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Neuro-Developmental Stimulation in school practice as a tool for inclusion.

Marja Volemanová


Article published at: VOLEMANOVÁ, M. (2017) Neuro-vývojová stimulace ve školní praxi jako nástroj k inkluzi. Integrace a inkluze ve školní praxi, ročník IV, číslo 9, květen 2017. ISSN 2336-1212


Primary reflexes have a significant impact on a child's psychomotor development. Through these reflexes, the brain gradually learns to properly control the functioning of the body, such as processing visual and auditory information, gaining balance and spatial vision, gross and fine motor skills including ocular and oral motor skills, hand-eye coordination, and more. As higher levels of the brain mature, primary reflexes fade away, mostly between 6 to 12 months of age. If control by higher brain functions over primary reflexes is insufficient, these reflexes can remain active into later life. The problems that persistent primary reflexes can cause are very diverse. For example, they can lead to poorer gross and fine motor skills, poor coordination of movements, reading and writing difficulties, concentration problems, bedwetting even after the age of 5, thumb-sucking beyond the age of 5, balance problems, poorer visual or auditory perception, extreme emotional instability, speech and articulation problems, and more. In school, we are accustomed to addressing what children cannot do. But do they even have the prerequisites to handle it?


Persistent primary reflexes.

A child is born equipped with primary reflexes, which gradually disappear as the child gains a certain degree of voluntary control over specific functions during proper development. It is assumed that inadequate inhibition of primary reflexes may be related to learning and behavioral disorders later in life. Currently, there are more studies linking primary reflexes, psychomotor development, and learning and behavioral disorders. Persistent primary reflexes can cause symptoms of many specific learning disorders ("dys" disorders) and attention disorders. If the symptoms are caused by persistent primary reflexes (which are not a classic case of "dys" disorder, although the symptoms are similar), we can solve these problems with simple exercises to inhibit primary reflexes and improve sensory integration. If a child has persistent primary reflexes in addition to learning disorders, the symptoms may be more pronounced. With exercises to inhibit primary reflexes, we can then alleviate these difficulties, but not completely eliminate them.


The Tonic labyrinthine reflex (TLR) is one of the primary reflexes that, in my experience, often persists in children with learning and behavioral disorders, so I will focus on it more in this post. TLR is a reflex reaction that is activated by a change in head position in the sagittal plane. It originates from the vestibular organ of the inner ear labyrinth. When we tilt a child's head back, the tone in the extensor muscles throughout the body increases (the child stretches), and conversely, when we tilt the child's head forward, the tone in the flexors increases (the child curls up its limbs). TLR helps the child cope with gravity at a time when they do not yet have sufficiently developed abilities to lift and hold their head and neck upright, and if we do not support the child's head, their muscles are either mainly in extension or in flexion.


TLR greatly affects gross motor skills. Newborns have only minimal voluntary control over their bodily movements, and every movement of the head is associated with a reflex response. These are holokinetic movements (movements of the entire body). Within a few weeks of life, babies start to control the muscles of their neck and head. Then the child gradually learns to control the muscle tone in the cephalocaudal direction, i.e. gradually from the head, through the upper half of the body, the lower half of the body to the heel. This enables the child to control the position of the head in relation to the body. This ability is essential for later maintaining balance, an upright posture, and coordination. The Tonik labyrinthine reflex helps this process. Before the child can gain control over the rest of the body, it must learn to control the head. Later, independent movements of the head and limbs develop, including the ability to cross limbs over the "center of the body", which is necessary for cross-movements. The child also needs to learn to move its head back and forth without triggering reflex limb movements. Primary reflexes trigger movements, and these repeated movements help strengthen nerve connections between the body and the brain. The child gradually gains control over body posture, develops strength and coordination, strengthens balance development, mobility, vision, hearing, speech, learning ability, and communication. Skills that form the complex of gross motor skills are considered the foundation of many higher learning and behavioral abilities. For a child to learn well in school, they must have the ability to sit still, concentrate, hold a pencil correctly, and need a range of well-developed eye movements necessary for reading written text without skipping words or lines. Gross motor skills are also related to muscle tone.


