TLR and Sensory Processing Disorder

For my last blog we explored the Symmetrical Tonic Neck Reflex and its connection to sensory processing disorder (SPD). If you missed it you can check it out here. For the next few months I will continue to delve into the most commonly retained primitive reflexes, so keep watching if we haven’t talked about the one you are looking to learn more about! Today’s blog is about TLR (Tonic Labyrinthine Reflex). Since sensory processing is what we are all about here at Sensory Sid, I also want to tie in to how these may be connected.

Okay, what is the Tonic Labyrinthine Reflex (TLR)? Learn this, what to do for a retained TLR and why it matters for those with SPD (sensory processing disorder). Let’s get familiar with primitive reflexes first.

A quick recap of primitive reflexes is that they are automatic movement patterns that are prompted by a specific stimulus. They are useful during birth and in infancy. As babies grow and develop, these reflexes are “replaced” by tracks of higher level brain and body nervous system communication that result in more refined movement and body use. This is called integration. We call a reflex “retained” if it continues to show up past its expected timeframe. Check out this recent blog if you want to learn even more about primitive reflexes.

These short periods of primitive reflexes in use are important in a baby’s development and in sensory processing. When reflexes are retained, the nervous system is losing out on opportunities for sensory processing development and other higher level skill development.

What is the Tonic Labyrinthine Reflex?

Tonic Labyrinthine Reflex (TLR) is an automatic movement pattern that starts while still in utero. There are two patterns for the TLR.

One movement pattern of the TLR is prompted when the head moves forward, as is pictured in the photograph to the left. When this happens, the arms and legs are pulled in to the body. This is known as the flexion pattern of TLR.

Photo by Rene Asmussen on Pexels

The other movement pattern of TLR is when the baby’s head moves backward. This prompts the arms and legs to straighten and splay away from the body. This is known as the extension pattern.

Photo by Rodnae Productions on Pexels

The TLR is thought to be one of the earliest responses to gravity. This reflex is active early on, when an infant has very poor control of their head and neck. The reflex patterns assist while the baby is learning and developing the physical skills to control their head movements. The TLR typically integrates or ‘disappears’ at 4 months old. This is when the baby has usually developed the higher level motor skills of head control to replace the reflex pattern.

What happens if the TLR is retained?

When the Tonic Labyrinthine Reflex is not integrated at the 4 month mark, it is retained. Someone with a retained TLR may demonstrate the following¹:

• Weakness/low muscle tone
• Trouble crawling
• Poor posture
• Poor balance
• Sports avoidance
• Challenges with spatial awareness
• Visual-perceptual difficulties
• Ocular motor challenges
• Difficulty with sequencing
• Poor organizational skills
• Challenges with sense of time and space
• Auditory processing challenges
• Difficulty handling simultaneous multiple sensory processing
• Dyslexia, dysgraphia and/or dyscalculia

How does this look in daily life? This may be the infant that started with poor head control and this spilled into challenges with creeping and crawling. Specifically they may end up splaying their legs straight out when their head tilts back effectively hampering crawling. Even sitting a child with a retained TLR may have poor posture and will generally be less secure with moving through space.

As the child gets older, a retained TLR may show up in different ways. This child may struggle to play sports, move clumsily and may develop a fear of heights or moving surfaces. They may struggle scholastically. A busy school room may overwhelm them with visual decor, written information on the white board, the teacher or students talking in the background and the organizational skills needed to process tasks. Teachers may bring up dyslexia or handwriting concerns. Sometimes these traits are what makes them appear to have sensory processing disorder.

TLR and sensory processing disorder

So how does a retained TLR relate to sensory processing disorder (SPD)? Or do they even relate at all? First, a retained TLR (or any other primitive reflex) does not mean that someone has SPD or the other way around. The connection is much looser than that. It goes back to what happens in the developing brain. 

Primitive reflexes are active while the baby is amassing a great amount of information about their world. Taking in sensory information is how that happens. They take in information from the world around them, react and respond to it and even take in sensory information from their own body from that reaction. It is a great loop of sensory and motor movements.

If sensory processing is a problem, the primitive reflex may remain active and will limit the motor skill development as well as additional sensory processing skills. Addressing the reflex will allow not only for higher motor functions but also improved sensory processing.

The Tonic Labyrinthine Reflex is a good example of how that feedback loop can affect multiple sensory systems. Balance and vision are deeply connected. Information on where the body is in space is gathered in the vestibular (inner ear) system and also visually. These pieces are looped together to provide a feedback system to gather information on position in space and then resulting corrections are made in the body. When the TLR is retained there may be faulty information sent between the brain and receptors. This affects multiple important sensory systems (vestibular, proprioception, and visual).

So what can you do to help someone with a retained TLR?

Integrating the TLR

When a reflex is retained past its useful time period there are some things that can be done to help. First off, I always recommend that you speak with your pediatrician and ask for an occupational or physical therapy referral to someone who specializes in primitive reflexes. They will be able to assess for retained reflexes and provide a plan to help these get integrated. 

A professional in primitive reflexes is useful because when one reflex is retained, often others remain as well. Helping these reflexes integrate helps the brain and body function more optimally.

The activities that you do to help integrate the Tonic Labyrinthine Reflex often imitate parts of the reflex itself, but should not stimulate the actual reflex. A very easy way to work on the TLR is to make sure that your child spends plenty of time out of any assistive devices (walkers, swings, carriers, car seats, etc) and has tummy time. You can make tummy time fun for all ages with books, mirrors, toys, puzzles or even balancing the child on your legs or a therapy ball.

Don’t forget the other (flexion) pattern of TLR. A retained flexion pattern can be greatly assisted by playing in side lying or on their back. Put fun socks on their feet or little rattling toys to encourage them to lift their legs up to their hands or mouth. Animal crawls are another great way to work on this reflex, especially as the child gets older.

Doing activities like these every day to integrate the TLR can usually help integrate it in 4-6 weeks. Totally worth 5 minutes a day! You will likely be making really great changes for the Tonic Labyrinthine Reflex and their sensory processing at the same time.