Dewey,
2018).

What is it?
The Babinski Reflex is a reflex that “tests the integrity of the cortical spinal tract”
(Acharya & Dewey, 2018). To stimulate the Babinski or Plantar Reflex, one must stimulate the
lateral plantar aspect of the foot. For infants and toddlers up to 2 years old, it would be
considered normal for the toes to extend or flare out when this part of the foot is stimulated.
When the reflex is unintegrated, the child’s toes would still extend or flare when that child is
older than the age for that to be considered a normal response (about 2 years old). As the
reflex integrates, the toes should curl when the lateral plantar of the aspect is stimulated,
rather than extend (Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova
Neurosensorimotor Reflex Integration, 2015).

Purpose
Unintegrated Babinski reflex may cause other complications to arise. Some of these
complications may include: lack of grounding and stability, poor balance and postural control,
poor bilateral integration, timidity, challenges with oral skills and articulation, and difficulties
with gross and fine motor coordination. The reflexes can be integrated using exercises. One
exercise that can be used for reflex integration involves the individual lying on their back or
sitting. “The therapist then will stroke the foot in the plantar area from the heel to the little toe.
After this, the therapist will then put one hand on top of the foot and the other hand under the
big toe. The therapist will the rotate the foot inward and up with the big toe directed toward
the head. Then the therapist will spread the metatarsus and toes like a fan. Once the foot is in
this position, the therapist will give a light stretch to the whole leg for 5-7 seconds and repeat
this exercise on the other foot” (Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova

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Neurosensorimotor Reflex Integration, 2015). Doing this exercise will help integrate the
Babinski reflex.

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 Babkin Palmomental Reflex
History/Background
The Babkin Palmomental Reflex is a reflex
that is found in newborn babies. The Reflex is
thought to be primitive in nature due to the fact
that one study found that the reflex was found in a
premature infant that was only of 26 weeks
gestation (Arthur H. Parmelee, 1963). The study
also found that the reflex was easier obtained in
smaller premature infants, but had a greater
intensity in the larger infants (Arthur H. Parmelee,
1963).

What is it?
The Babkin Palmomental Reflex is the infant reflex that occurs when pressure is put on
the palms of both hands. When pressure is applied to the palms, the infant should show head
flexion and rotation along with opening of the mouth. This reflex is instinctive for the infant
searching for food. The reflex is connected to eating reflexes such as sucking, swallowing, and
chewing. The reflex does begin development at the 9th week utero and should be fully
integrated by 4 months old (Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova
Neurosensorimotor Reflex Integration, 2015).

Purpose
The reflex, if unintegrated, can allow for other complications to arise. Some of the
complications include: poor postural control, tension in jaw or overflow of lip and tongue
movement associated with oral-motor tasks, delay in speech/articulation, fears, and poor
muscle tone regulation in the upper body and oral-facial system. One exercise that can be done
to help integrate this reflex involves 3 steps. “Step 1: Press the palm of the child with the
thumbs in the middle of the palm. Touch both palms at the same time and then both pals
individually. Step 2: Ask the child to open their palms slowly while breathing outward with a
relaxed jaw and then inhale with relaxed hands. Step 3: Have the child close their hands into
fists. Firmly hold both of their fists and ask them to try to open their hands within your grasp.
The child should feel an automatic opening of their jaw” (Masgutova & Masgutov, Parent's
Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015). By doing this
exercise, it can help the Babkin Palmomental reflex begin to fully integrate.

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 Bauer Crawling
History/Background
The Bauer Crawling Reflex is reflex that
appears at around 28 weeks in utero. As the child
grows, the reflex should fully integrate and
disappear by the time the baby is about six weeks
old, but usually the reflex will appear again at the
child is learning to crawl (Bauer Crawling Reflex:
Delays in Learning and Motor Development is Your
Child Skips the Crawling Stage, 2016). Like many of
the other reflexes of early development, this reflex
is crucial and huge for full, healthy development of
the child.

