#383 - Low Muscle Tone or Retained Reflex? How to Decode the Signs

This is an interesting reflex because It can remain active through the first three to three and a half years of life. So when we're talking about integration of primitive reflexes, this is kind of like the longest one. And I think it's because it relates to posture

so much. You know, when we're talking about reflexes, we have some reflexes that are only seen in utero, and then we have the primitive reflexes that we see throughout infancy and toddlerhood. And then we have our secondary postural reflexes and even though the TLR is not a postural reflex. it is connected to the landau, which the landau is a postural reflex. And so I think that's why it sticks around for so long.

I'm Rachel and I'm Jessica. And this is All Things Sensory by Harkla. We are both certified occupational therapy assistants and together with Harkla we are on a mission to empower parents. Therapists and educators to help raise confident and strong children of all abilities. On this podcast, we chat about all things sensory, diving into special needs, occupation parenting, self-care, overall health and wellness, and so much more.

We are here to provide raw, honest, and fun strategies, ideas, and information for parents, therapists, and educators, as well as other professionals to implement into daily life. Thank you so much for joining us. Hey there, welcome back to All Things Sensory by Harklow. We're so happy to have you here for another episode. I'm Rachel. I'm Jessica. And today we're talking about a specific primitive reflex called the tonic labyrinthine reflex.

as well as muscle tone, what you need to know about both. We received a question from a customer, a listener, and they asked, how do I differentiate between low core strength and a retained TLR? during the Superman exercise. So we're gonna talk about that and we're gonna answer a listener question at the end. Yes. Another listener question, I guess.

So one way that we test for a retained tonic labyrinthine reflex or a TLR is by having the child lay prone and hold a prone extension against gravity position, which means arms are extended. Upper body is extended off the floor, legs are extended off the floor. And so that gives us a pretty clear picture of what the child's muscle tone looks like, what that reflex is doing. And then we have them flip over and do supine flexion, which is just working on the flexion side of

the muscle control. So that's really what the Superman is in regards to this question and the the person was wondering how to tell the difference between oh the child can't do the Superman pose or they can't hold it with good form, but how do I know that that's the reflex and it's not muscle tone or weak core. And we've actually gotten this question inside of our digital course a couple of times. It's a great question. I mean I always wonder it too, you know?

Yeah, like what came first, the chicken or the egg. Mm-hmm. So that's what we're gonna try to answer if possible. I don't know if there's a clear answer. We're gonna try. Yeah. Let's see how it goes. Okay.

So first we want to talk about what is low muscle tone because that is a big factor in a retained TLR. So low muscle tone, also known as hypotonia, refers to decreased tension or resistance in the muscles at rest. So the muscles are gonna be soft or floppy, they're not gonna provide enough support. for good posture, for good coordination. Um, this is different.

Different from muscle weakness and we do have another podcast episode where we talk huh? I think we have a couple now. Yeah, where we talk about the difference between muscle tone and muscle strength. Um they can occur simultaneously, but they are different. Um Now, low muscle tone can be identified in infancy or even early childhood. Sometimes it's associated with other conditions like Down syndrome or cerebral palsy, developmental delays, um, or it can just be kind of

Kind of on its own, and you can just look at a child and you can say, I can see that they have low muscle tone in their face, low muscle tone in their hands, their core, their lower body. Um, so you can see. See it once you know what to look for. Mm-hmm. Yeah. And this is different from hypermobility as well.

you think about a child or an adult who's hypermobile and they can like, you know, contort themselves and they're, you know, double jointed. Yeah. And you know So that has more to do with their joints and ligaments. Yeah. Yeah. Yeah. Not necessarily a tone challenge. Yeah. That was a good I good point. Yeah.

So the TLR is a primitive reflex that is present at birth and it really helps the infant recognize what gravity is. They've been in this world without gravity for n you know, nine, ten months and Now they come out and they're like, whoa, what is this? I have to like actually work my muscles. This is tough. And the reflex splits the body in half from front to back. So there's really two different sectors of this reflex. You've got the flexion side,

And then you have the extension side. And the Superman position is really testing the extension side of it. And the supine flexion or the bouncy ball hold or banana. Or banana is really testing the flexion side of this reflex. reflex. And so really it's helping baby develop muscle tone and holding their muscles against gravity, their body against gravity.

Um we see babies who are struggling with tummy time. They are struggling to really integrate this reflex. Um we see a lot of connections too with the development of the vestibular system and um recognizing body in position to space and gravity

um, you know, the vestibular system is in the inner ear, so w it's just it's it's all connected. That's what we're getting to. It's all connected and and the reflex really just helps develop extensor tone, flexor tone, muscle strength, um yeah anything else that I missed? No, I was just gonna comment that this is an interesting reflex because it can remain.

active through the first three to three and a half years of life. So when we're talking about integration of primitive reflexes, this is kind of like the longest one. And I think it's because it relates to posture so much.

much. You know, when we're talking about reflexes, we have some reflexes that are only seen in utero, and then we have the primitive reflexes that we see throughout infancy and toddlerhood. And then we have our secondary postural reflexes and even though the TLR is not a postural reflex. It is connected to the landau, which the landau is a postural reflex. And so I think that's why it sticks around for so long. Yeah.