If TLR persists, it often creates an imbalance (and therefore faulty posture), resulting in changes in statics and motor stereotypes. If TLR persists more into extension, children often have hypertonus (increased muscle tone), their muscles are firm to the touch, and these children tend to walk on their toes. When they are happy or upset, the hypertonus increases, and they "tip-toe" while waving their hands. Many children with learning disabilities, attention disorders, or autism have altered muscle tone. Lower muscle tone is also seen in children where TLR persists more into flexion. If such a child sits while reading (so that the head is slightly bent forward), it affects their muscle tone, causing an increase in flexors' tone - after a while, the child sits with rounded back, supporting their head or even lying on the table. We find a forward head posture, accentuated cervical lordosis, and altered scapula position. Increased tension of the chest muscles causes greater kyphosis of the thoracic spine (rounded back) and a forward shoulder posture. Such children also have a "bulging belly," weak abdominal muscles, and greater lordosis of the lumbar spine. TLR, therefore, affects both body and head posture. Breathing can be affected, and blood oxygen levels can be reduced, which can cause improper brain function since the brain needs enough oxygen to function correctly. Persistent TLR worsens concentration, as each movement of the head up or down causes flexion or extension of the upper and lower extremities reflexively. It is very difficult, for example, to concentrate on reading a text. Similarly, copying text from the board is very challenging because this activity requires the head to alternately bend forward and backward, causing reflexive extension and flexion of the upper and lower extremities. Children with persistent TLR are constantly engaged in physical activities that other children do unconsciously, making them tire quickly. At the end of the lesson, these children lie with their faces on the table or support their heads with their hands. Children with persistent TLR will be nervous, restless in the classroom, "wrap their legs around the legs of the chair," sit on their heels, or do anything else to fix their legs. In response to reflexive extension of the lower extremities, they often balance on the back legs of the chair - "rock on the chair," or stand up. Lower muscle tone, also known as hypotonic muscles, are longer than usual at rest, causing increased elasticity and lower joint stability, so these children have less stable posture, less strength, poorer endurance, and inadequate proprioception.Proprioception is the ability of the nervous system to perceive the body's position without movement. It is necessary for proper coordination of movement, registering changes in body position, muscle tone, and some reflexes. Incorrect information from one source (both sensory organs and proprioceptors) affects other sensory organs as well. Some children who have little proprioceptive information need to constantly move to compensate for the lack of kinesthetic proprioception (a set of feelings that allow for the perception of movement). Babies and older children with poor proprioception often need to be held tightly, hugged, and require physical contact when falling asleep and sleeping (they only sleep when cuddled up to their mother). An important component of kinesthesia is kinesthetic memory, which means learning positions and sequences of changes in those positions for repeated, routine movement. If we can rely on kinesthetic memory while performing a certain activity, we can also focus our attention on other aspects of our environment or other tasks. For example, we should have writing stored in kinesthetic memory. One of the most difficult tasks for kinesthetic memory is human speech.


Proprioception is the ability of the nervous system to perceive the body's position without movement. It is necessary for proper coordination of movement, registering changes in body position, muscle tone, and some reflexes. Incorrect information from one source (both sensory organs and proprioceptors) affects other sensory organs as well. Some children who have little proprioceptive information need to constantly move to compensate for the lack of kinesthetic proprioception (a set of feelings that allow for the perception of movement). Babies and older children with poor proprioception often need to be held tightly, hugged, and require physical contact when falling asleep and sleeping (they only sleep when cuddled up to their mother). An important component of kinesthesia is kinesthetic memory, which means learning positions and sequences of changes in those positions for repeated, routine movement. If we can rely on kinesthetic memory while performing a certain activity, we can also focus our attention on other aspects of our environment or other tasks. For example, we should have writing stored in kinesthetic memory. One of the most difficult tasks for kinesthetic memory is human speech.