What is it?
The Bauer Crawling reflex is a reflex that can be triggered by applying pressure to the
foot of an infant that is lying in the prone position. The reflex response is described as the
“automatic sequential pushing with the feet, accompanied by whole body cross-lateral
activation and extension of the head” (Masgutova & Masgutov, Parent's Guide to MRNI:
Masgustova Neurosensorimotor Reflex Integration, 2015). The reflex plays a vital role in the
infant’s ability to exit the birth canal and functions immediately at birth.

Purpose
The Bauer Crawling reflex “assists in the development of cross-lateral motor
coordination” (Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova
Neurosensorimotor Reflex Integration, 2015). It helps link the upper and lower body together
as well as the limbs and the core. It also plays a major role in preparing the infant for crawling
and eventually walking. The Bauer crawling reflex is important for supporting the myelination
of the lower motor neural pathways and creating the basis for integration in both brain
hemispheres (Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova
Neurosensorimotor Reflex Integration, 2015). Complications can arise when the reflex is
unintegrated such as poor gross motor planning, flexibility, coordination, speed and control,
poor space-time orientation, academic difficulties, and more. One exercise to help integrate
this reflex is a 3-step exercise. To set up, have the child lying on their stomach. “Step 1: Press
against the bottom of the foot of the child’s flexed leg and the opposite shoulder to activate the
stimulation of opposite sides of the body. Step 2: Do this same thing again, but this time, ask
them to push into your hands. Step 3: Press under the flexed knee and against the opposite

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shoulder and ask them to push into your hands” (Masgutova & Masgutov, Parent's Guide to
MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015). This exercise will help
integrate the reflex.

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 Bonding Reflex
History/Background
The Bonding Reflex is considered one of
the most important primitive reflexes. But what
exactly is a primitive reflex? A primitive reflex is a
primal movement pattern that develops while
still within the womb. Often times, these
primitive reflexes help us throughout the birthing
process as well as help us to survive our early
months or years of our lives. They also are
reflexes that operate automatically. As we grow
older, the reflexes are no longer needed and
should become fully integrated. Sometimes these reflexes, however, do not get fully integrated
which can lead to complications (Galvin, 2015).

What is it?
The bonding reflex is a reflex that is the instinctive love/attachment found in newborns,
infants, children and even adults. It is a complex reflex that influences us, as humans, at both
the physical and emotional level. It creates a feeling of love and safety based on kinesthetic
integrity. Overall, this reflex helps give us a feeling of overall comfort, harmony, and well-being.
It can also trigger attachment to parents, caregivers, and whole family unit (Masgutova &
Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).

Purpose
This reflex, like many others, can bring about other complications if the reflex is not
integrated fully. Some of the complications that can arise include: poor stress management,
pessimism, fear/worry/depression, emotional fragility, poor self-identity, self-rejection,
tendency for isolation, lack of trust in others, etc. There are a couple exercises to help this
reflex integrate. One exercise involves the use of deep proprioceptive pressure on the upper
and lower limbs using both hands. In this exercise, touch must be deep, soft, and comfortable
using the whole palm and held for about 7 seconds. This is called “Embracing Squeezing”. The
second exercise involves one individual sitting with their arms embracing their chest. Another
individual will sit or stand behind them and ask them to rock and breathe deeply. As this
individual rocks, quietly speak to them about their strengths and good qualities. This will tend
to draw out their self-confidence and dreams for their future. Doing either of these exercises
are beneficial for helping the Bonding Reflex to integrate fully (Masgutova & Masgutov,
Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).

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 Foot Grasp
History/Background
The Foot Grasp Reflex is a reflex that, like many
other reflexes, is a primitive reflex. According to a study,
the foot grasp reflex shows great clinical significance
when it comes to detection of spasticity. The reflex is
“mediated by a spinal reflex mechanism, which appears
to be under the regulatory control of non-primary motor
areas through the spinal interneurons” (Futagi, Toribe, &
Suzuki, 2011). The foot grasp reflex can be regarded as
the rudiment of phylogenetic function, according to the
study. The reflexes are typically pretty “easy to elicit but
have been proven to be of distinctive clinical significance
for the early detection of infants with
neurodevelopmental abnormalities” (Futagi, Toribe, & Suzuki, 2011).