I agree. As the toddler starts walking and running, jumping, skipping, all of those skills that require posture and muscle tone. Yeah.

So I that's what that's my theory. I agree. Yeah. I think it's a great theory. No, thank you. Yeah. Okay, so Moral of the story here, what does core strength look like or low core strength. Um which can be related to low muscle tone. Yes. But if we're trying to isolate low co uh weak core or weak core muscles, we can see fatigue after just a few seconds. While we're holding that Superman position, we can see they are either like

over extending in that position, like they're really extending, or they're really struggling to get into a good extension position. Their neck is down, their arms are gonna be bent rather than straight, their knees are gonna be bent, they're really gonna struggle. to get into a good position. But you'll also see improvements. in this Superman position with continued repetition and you'll see progress

if it truly is core street weak core. And some other things that I was thinking about for you know weak core muscles is we're gonna see children who are more like slumped in their posture when they're outside of the superman position. Yes. Just like just day to day. Yes.

Yes, exactly. You're also gonna see them, you know, when they're sitting on the floor or sitting in a chair, they're gonna have a very rounded back because they're not activating those core muscles. We're gonna see challenges with sports. Or challenges with climbing, challenges with just overall movement activities. We might see that they're clumsy because really are I'm actually taking a course on the core right now and

some professionals actually identify that the core involves the hips all the way up to the shoulders. Um, so when you think of the core in that way. you know, the front of the core, the back of the core, the hips, the shoulder girdle. Like there are so many movements and activities that involve those muscles that if there are challenges in those areas, we need to look at the core. Mm-hmm. Yeah, definitely.

So then what a retained TLR might look like is they are struggling to even get into that position, that prone extension. position properly. They don't have good form with it. They either are asymmetrical in how they extend. So maybe like their upper body extends first and then their lower body. and maybe they're like wavering side to side. I do see the wavering side to side though with a weak core as well. So that's a tough one to differentiate. Um

and then struggling to improve the prone extension or the the Superman position despite continued repetition and practice. Mm-hmm.

So that's something to think about. Separating the two can be difficult, but generally when we're testing a TLR with a Superman and with a Supai inflection. It's difficult to differentiate between a weak core and a retained reflex because oftentimes you know what came first the chicken or the egg. They have a retained TLR, so they have a weak core.

core, they have a wheat core, so they probably have a retained TLR as well. They probably didn't like tummy time. So what I will do is I generally will test this reflex in two different ways. I'll do the prone, the supine test, and then I'll have them stand up and then I'll have them look up to the ceiling and close their eyes and I'll observe what their body does without the

strength aspect included. And then I get a really good idea of like what their body is doing, how they're compensating when they're when they have the neck flexion and the neck extension as well. So um I think that would be a really important takeaway from this episode is if you are just doing the Superman and supine flexion testing.

then you should add in the standing test as well to get a better picture. We do teach that in our course. We do. We teach both. The other thing would be to also identify if they have Other retained primitive reflexes, specifically if they have a retained moral reflex, because the TLR requires an integrated moral reflex to integrate. So if the child also tests positive for a retained moral reflex, Then we can

I'd say confidently say that there's likely a retained T L R as well. But we also wanna look at their day to day life and are they exhibiting signs of challenges related to core strength and or challenges challenges related to the T L R. We also wanna id identify those functional implications at the same time. Yeah, and with a retained TLR sometimes we see other challenges like poor organization, poor time management. Some of those

you know, more executive functioning side of things rather than just the poor balance, the poor motor coordination, the poor vestibular processing, poor auditory processing as well. So there's definitely more factors that

coordinate with a retained TLR than just a weak core and poor balance and coordination. So making sure that we're looking at that whole picture and the function as well. Yeah, and that was gonna lead me to my next point, which is I don't want us as practitioners specifically to get so stuck on well is it the TLR or is it the core? What do I address first? I don't want us to get so stuck in these little

spots. It's like we need to look at our clients as a whole. We need to look at the whole picture. What are they struggling with in their daily routines? Are they struggling in school? Why? What is what is causing these challenges? And what can we do to intervene versus getting so stuck on those like specifics? Because then I do think that it causes.

challenges for us to then provide helpful interventions. Exactly. So if you wanna learn more about primitive reflexes, you should check out our digital course where we do teach you more about what primitive reflexes are, how they integrate, what it looks like if they don't integrate. And then we teach you how to test.

