Tonic labyrinthine reflex
Original Editor - Trista Chan
Top Contributors - Trista Chan
Introduction[edit | edit source]
The Tonic Labyrinthine Reflex (TLR) refers to the response of an infant's body when held in a prone suspension. When the infant's neck is flexed, their shoulders protract and their hips flex. However, when the infant's neck is extended, their shoulders retract and their hips extend.[1]
Emergence & Integration[edit | edit source]
The Tonic Labyrinthine Reflex emergences by two weeks from birth. It usually integrates by 24 months.[3]
Position[edit | edit source]
Placing infant into prone and supine position
Stimulus & Response[edit | edit source]
In the prone position, the baby will flex the neck and limbs. In supine position, the baby will extend the neck and limbs.
Clinical Implication[edit | edit source]
Infant pattern of movement is often assessed in neonates and children as a part of their neurological assessment. Absence, abnormal or persistent primitive reflex may be associated with problematic central nervous system or motor development.[4]In particular, the disintegration of the Tonic Labyrinthine Reflex is associated with delayed neuromotor development. [5] Children with persistent TLR may experience difficulties with balance, orientation, and restoring emotional and physical equilibrium.[6] This can also affect binocular vision, which results in frequent timing errors.[6] A common clinical presentation of persistent TLR in children is toe- walking, especially in children with autism spectrum disorder.[7]
Testing for Persistent Tonic Labyrinthine Reflex[edit | edit source]
To test for the Tonic labyrinthine Reflex, the child should stand with feet together and arms beside the body. The child will then lift the head up, close the eyes and hold for 10 seconds. After 10 seconds, the child should look down slowly and hold for another 10 seconds. Repeat the whole process for four times. [6]
If a child has persistent Tonic Labyrinthine Reflex, they may experience various symptoms such unsteady balance during tests, alteration in muscle tone, disorientation or loss of balance completely.[6] It is important to supportive child throughout the test and cease testing if the child becomes dizzy or nauseous.
Physiotherapy Management[edit | edit source]
Physiotherapists has an important role in improving participation in children with persistent primitive reflex. Physiotherapy intervention can help these children to improve their gross motor function, such as providing exercise intervention for reflex integration, and tailoring exercises programs to target specific functional limitations and structural impairments (e.g., balance and coordination).[9] Positioning exercise, in particular, is found to be helpful in improving TLR integration and enhancing function in children with Cerebral Palsy.[10]
Multidisciplinary Team[edit | edit source]
Persistent TLR can interfere with participation in daily activities. It may be associated with developmental language disorders[14], learning difficulties, and behavioural problems[9], in addition to delayed neuromotor development. Therefore, managing persistent TLR typically requires the involvement of a multidisciplinary team, including but not limited to, paediatricians, physiotherapists, occupational therapists, speech pathologists and psychologists.
References[edit | edit source]
- ↑ Polin RA, Ditmar MF. Pediatric Secrets E-Book. St. Louis: Mosby; 2010.
- ↑ Primitive reflexes- TLR [Internet]. YouTube. YouTube; 2015 [cited 2023Apr22]. Available from: https://www.youtube.com/watch?v=c0hoBFskgg0
- ↑ Capute AJ, Wachtel RC, Palmer FB, Shapiro BK, Accardo PJ. A prospective study of three postural reactions. Developmental Medicine & Child Neurology. 2008;24(4):314–20.
- ↑ P; MAKT. Primitive reflexes [Internet]. National Center for Biotechnology Information. U.S. National Library of Medicine; [cited 2023Apr22]. Available from: https://pubmed.ncbi.nlm.nih.gov/32119493/
- ↑ Mandich M;Simons CJ;Ritchie S;Schmidt D;Mullett M; Motor development, infantile reactions and postural responses of preterm, at-risk infants [Internet]. Developmental medicine and child neurology. U.S. National Library of Medicine; [cited 2023Apr22]. Available from: https://pubmed.ncbi.nlm.nih.gov/8168658/
- ↑ 6.0 6.1 6.2 6.3 M; GEZCAMP-B. Persistence of primitive reflexes and associated motor problems in healthy preschool children [Internet]. Archives of medical science : AMS. U.S. National Library of Medicine; [cited 2023Apr22]. Available from: https://pubmed.ncbi.nlm.nih.gov/29379547/
- ↑ W; APJB. Toe walking in autism: Further observations [Internet]. Journal of child neurology. U.S. National Library of Medicine; [cited 2023Apr22]. Available from: https://pubmed.ncbi.nlm.nih.gov/24563477/
- ↑ Testing for a persistent tonic labyrinthine reflex (TLR) [Internet]. YouTube. YouTube; 2020 [cited 2023Apr22]. Available from: https://www.youtube.com/watch?v=b7m7poKTxaQ&t=18s
- ↑ 9.0 9.1 Pecuch A, Gieysztor E, Wolańska E, Telenga M, Paprocka-Borowicz M. Primitive reflex activity in relation to motor skills in healthy preschool children. Brain Sciences. 2021;11(8):967.
- ↑ R; SSKISSN. Effect of positioning on tonic labyrinthine reflex in cerebral palsy: A Single-Centre Study from Lahore [Internet]. JPMA. The Journal of the Pakistan Medical Association. U.S. National Library of Medicine; [cited 2023Apr22]. Available from: https://pubmed.ncbi.nlm.nih.gov/31000848/
- ↑ Exercise #1 for retained TLR Reflex [Internet]. YouTube. YouTube; 2019 [cited 2023Apr22]. Available from: https://www.youtube.com/watch?v=vWBbZJBUnzs
- ↑ #2 in TLR Reflex Integration Series [Internet]. YouTube. YouTube; 2019 [cited 2023Apr22]. Available from: https://www.youtube.com/watch?v=AuQVziNPwcE
- ↑ #3 in TLR Reflex Integration Series [Internet]. YouTube. YouTube; 2019 [cited 2023Apr22]. Available from: https://www.youtube.com/watch?v=gmig3y9Ra_4
- ↑ Matuszkiewicz M, Gałkowski T. Developmental language disorder and uninhibited primitive reflexes in young children. Journal of Speech, Language, and Hearing Research. 2021;64(3):935–48.