What is it?
The Plantar Grasp Reflex or Foot Grasp Reflex is a reflex that we, as humans, have
throughout the entirety of our lives for protective purposes. This reflex can be stimulated by
touching at the base of the ball of the foot. It can also be stimulated by with a loss of stability
and as a response for physical or emotional distress. The reflex typically emerges about the 11 th
or 12th week in utero. “Its maturation occurs between the 1st and 2nd years of life, but is often
reactive in children up to 3 years old or older” (Masgutova & Masgutov, Parent's Guide to
MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).

Purpose
“The purpose of this protective response is make a person more stable on the ground,
and maintain balance” (Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova
Neurosensorimotor Reflex Integration, 2015). The reflex is very important for protection of our
foot and ultimately our whole self. If the reflex does not get integrated properly, other issues
can arise. Some of these issues include: poor sensory system in feet, delay in standing, poorly
functioning gravity, grounding, and stability, which can cause lack of postural control, poor
running, jumping, or climbing, emotional instability and lack of self-confidence, delay in
articulation, and many more (Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova
Neurosensorimotor Reflex Integration, 2015). An exercise to help the foot grasp reflex fully
integrate is a 3-step exercise. “Step 1: Firmly press on the ball of the foot to activate a slight
curling of the toes. Step 2: With one hand, hold the ball of the foot and with your other hand,
press gently on the instep of the toes bringing the foot into “foot grasp” and stretch firmly to
extend the ankle joint. Step 3: Press inside the digits of the foot without fingers stretching the
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area between the digits and toes across the horizontal plane of the foot” (Masgutova &
Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).
This exercise should help integrate the foot grasp reflex.

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 Foot Tendon Guard
History/Background
The Foot Tendon Guard Reflex is a
primitive reflex that is important for the
survival, protection, and development of an
infant. Some children with autism or other
developmental problems may be “toe
walkers”, meaning they walk on their toes
rather than on their whole foot. This can be
due to extremely tight calf muscles and
tension in the tendons and muscles used to
walk with the whole foot. The tension can
cause children to walk on their toes, and the
tension can be caused by a tendon guard reflex that is not fully integrated. Therefore, children
who have autism or another developmental disability may also have an unintegrated tendon
guard reflex (Autism, toe walking, and Tendon Guard Reflex, n.d.).

What is it?
“The Foot Tendon Guard Reflex is a protective reaction to a physical or emotional stress.
The body reacts to stress by contracting the tendon to protect itself. Structurally the big toe,
foot tendons, Achilles tendon, hamstrings, sacrum area, and the whole spine including the
cervical spine, and occipital tendons are all activated by this reflex pattern” (Masgutova &
Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).

Purpose
“Improper formation of this reflex can cause poor musculotendinout regulation. Chronic
tension and lack of mobility and flexibility can cause dysfunction in this reflex pattern, and even
lead to deformities in feet, knees, hips, spine, and whole body posture” (Masgutova &
Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).
Other effects of non-integration can also arise such as delays in cross-lateral gaits and walking,
emotional instability and lack of self-confidence, difficulty standing, uneven support of body
weight on arches, and more. One exercise to integrate this reflex is a 5-step exercise. “Step 1:
Press slowly and firmly at the beginning and end of the foot arch inside the plantar surface.
Step 2: With your hand, flex the big toe towards the head and hold for about 7 seconds. Step 3:
With your hand, flex the entire foot towards the head and hold for about 7 seconds. Step 4:
With your hand, flex the entire toe and foot toward the head and hold for about 7 seconds.
Step 5: The knee is flexed at 90 degrees. Keep the heel of the foot on the table and flex the big
toe and foot towards the head and also push above the knee simultaneously” (Masgutova &

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Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).
Doing this exercise repeatedly should aid in the integration of the Foot Tendon Guard Reflex.

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 Hand Pulling
History/Background
The hands pulling reflex is a primitive
reflex that is crucial to the development and
survival of the infant. It is often found that
children with cerebral palsy will have a
dysfunctional hands pulling reflex, along with
dysfunctions with a variety of other reflexes.
Testing these different reflexes, including the
hands pulling reflexes in a part of the diagnosis
process for children who potentially have
cerebral palsy. Hands pulling specifically falls
into the medial-lateral motor coordination
aspect of cerebral palsy which means that if children with cerebral palsy have unintegrated
hands pulling reflex, they will have issues with movements on the left and right sides of their
body (Masgutova, Masgutova Method of Reflex Integration for Children with Cerebral Palsy,
2008).

