The Neuro-Optometric Rehabilitation Association International is an interdisciplinary group of professionals dedicated to providing patients who have physical or cognitive disabilities as a result of an acquired brain injury with a complete ocular health evaluation and optimum visual rehabilitation education and services to improve their quality of life.

BLOG: Brain injury can relaunch long-dormant ‘system codes’

 
Patti Andrich
 
Alex Andrich

by Patti Andrich, MA, OTR/L, COVT, CINPP, and Alex Andrich, OD, FCOVD

When you were developing in your mother’s womb, you inherited several codes. You had innate codes for your hair color and your eye color.

You also had “system codes” to run your neurological sensory and motor operations. These primitive codes allowed for the emergence of early patterns of movements. These early movement patterns assisted in your being born and helped you to learn to sit, stand and eventually perform the everyday complex movements you rely on.

Primitive reflexes

The system codes are called primitive reflexes. Initially, they are necessary for surviving the birth process and after birth they serve as the basis for ongoing development. Some of these primitive reflexes are well known to anyone who has spent time with an infant: The rooting reflex helps newborns nurse, while the palmar reflex gives a baby that tight grip. The Moro reflex is important for the first breath of life and eventually transforms into the adult startle reflex.

The tonic labyrinthine reflex is important for building core muscle tone and proprioception. This reflex also helps a baby learn about gravity and prepare for rolling over, crawling and walking. The asymmetrical tonic neck reflex ensures that when a young infant turns his head to the right, the right arm and leg extend and the left arm and leg bend. This movement pattern helps the baby begin to distinguish left and right and leads to early eye-hand coordination.

Infants use these reflexes as a means to develop sensory and motor skills needed to explore the world around them. Primitive reflexes are vital to development.

However, they are not meant to linger around. After they have fulfilled their purpose, their activity is suppressed. This occurs sometime around a child’s first birthday. If the primitive reflexes stick around into later years of childhood or into adulthood, they can become quite detrimental. That’s why primitive reflexes “hibernate” once they have served their developmental purpose. Within the first few months or years after birth, they are gradually suppressed by higher-level brain functions and then become “integrated” as the nervous system matures.

The impact of brain injury

When the brain is injured by, for example, a blow to the head or a stroke, higher level cortical functioning shuts down, and primitive survival reflexes that had been stored in the brain can re-emerge.

As you might imagine, restarting these old system codes can wreak havoc in a person’s life. People with brain injuries can lose the ability to walk, talk and think clearly. They often have visual complications in addition to sensory and motor disruptions. In essence, they have to re-learn many skills they had learned early in life.

Recently, a male patient in his early 30s had suffered a head injury at work in a factory. As a result, his eye movements became disorganized and he lost the ability to accurately fixate on objects. He also began to suffer from significant vestibular problems and he reported “not feeling right in his own skin.” A primitive reflex evaluation revealed that he had what neurologists call the Babinski sign, a re-emergence of a primitive tactile reflex that causes the toes to flare when the sole of the foot is touched.

Imagine trying to stand when your brain is constantly getting a signal to lift your toes off the floor! The young man tried to use his eyes to help his body feel balanced, but he had limited success because his feet created an unstable base of support. He stated he felt the worst when standing. It was clear that in order to improve his visual skills, we would have to start with his feet.

This patient’s therapy began with reflex integration exercises aimed at getting his toes to grip the floor, to create stability when standing, so that his eyes could re-learn how to move accurately and process visual information. It was in treating the neurological basis with an understanding of the role that primitive reflexes play in developing visual skills that we were able to improve his balance, reduce his anxiety and nausea, help him to be comfortable in his own skin again and ultimately improve his visual functions.

This is just one of the ways that we use reflex integration activities in our practice to speed up recovery after a brain injury. You can think about the aftermath of a significant brain injury like a house that has been destroyed by a tornado. To rebuild the house, you have to start with the foundation (re-integrating the primitive reflexes) before you can even think about replacing the roof and siding (recovering fine and superfine motor control functions like fixation, convergence and eye tracking).

Primary care optometrists who may see patients post-concussion should be aware that feeling nauseous or uneasy can actually be related to visual-vestibular problems. We would encourage you to strongly consider referring anyone with these symptoms or balance problems to a neuro-optometrist who can treat the neurological basis for the problems.


For more information:

Patti Andrich MA, OTR/L, COVT, CINPP, is an occupational and vision therapist and board director of NORA. Alex Andrich, OD, FCOVD, is on staff in the physical medicine and rehabilitation departments at University Hospitals Parma Medical Center and the MetroHealth Rehabilitation Institute of Ohio and serves as president of the International Sports Vision Association. They are in practice together as The Vision Development Team in North Royalton, Ohio (sensoryfocus.com).

Alex and Patti Andrich will offer an advanced course on reflex integration following brain injury at the NORA annual conference, Sept. 19-22, 2019, in Scottsdale, Ariz. For schedule and registration, visit noravisionrehab.org/about-nora/annual-conference.


Disclosure: The authors report no relevant financial disclosures.


Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.