In this article, I will also address the Moro reflex, which is important during the physiological period because it helps in the development of the respiratory mechanism (in utero), facilitates the first breath, opens the airways in the event of choking, and thus helps the child survive. A helpless child responds to unpleasant stimuli (pain, uncertainty, hunger) with the Moro reflex, begins to cry, and attracts the attention of an adult. However, it should be inhibited in its basic form by 2-4 months of age and replaced by the mature Strauss reflex. If the Moro reflex is not inhibited, the child is oversensitive to (some) sensory stimuli and reacts to them too strongly. Unexpected sound, light, movement, change of position, or balance can activate the Moro reflex in this child, and the child will be constantly "on guard." Activation of this reflex also stimulates the production of adrenaline and cortisol (these hormones are also sometimes called stress hormones), which increases the child's reactivity and sensitivity. Increased adrenaline levels cause hyperactivity, aggressiveness, and the need to influence what is happening around. Cortisol affects blood sugar levels. Low blood sugar levels cause irrational behavior. Children with persistent Moro reflex perceive all stimuli equally strongly and cannot "filter out" less important stimuli, which can result in overload. The child is interested in everything that is happening around, their eyes move after every stimulus that enters their peripheral visual field, they look everywhere "where things are flying." In sensory integration, this phenomenon is called a sensory modulation disorder, and children with such an indication can be either hyperreactive, hyporeactive, "seekers of sensory stimuli," or these states alternate.


Neurodevelopmental therapy

Neurodevelopmental therapy (NDT) is a method that is based on the assumption that one approach is often not enough, and therefore combines different approaches and methods, such as: inhibition of primary reflexes, sensory integration (vestibular, tactile, auditory, and others), special education (mainly improving partial functions such as visual differentiation and memory, auditory differentiation and memory, intermodality, seriality, and others), physiotherapy, and visual screening (checking binocular functions). NDT is used individually. Children attend therapy (with parents) once every 6-8 weeks, where they learn prescribed exercises, which they then practice every day at home. Gradually, in this way, we inhibit all primary reflexes and improve the cooperation of brain hemispheres. We give children a solid foundation on which they can build further (school) skills.


Neurodevelopmantal stimulation, NDS Learning through Movement

The foundation of Neuro-Developmental Stimulation (NDS) in school practice is Neuro-Developmental Therapy. Tests and exercises are adapted to be used effectively for larger groups of children. NDS is suitable for children as young as 4 years old, but can be used for any age. Ideally, it should be practiced in preschool or in the early years of primary school. The basic program of NDS is based on simple exercises that often imitate movements triggered by primary reflexes, giving the brain a second chance to gradually learn how to properly control the functioning of the body.


Among the most important principles of NDS is that we first start developing balance in children and combine inhibition of primary reflexes with improved sensory integration, and only later add more skills. Another important principle is that NDS utilizes the natural craniocaudal direction of development, which means the direction from head to toe. Without proper head control, other movement stereotypes will not develop properly.


A great advantage of NDS is that it is applicable to whole classes, not just children with obvious learning problems. This means that we do not have to separate "unsuccessful" children from "normal" ones, but all children exercise together. It can also help children who may handle schoolwork without significant difficulties (e.g., due to their above-average intelligence) but still have problems with concentration or coordination of movements (including eye movements). These children often do not visit educational-psychological counseling and their problems are therefore not diagnosed. For children who do not have any primary reflexes, the exercises will not harm them and they will at least have a nice workout. Many children today are less interested in physical activity and are more interested in the latest technological inventions. Many of them already have faulty posture in the first grade, and long periods of sitting in school and then at home on the couch or computer will not improve their condition. All exercises for inhibiting primary reflexes also strengthen the inner core. The inner core (deep muscels) is composed of muscles that provide stability (firmness) to the spine during all our movements. Their involvement in spinal stabilization is automatic and involuntary. inner core plays an important role in protecting the spine from external forces, loads, and pressures on the spine structures. Its disorders are an important factor in the development of vertebral problems.

Inclusive education, also known as mainstream education, is based on the belief that all students have the right to be educated in groups with their peers in schools in their local communities. NDS represents a specific opportunity to improve the inclusion of students with special educational needs.


VOLEMANOVÁ, M. (2017) Neuro-vývojová stimulace ve školní praxi jako nástroj k inkluzi. Integrace a inkluze ve školní praxi, ročník IV, číslo 9, květen 2017. ISSN 2336-1212

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