What is it?
“The Hands Pulling Reflex pattern is triggered when an infant, lying down on their back
is held by the forearm at the wrist, and pulled forward into a sitting position. The expected
automatic response in this pattern is the sequence of flexion of 1) the elbows 2) the head 3) the
core and legs flexion as one whole movement attempting to sit up” (Masgutova & Masgutov,
Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).

Purpose
“Improper sequencing of the flexion of elbow, head, and core, and also extensive flexion
of the knees is evidence of immaturity of this reflex pattern.” (Masgutova & Masgutov, Parent's
Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015). As with every other
reflex previously discussed, there are complications if the reflex is not fully integrated. These
complications include: poor muscle tone in arms, poor gross and fine motor skills, speech
delays, and more. There is a 4-step exercise to integrate this reflex. “Step 1: Take the child by
the wrists and gently pull forward flexing their elbow and shoulder, attempting to bring them
into a sitting position. Their arms should be bent at 90 degrees or less. Hold that pulling
position for 7 seconds and allow a break after 7 seconds. Step 2: As you hold the child by the
wrists, have the child activate their neck muscles by attempting to flex the beck in sitting up.
Step 3: Have the child move their hands/arms in and out, side to side and alternating directions
while you provide resistance. Step 4: Hold the child’s wrist with their elbow flexed, Hold them
above their wrist joint and pull with the other hand stretching below the elbow joint for the
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shoulder to activate an automatic response of head flexion” (Masgutova & Masgutov, Parent's
Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015). Work each arm
individually. Repeat these exercise several times a day to begin to help the reflexes become
integrated.

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 Hands Supporting
History/Background
The Hands Supporting Reflex is considered
a primary postural reflex. A primary postural
reflex means that this reflex is should be in place
at conception, however, the reflex does not
emerge until different periods in brain
development. All of these reflexes are designed to
integrate as the child grows, which will give way
to more mature neurological functions (Day, n.d.).
Like almost every reflex as previously discussed,
the integration of reflexes is crucial to further
childhood development, not only physically, but
often emotionally and cognitively as well. Luckily,
there are exercises in place to help integrate the hands supporting reflex in children who did
not have this primary reflex integrate.

What is it?
The Hands Supporting Reflex is a reflex that is triggered in an infant when there is a loss
of stable vertical position. This reflex is specifically triggered when there is a loss of vertical
position when the infant is held by their chest under both arms and is moved from vertical to a
horizontal face down position. As the infant is lowered to the ground or flat surface, the infant’s
elbows and arms extend and the hands open as they reach toward the surface (Masgutova &
Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).

Purpose
There are implications to this reflex not being fully integrated. Some of these negative
effects include a tendency for anger/aggression, difficulty with constructive protection of “own
space”, more prone to injuries to upper body and face, poor personal boundaries and more.
One exercise to help integrate this reflex is a 4 step exercise. “Step 1: Have the child lay on their
back or sit. Put your thumb on the base of the palm of the child’s hands and push firmly. Slightly
increase the pressure progressively for 7 seconds. Keep the child’s elbow bent and forearm
straight with the palms open throughout the exercise. Step 2: With the child lying down, keep
their arms straight along the sides of the body. Push gently on the base of their palms to start
pushing activation with a “1-2-cha-cha-cha” rhythm in the same place. Step 3: The child bends
their arms to 90 degrees at the elbow with palms facing the ceiling. Have the child open their
palms. Gently press on the base of the child’s palms in this position with the same rhythm of “1-
2-cha-cha-cha”. Step 4: Maintain the same position from step 3, press firmly on the base of the
child’s palms, but this time have the child extend their arms toward the ceiling against the
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resistance” (Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor
Reflex Integration, 2015). This exercise will aid in the integration of the hands supporting reflex.

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 Landau Reflex
History/Background
The Landau Reflex is a reflex that
usually first appears about the 4th month of
life and is around until the infant is about 1-2
years old. After the infant is 1-2 years old, the
reflex should become integrated. This reflex
represents a combination of tonic-labyrinth,
neck tonic, and visual reflexes. When the
reflex is stimulated, the child is trying to
“counteract the effects of gravity while
looking forward to find a visual reference
point” (What is the Landau Reflex and How is
it Evaluated?, 2018).

