The Tonic Labyrinthine Reflex (TLR) is one of many infant primitive reflexes - an involuntary movement pattern that we are all born with. The TLR can be most easily seen in infants when laying on the tummy - it looks like the Superman position.
The TLR has two movement patterns - forwards and backward. This reflex is activated with neck flexion (forward) or extension (backward) - movement of the head up or down. When an infant looks down (neck flexion), this causes the arms and legs to flex or curl into the body. When an infant looks up (neck extension), this causes the arms and legs to extend (Superman!). The TLR is thought to help the infant with the newfound challenge of gravity. It also directly affects muscle tone due to the movement of the arms, legs, neck, and trunk.
Additionally, because head movements activate the TLR, this reflex is also directly related to the Moro Reflex. As the infant begins to gain head control, the TLR and Moro will begin to integrate, and the response in the arms and legs will begin to change - more control of the arms and legs will begin to develop.
The TLR forward pattern (flexion) emerges in utero, should be fully developed at birth, and should integrate - go away - at approximately four months of life. The TLR backward pattern (extension) emerges at birth and can begin integrating as early as three months and as late as three years of age.
Although there is no one scientific method to ensure full primitive reflex integration, there are some things to consider when discussing the integration of the TLR.
Let’s talk about sensory integration. By providing an infant with different types of sensory stimulation, new neural pathways will be developed in the brain, thus stimulating new movement and cognitive development. An article on sensory integration discussed that the engagement in sensorimotor activities promoted adaptive behaviors via neuroplastic changes - simply put, by experiencing different types of sensory activities, our brains can change and thus promote new behaviors!
So, what types of sensory activities should you provide to your newborn infant? Keep it simple!
Because every newborn is different and every experience is different, there’s no one way to guarantee that the Moro reflex will be successfully integrated by six months of age. However, you can feel more confident that your baby is getting the sensory experiences necessary for potential primitive reflex integration by using the above strategies.
Potential factors for unintegrated primitive reflexes, including the TLR, are:
Additionally, if a child has successfully integrated their primitive reflexes, a sudden or chronic bout of trauma, stress or injury can re-activate these reflexes.
While there is no guarantee for reflex integration, there are contributing factors to consider if your child has an unintegrated TLR.
As previously mentioned, the TLR is linked with the Moro reflex as well as has a direct correlation to muscle tone and head movements. These connections go even further to include vision and ocular motor skills, balance, and coordination.
Symptoms related to an unintegrated TLR in older children are:
If your child exhibits any of the above symptoms/challenges, the first step will be to talk with your pediatrician. Discuss your concerns - if your pediatrician is familiar with primitive reflex integration, they may already have a plan of action ready. If your pediatrician is unfamiliar with primitive reflex integration, feel free to share what you've learned! If you ever feel uncomfortable or that your concerns are being pushed to the side don’t be afraid to seek out a new pediatrician.
Many Occupational Therapists (OT) are trained in primitive reflex integration techniques. Seek one out! Talk with friends and family members to see if they know anyone specific. Use Facebook groups and Instagram to find someone who has training. Physical Therapists (PT), cranio-sacral therapists, and chiropractors may also have knowledge of primitive reflex integration. It can take some time to locate the right professional, so don’t give up!
Meanwhile, there are some different exercises and play activities that you can incorporate into your child’s daily routine that can help promote the integration of the TLR.
For babies, decreasing the amount of waking time spent in containers is the best way to integrate the TLR. When baby is awake, provide natural movement activities and as much tummy time as possible. Make sure to rotate between play in supine (on the back) and side-lying on both sides as well to prepare for the next foundational milestone (rolling) to occur!
If your child is young, under 3 years old, focus on developmental movements. Try engaging them in more tummy time activities:
If your child is older, you can still focus on the same developmental movements and incorporate tummy time into daily tasks.
If your child is struggling with some of the signs/symptoms associated with an unintegrated TLR, try some of these strategies:
As you continue on your path through primitive reflex integration, keep in mind that your child is unique and there's nothing wrong with them! Even if they have an unintegrated TLR and seem to be struggling more than other children, your job is simply to help guide them along the way and provide as much support as possible.
You and your child are doing the best you can with what you have, so keep researching and keep trying new things until you find what works. Even then, keep searching because what works now might not work forever, especially as your child grows and develops through different seasons of life!
For the ultimate education on primitive reflexes, check out our Primitive Reflex Integration Training!
Check out our podcast episode from All Things Sensory by Harkla Podcast where we discuss TLR in depth!
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