And we teach you the specific exercises for integration as well as some other play-based activities to add into the routine. If you're an OT practitioner, you can get continuing education through AOTA. when you take the course and then you also get the physical workbook, which if you follow our Instagram, All Things Sensory Podcast, um, anytime I go into the clinic on Tuesdays and Thursdays,

Um, if one of my other fellow therapists is using one of our workbooks, I'll like snap a picture or video. And right before I went on vacation a couple of weeks ago, um one of the other therapists was creating a primitive reflex home program for a client and was going through the work.

workbook book and I took a video of it. So those workbooks, especially for clinicians, is so such a valuable piece because you can have the workbook in your office, you can make copies, send home programs home and it's just so simple and easy. Yeah, I feel like that is really a big part of it too. Like we created that workbook because there was nothing else like that.

available for practitioners and it was like this is what we needed. We selfishly created it for us because we wanted something to just make copies, send home for home exercise programs. Oh, you need to learn how to test the TLR. Oh, okay, let's flip this and get a quick refresher rather than having to go back into the course. It's just like it's all there.

It's all there. So if you are listening to this and you're like, I just need a few quick intervention strategies, we will not leave you hanging. We'll give you a couple of activities that you can implement to both work on the TLR and both work on um some core strength. So the first one is crawling, mm-hmm, just getting on the floor and crawling, you know, reciprocal movements, crawling with the head looking up, hands pointing forward. We don't want

our fingers to be like this or our hands to be like that. We want hands forward, not externally, internally rotated and crawling forward, crawling backwards, crawling through tunnels, crawling over obstacles. Just crawling. Yeah. I think my favorite activity for it would be to do like ball walkouts and activities over the therapy ball.

So whether it's a peanut ball or the round therapy ball, having the child lay on their stomach, walk out on their hands and hold that like plank position and do an activity, hold it for five to ten seconds as a strengthening exercise. walk back and continue on and add that into an obstacle course, send it home for them to do at home. But doing those ball walkouts over the therapy ball is gonna be great for the core. Definitely. Alright, so

One little quote from a research article that is, you know, just my love is finding some research articles. I actually just got a question the other day Someone said that it was a parent and she said, My OT said there isn't a lot of research to support the interventions of primitive reflex integration. So that's why we're not doing it. And I'm like, if that's what your OT is saying, they're very closed-minded.

You know me Well and they're not doing any research. And they're not doing the research because if you sit down, you will go down the rabbit hole of the research and you will find some really interesting articles about intervention programs. and the benefits. We interviewed Tessa recently and her episode is out there. We'll link it in the show notes. But she um facilitated a research article on primitive reflex integration in the classroom. So the research

Yes, and obviously it could be better always, but there is a ton of research out there. So This little quote, overall there was a significant negative relationship between the persistence of these reflexes and both fine and gross motor skills, indicating that retained reflexes are associated with lower motor proficiency in children. So just

just leaving you with that little nugget. Um we'll link that article in the show notes, but there are obviously so many others that we can link as well. Yeah, but just that really just shows the connection between Muscle, tone, and primitive reflexes. And motor coordination. And coordination. It's all connected.

All right, quick listener question. Ready? Ready? Okay, I'll read this one. You're reading this one. Um, boy age six. The boy is a migrant in temporary accommodation, one room for a family of five. He has no diagnosis. He's a sensory seeker. He's always chewing on something, whatever he can get his hands on. He loves touching breasts and the software.

skin under the chin. He has a chewy, but sometimes prefers not to use it. He's an attention seeker, positive and negative, it doesn't matter. So we don't react react to his challenging behavior. He doesn't like anything In his words, so he's verbal it sounds like. Um he says he doesn't like anything and therefore giving him a choice doesn't work and the behavior can be extremely challenging.

Um I'm curious if this is a therapist working with the this boy in the home or is this boy going to a clinic? I'm not sure. Yeah, I think my first thing is whenever we have that like severe negative reaction like I don't like anything, nothing's working, like really negative. I think about fear paralysis and morrow reflex to start. And no self confidence. No self confidence. No self confidence. We think about um they said that the boy is a migrant.

in a temporary accommodation, one room for a family of five. Lots of trauma. Think about a traumatic experience. Think think about a safe environment. Like those factors are really important for fear, paralysis and morrow to integrate. So that would be something I would I would put on the radar and at least start working on that if possible. If possible. Um

Yeah, and building up his self competence. So start finding positive things that you can praise him for. Whether it's hey, you did a really good job turning the light off when I asked you to. Like literally anything that you and maybe you can teach the family to positive provide pro positive reinforcement to this child. Every day, all day, every day. He needs to see that he is good, that he can do good things, but just like everything about

This question screams no self-confidence. He feels like a bad kid. He doesn't like anything. He doesn't know how to do anything. So we need to figure out how to give him a lot of Of positive reinforcement to build his self-confidence. And the last thing we'll leave you with is if he is such a high sensory seeker, meet those sensory needs rather than just giving him a chewy, give him more. vestibular, proprio receptive, tactile input, big body movements.

that he can do proactively throughout the day, give him more and then use some of those calming strategies rather than just like, Okay, here's a Chewy. You're craving, you know, you're chewing on things, here's a Chewy. Try coming at it from the full body instead of just the oral needs. Yes, absolutely. Hopefully that was helpful to get started. Feel free to if the person if you are listening, feel free to provide more details if you want, if you can, or if this was helpful, let us know. Yeah.

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