What is it?
The Landau Reflex is seen when a healthy infant is lying face down. The reflex comes
about in response to a combination of pressure on the belly and the sight of an exciting new toy
or a beloved family member. In this reflex, the head, spine, and limbs arch backwards extending
the whole body as the infant balances on his belly. The reflex resembles a look like “Superman
or a bird in flight” (Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova
Neurosensorimotor Reflex Integration, 2015).

Purpose
There are some effects to non-integration. Some of these implications include: irregular
cranial rhythm, depression and fears, skewed visual code, difficulty understanding new
information, decreased motor activity, structural and postural disorders, and lack of ability to
concentrate on details. There is a 2 step exercise to aid in the integration of the reflex. “Step 1:
With the child lying on their stomach, ask the child to extend their head, upper trunk, and legs
backward. Place your hands on the back of their head at the base of the skull and above the
ankle joints. Apply pressure behind both legs and the back of the head at the same time. Step 2:
Ask the child to lift their head, upper body, and legs, or just behind their knees, depending on
their physical condition. Next, apply pressure on one leg and then both legs from the front of
their body. Ask them to press against your hands” (Masgutova & Masgutov, Parent's Guide to
MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015). Completing this exercise over
time will help in the integration of the Landau Reflex.

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 Moro Embrace Reflex
History/Background
The Moro Embrace Reflex is a reflex
that is sensitive the infant’s level of alertness.
Normally a depression or absence of the Moro
Reflex is due to a disturbance of some kind in
the central nervous system (Volpe, n.d.). “The
Moro Reflex, along with ATNR, is one of the
best-known and best-studied reflexes of child
neurology. It is present in almost all newborns
except for premature babies” (Volpe, n.d.).
There has been debate whether the Moro
response and the startle response are
continuous patterns, but because of the fact
that both the Moro and startle responses
appear at birth, they are thought to be discontinuous. “The Moro Reflex usually reaches its
peak at 2 months and diminishes by 4 months” (Volpe, n.d.).

What is it?
The Moro Embrace Reflex is “triggered by a sudden change of the infant’s head position,
usually tilting it backward by 30 degrees. In response, the infant opens the core of their body,
extends the arms and fingers, and takes a deep breath in and holds it. Next, the infant closes
the core by flexing the limbs, making fists and exhaling, often crying. In the final embracing
phase, the infant is ready to calm down and find comfort by hugging a person/toy” (Masgutova
& Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration,
2015).

Purpose
If the Moro Embrace Reflex does not diminish and fails to integrate correctly, other
health issues will arise. Some of these issues include: negative protection, difficulty making
choices, lack of self-organization, hyperactivity, space-time disorientation, dependency or
attachment problems, negative influence on the immune system, and more. There is a 4 step
exercise to aid in the integration of the Moro Embrace Reflex. In this exercise, the child is laying
on their back. “Step 1: Bring the child’s chin forward/up extending the head backwards 30
degrees with light upright stretch of the neck muscles. Step 2: Begin with the child lying on their
back with head and limbs flexed, arms and ankles crossed, and hands in a fist. They should look
like they are curled into a ball. Then ask the child to slowly extend their limbs, open their palms,
and tilt their head back and chin up. They should look like a starfish in the position. For the step
3, the child is not on their back. Step 3: Ask the child to hug a large stuffed animal or pillow
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using their limbs and core. Their head should be on the stuffed animal or pillow. Ask the child to
press the ball with all of their limbs. This can be done from either a prone or supine position.
Step 4: With the child once again on their back, bring their opposite knee and elbow together in
maximum flexion and the apart for partial extension. Do this to both sides. By repeating this
exercise, the Moro Embrace Reflex should begin to become integrated” (Masgutova &
Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).

