Testing for a persistent TONIC LABYRINTHINE REFLEX (TLR)

The Tonic Labyrinthine Reflex is a reflex that emerges at birth and is expected to have integrated within 2-4 months after birth.
The tonic labyrinthine reflex is tested in standing position with feet pushed together and hands alongside the body. The child is asked to tilt their head back “as if looking at the ceiling” with their eyes closed. After pausing for 10 seconds the child is then asked to bring their head slowly forward “as if looking at the toes” and holding this position for a further 10 seconds. This movement is repeated four further times.
Indications of persistent TLR may be changes to balance, changes to muscle tone, postural sway in either front-back or side-side planes, developing disorientation, loss of balance, developing dizziness or nausea.
STOP THE TEST IF CHILD BECOMES DIZZY OR NAUSEOUS
Persistence of the TLR may be associated with dyspraxia or disorientation, poor posture, poor balance, persistent toe walking, unable to sit up at a desk or holding their head in hands when sitting, as well as problems with establishing their emotional and physical balance. Persistence of the TLR may interfere with binocular vision leading to a poor sense of timing and frequent careless mistakes.
REFERENCES
Persistence of primitive reflexes and associated motor problems in healthy preschool children. Ewa Z. Gieysztor et al. Arch Med Sci. 2018 Jan; 14(1): 167-173.
Role of early-childhood reflexes in the psychomotor development of a child, and in learning. Grzywniak C. Acta Neuropsychologica, (2016), 113-129, 14(2)

[@Painfreewithjordan]

Hi thank you for these videos. how do you test reflexes on child who are unable to follow these directions. thank you

[@AskDrChristian]

Hi Jordan, great question. Are we talking a compliance issue due to age or just not wanting to do it? If they are young, you might be able to use a bell or toy and while they are sitting on a parents lap coax them to look their head up or down. Not going to be quite as effective however. You can also try using large gym balls and seeing if they are better sitting on one of those. Hope that helps! Christian

[@Painfreewithjordan]

Ok thank you. More so for toddlers with autism or adhd. But I can try to get the parents involved and do a modified testing of all reflexes.

[@AskDrChristian]

It can be really difficult to test all reflexes in all kids, and toddlers even without ASD/ADHD can be a challenge to begin with. Yes, getting parents involved is really helpful. In some cases, you have to question the usefulness is knowing the persistence of a reflex versus the difficulty in obtaining an exam result. Are you getting an accurate finding if you have to vary the technique a lot? Then the question becomes what does this reflex do? What could persistence look like? Could you make a clinical judgement based on history and observations? Have fun!

[@janinekalmar3417]

If these reflexes have not been integrated, how do you integrate them?

[@AskDrChristian]

Hi Janine, and thank you for your question. Each case presents in its own way, and as such integration or management will be dependent on what that case is showing. So I'm really sorry, but I can't tell you a specific exercise or integration method to do, as the body just doesn't work that way!