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 Robinson Hands Grasp
History/Background
The Robinson Hands Grasp Reflex or
Palmar Grasp Reflex is a primitive reflex that
can be observed in infants up to 4 months old.
This reflex is present until it is suppressed by
myelination of the supraspinal centers. “The
presence of palmar grasp reflex allows to
measurement of the flexor tonus necessary for
grasping movements of hands, and, possibly of
legs” (Marques-de-Moraes, Dionisio, Tan, &
Tudella, 2017). This reflex is important to the
infant because it allows the infant to perform
manual grasping in the first few weeks of life
(Marques-de-Moraes, Dionisio, Tan, & Tudella,
2017).

What is it?
“The Robinsons Hands Grasp Reflex in an infant consists of steadily gripping and holding
an object or an adult’s finger. Sometimes the infant’s grip is so strong, it can raise the baby.
With continued physical development of the infant, this reflex becomes sequentially integrated
resulting in the hands functioning more fully for more advanced physical skills” (Masgutova &
Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).

Purpose
This reflex does create a foundation for further cognition and motor coordination for
the entire body by the end of the baby’s first year of life (Masgutova & Masgutov, Parent's
Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015). Some implications of
this reflex not being fully integrated include: delay in ability to grasp/manipulate objects, poor
gross and fine motor coordination, feeling “needy”, poor speech development/communication
skills, and more. There is a 7-phase exercise that can help develop this reflex. “Phase 1: Grasp
thumb in. Phase 2: Grasp thumb outside, resting on the index and middle fingers of a closed
fist. Phase 3: Grasp with the thumb out at the side of the closed fist. Phase 4: Hanging grasp
(open palm with thumb out and all fingers curled toward palm at the second knuckle). Phase 5:
Pointing with index finger. Phase 6: Pincer Grip. Phase 7: Tri-Pod Gripping (bringing the thumb,
index, and middle finger together)” (Masgutova & Masgutov, Parent's Guide to MRNI:
Masgustova Neurosensorimotor Reflex Integration, 2015).

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 Spinal Galant Reflex
History/Background
The Spinal Galant Reflex is a
primitive reflex that aids in the birthing
process. It aids in the birthing process by
helping the unborn baby turn their body
and head down for the birth itself. It first
appears during the 10th week utero and is
often matured and integrated into the
whole body movement system by 5 to 9
months after birth (Masgutova & Masgutov,
Parent's Guide to MRNI: Masgustova
Neurosensorimotor Reflex Integration,
2015).

What is it?
“The Spinal Gallant Reflex is activated when an infant, lying on their side or stomach, is
touched on the side of the spine by stroking from top to bottom. This causes flexion of the
whole body to the side of the touch. Sometimes the infant responds by raising and extending
their leg” (Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor
Reflex Integration, 2015). “The Spinal Galant Reflex influences future development like spine
motions, stretching, stability, focusing, and concentration” (Masgutova & Masgutov, Parent's
Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).

Purpose
There are many negative effects to non-integration including: poor gross motor
coordination and motor planning, tendency for ADD and ADHD, deficits in auditory processing,
poor physical development (spine disorders), bedwetting and more. There is a 4-step exercise
to help integrate this reflex. The person is lying on their side for each step. “Step 1: Slowly run
your fingers along the side of the person’s spine from the neck to the sacrum. Repeat with the
child lying on their other side. Step 2: Press downward (toward the table or floor) on the child’s
shoulder and hip, and have them slightly resist your hands. Step 3: Stretch the side of the body
by pushing the shoulder and hip away from each other. Ask the child to resist your hands again
by bringing their shoulder and hip together. Step 4: Flex the side of the body by pushing the hip
and shoulder together, followed by stretching the hip and shoulder apart” (Masgutova &
Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).
By repeating this 4-step exercise, the Spinal Galant Reflex should begin to integrate.

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 Spinal Perez Reflex
History/Background
The Spinal Perez Reflex is
considered a primitive reflex and the reflex
is designed to help protect the infant from
harm as well as prepare the infant for
future developmental challenges such as
sitting and crawling (Spinal Perez Reflex
and ADHD, n.d.). “The Spinal Perez Reflex
emerges at 12 weeks utero and is active at
the moment of birth. It stays active until
the 2nd or 3rd year of life and integrates
with the whole body motor system
between the 3rd to 6th months of life”
(Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex
Integration, 2015).

What is it?
“The Spinal Perez Reflex is activated by moving fingers upward along the spine from the
tailbone to the base of the neck of an infant in a prone position causing the backward arching of
the trunk/torso, flexion of upper and lower limbs, lifting of the head and sacrum/pelvis, and can
be accompanied by screaming” (Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova
Neurosensorimotor Reflex Integration, 2015).

Purpose
There are negative effects to non-integration of the Spinal Perez Reflex. Some of these
effects include: lack of muscle tone regulation, incorrect hip rotation, inhibition of rolling over,
sitting up, crawling, and standing, poor head-leveling, spinal deformities, tendency for
ADD/ADHD, bedwetting, chaotic constant jumping (stimming), fears/phobias, deficits in
auditory processing, and more. There is a 4-step exercise to help integrate the Spinal Perez
Reflex and the entire exercise is done with the child lying on their stomach. “Step 1: Press and
stroke with your fingers gently/firmly along the spine from the lower sacrum to the neck. Step
2: Apply pressure on their sacrum at a 45 degree angle in a downward direction. Ask the child
to push against your hands. Step 3: After stroking the spine again, press simultaneously on the
person’s back and upper sacrum. Ask for light resistance against your hands. Step 4: Press
simultaneously on the child’s shoulder and upper sacrum. Ask them to lightly push against your
hands (repeat this with the other shoulder)” (Masgutova & Masgutov, Parent's Guide to MRNI:
Masgustova Neurosensorimotor Reflex Integration, 2015). This exercise will aid in the
integration of the Spinal Perez Reflex
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 STNR
History/Background
STNR or Symmetrical Tonic Neck Reflex is a
reflex that provides separation of body movements
between the upper and lower half of the body. It is
typically developed after the ATNR or Asymmetrical
Tonic Neck Reflex and allows the infant to defy
gravity on their hands and knees. This reflex is
often a precursor to creeping or crawling. The
reflex usually emerges between 6 to 9 months of
life and will hopefully be fully integrated into the
whole body motor system at some point between 9
to 12 months of life. This reflex is often very “short-
lived” being that it is usually only around for 6-
months maximum, but that does not make it any
less important to the future and full development
of the child (Symmetrical Tonic Neck Reflex (STNR), n.d.).

What is it?
“The Symmetrical Tonic Neck Reflex (STNR) is activated in three positions: 1) the child
sits up on their knees with their head down, elbows flexed, and bottom up 2) in the sphinx
position with arms extended and a tendency for leg flexion, and 3) on all fours with arms
extended and legs tending to flex. In all three positions, the spine extends. This reflex is
important for visual development and coordination” (Masgutova & Masgutov, Parent's Guide
to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).

Purpose
Similar to every other reflex previously mentioned, there are negative
implications if the STNR fails to integrate fully. Some of the implications include: poor athletic
skills, poor focusing or memorization, difficulty making choices, social issues, sitting on one leg
or “W” position, academic challenges, ADD/ADHD, poor differentiation and coordination of the
neck, hand, arm, and upper back muscles, poor balance and equilibrium, and more. There is a
2-step exercise that can help to fully integrate this reflex. The exercise is done with the person
sitting in the STNR position (feet tucked under the bottom, trunk arched backward with
head/eyes up, looking straight ahead and arms straight down from the shoulder with hands on
the ground). “Step 1: Ask the child to sit in the STNR sphinx position with extended spine and
head upward and slightly backward, straight elbows, and flexed legs. Ask them to keep this
posture while you give a stimulus- light pressure to the back of the head. Step 2: Be in the same
position as step 1, and into your hands for 7-8 seconds upon exhaling while you activate the
24
neck flexors and extensors by lightly pressing on the back of the head” (Masgutova &
Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).
Repeating this exercise will help the STNR to integrate fully.

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 TLR
History/Background
TLR or Tonic Labyrinthine Reflex is a
primitive reflex in children, similar to STNR
and ATNR. The TLR is the opposite of the
STNR. In the STNR, children’s limbs extend
when their head is tilted back, in TLR, their
limbs fold in when their head goes down. The
Tonic Labyrinthine Reflex should be fully
present at birth and should remain present
until about 4 months old. This reflex plays a
role in the birthing process along with several
of the other primitive reflexes. (Reflexes,
n.d.).

What is it?
“The Tonic Labyrinthine Reflex (TLR) is activated by a person’s body and head positions
relative to their midline and gravity line. The TLR takes part in developing control mechanisms
for whole body muscle tone. In extension (head back), the tone of the head, back, and leg
extensors increases. In flexion (head forward) the tone of the neck, back, and leg flexors
increases. This trains the neurophysiological links between the proprioceptive and vestibular
senses” (Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor
Reflex Integration, 2015).

Purpose
Some negative effects of non-integration of the TLR include: poor ability to resist gravity
and lack of postural control, apathy/easy fatigue, delayed crawling/walking, poor muscle tone
regulation, and poor perception and confusion of time and space. One exercise to help
integrate TLR is a 4-step exercise. During steps 1/3, the child is in the TLR flexion position face
down. The knees should be tucked under them with they head down toward the ground and
their arms bent with elbows and forearm on the ground. For steps 2/4, the child is lying on their
back. “Step 1: The child is holding the TLR in flexion position. Touch them lightly on their
forehead and ask them to move into your hand lightly. Step 2: The child is holding the TLR in
extension position. Touch the stably on the back of their head and ask them to move gently into
your hand. Step 3: The child is holding the TLR in flexion position as above in Exercise 1. With
one hand, touch them lightly on their forehead and with the other touch one shoulder from the
front. Ask them to move simultaneously into your hands with head and shoulder both flexing
forward. Repeat for the forehead and other shoulder. Step 4: The child is holding the TLR
extension position as above in Exercise 2. With one hand, touch them stably on the back of
26
their head and with the other, hold one shoulder from the front. Ask them to move
simultaneously into your hands with their head and shoulder both extending backwards.
Repeat for the other side” (Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova
Neurosensorimotor Reflex Integration, 2015). This exercise will aid in the integration of the TLR.

27
 Trunk Extension Reflex
History/Background
The Trunk Extension Reflex, like many
of the other previously discussed reflexes is a
primary reflex. Primary reflex means that
these reflexes should be in place from
conception, however, the reflexes will
emerge at different times. The trunk
extension reflex is specifically a primary
postural reflex, which puts in the same
category with the “hands pulling” and “hands
supporting” reflexes (Day, n.d.). This is
considered a primary postural reflex because
of the fact that it can affect the spine, which
ultimately affects “front-back muscle coordination and thus postural control” (Masgutova &
Masgutov, Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).

What is it?
The Trunk Extension Reflex can be seen “when an infant is held under the arms and
lifted into a vertical position with their feet on a hard surface, and they automatically extend
their trunk and stay on their toes as their body and midlines come together. Trunk Extension
Reflex is connected with ‘so-called’ Infant Stretch Reflex and influences the development of all
righting responses of the head and trunk as well as muscle tone regulation in the neck and
throughout the body” (Masgutova & Masgutov, Parent's Guide to MRNI: Masgustova
Neurosensorimotor Reflex Integration, 2015).

Purpose
There are negative effects of non-integration of the Trunk Extension Reflex, however,
there are not as many negative implications to non-integration of this reflex compared to other
reflexes. The negative effects of non-integration are tendency to bend forward/backward, toe
walking, and narrow range of perception and engagement. Although there are less negative
implications for this reflex being non-integrated, it is still very important for this reflex to
become integrated. There is a 3-step exercise to help integrate this reflex. For this exercise, the
child will either be standing, lying on their back, or sitting, depending on which step is being
performed. “Step 1: Ask the child to stand straight and extend the trunk feeling the body
midline and gravity line, and if possible, stand on their toes. Step 2: With the child lying down
on their back, explain the exercise before starting. Using your flat palms, move both feet into
maximum extension, then give a firm push toward the head as they exhale, asking them to push
back against your hands. Step 3: Ask the child to do a whole body stretching exhaling in
28
different positions: lying down, sitting, and standing. Notice their ability to keep their body
straight, head righting, eye leveling, and their ease of extension” (Masgutova & Masgutov,
Parent's Guide to MRNI: Masgustova Neurosensorimotor Reflex Integration, 2015).

29
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