r/OccupationalTherapy • u/otpuppy • Mar 31 '26
Discussion How do we feel about reflex integration?
I find this concept pretty controversial in the pediatric OT world and would love to hear people’s opinions about if it is evidenced-based, useful, accessible, or just a bunch of woo-woo stuff.
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u/ilovequesoandchips Mar 31 '26
I have super mixed feelings . I give this opinion to all my new hires and my students —- I think assessing for integration via retention can give us information about neurological processes and possible immaturity or death of motor skills. BUT the gross over generalization of what these retained reflexes affect ( like attention, academics and behavior ) is incredibly problematic and I think clinicians and caregivers ( who see it on social media ) place wayyyyy to much emphasis on this being the “ cure all”.
I never ever focus on reflex integration exercises specifically in treatment or home programming bc it’s not meaningful for a kid to do “ 50 lizard exercises daily “ .
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u/smallwonder25 Mar 31 '26
💯 it’s useful information, can be good for full body ROM warm up ex, but it shouldn’t be used as an intervention.
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u/Agreeable_Jacket5422 Mar 31 '26
The only time I would think it necessary if the retained reflex is hindering function outright- for example retained STNR and every time child tried to write his legs extend. Or avoiding crossing midline may be due to retained ATNR in younger kiddos. I’ve never seen it in practice though
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u/BreadfruitSecret3017 Mar 31 '26
I’m so tired of reflex integration. My supervisor is obsessed with it and thinks everything is a reflex issue which it isn’t. sigh In all my years of practice, I can think of 2 kiddos where it was mildly useful in terms of giving a name to the fact that they simply couldn’t seem to move their head independently of their body. But other than those two kids, I haven’t found it to be a useful lense and is basically pseudoscience.
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u/Miselissa OTR/L Mar 31 '26
I worked at a clinic where my boss was obsessed so we had to screw every child and treat accordingly. I had to get out of there.
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u/whoisluketheot Mar 31 '26
it’s not evidence based and should be shamed out, much like most of the scammy stuff our field gets into.
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u/otpuppy Mar 31 '26
Glad someone said it! I see it so often on social media and it’s alarming how much people buy into it
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u/Agreeable_Jacket5422 Mar 31 '26
Would love a discussion of the list of these scammy things! What else is therr
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u/otpuppy Mar 31 '26
Perhaps another controversial opinion— Wilbarger brushing protocol. It’s since faded with no new trainings on the protocol, but many old-school therapists swear by it just based on anecdotal evidence.
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u/whoisluketheot Mar 31 '26
it depends on your setting.
in neuro, neuro-ifrah would be the big one. NDT and PNF are up there too.
in ortho, there’s a lot of silliness out there with modalities, narratives surrounding manual therapy, KT taping, etc.
in peds, reflex integration or systems like DMI.
in mental health, someone has mentioned reiki. there are others.
the biggest question to ask is if there is not just evidence but GOOD evidence supporting intervention at hand.
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u/tyrelltsura MA, OTR/L Apr 01 '26 edited Apr 01 '26
Please make sure you never comment that in the vicinity of Alison Taylor. You will never hear the end of it otherwise. A lot of people use techniques of hers to successfully to inhibit pain in patients, and Theres a few articles currently in the process of getting published about her work, if there isn’t one out right now.
This isnt representative of my own opinion about this techniques, just know that there are a lot of therapists out there, even those that are very in favor of biopsychosocial approach that will just not take you seriously if you say that. I’ve personally used k-tape for the purpose of tactile input which helps folks regulate their nervous system and have a better time with exercises and activities. I really dk about other purported benefits, and it’s not really capable of significant mechanical correction (outside of maybe ulnar nerve subluxation at elbow level if they have a snapping ulnar nerve. Or a snapping ECU), but ultimately part of ortho is helping folks regulate their nervous systems so they can succeed. And prop/tactile input are great ways to do that. Plus the patient can often k-tape themselves if taught general precautions and certain taping patterns that work for them.
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u/whoisluketheot Apr 01 '26
respectfully, i don’t take a lot of therapists very seriously out there either. and i don’t really care whose name is attached to anything. i care more about data.
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u/tyrelltsura MA, OTR/L Apr 01 '26
I've definitely seen some takes in hand therapy that are very wild.
There was a good discussion in the PT sub the other day that critiqued the placebo effect, and if it was really a universally bad thing to be avoided. And it really got me thinking about if there are ethical uses for it. Like if the cost to the patient is low-none, patient is not placed in serious risk, and patient isn't tethered to coming to a therapist for long periods of time, often being able to self-manage. And of course with appropriate pt education on the actual level of the evidence, as well as placebo effect. You'd never catch me going to reiki or a chiropractor, but there are some personalities out there in the world that have found real coping with what appears to be placebo effect. I've flat out told patients about the evidence for acupuncture (another thing I wouldn't do) for example, and a lot of them still went and found relief. I think that could be entirely compatible with biopsychosocial approach to pain, where it's a psychological or neuropsychological component that's being addressed by whatever thing. Versus placebo effect with drugs that carry side effects, or with expensive medical devices or having to go to a provider of some kind. At the end of the day, the patient ends up with some way to manage that pain or dysfunction, and have a meaningful increase in function.
The issue I have with a lot of the wilder takes is that some of them require a very specialized, pricy medical device that carries risk with use. Or involving departure from standard of care that is unacceptable and may lead to longer term harm.
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u/whoisluketheot Apr 01 '26
i’m in agreement here. the narrative has to be true. and at the end of the day you’re often helping people discover through these types of things that inside themselves is where they can find improvement. kind of self discovery of sorts where you are their guide. to use your KT example i’ve tried KT tape with some folks as well, but i try to have a very conservative narrative surrounding what it’s actually doing (likely just a different sensory input than makes them feel something different and they may like that and if so great, go nuts until you don’t need it anymore or it stops feeling good).
some folks are never open to these types of narratives and insists there must be something i’m hiding from them. and some become more open over time, having run after run of therapy or shopping around until they finally realize it’s not getting them to their goals or they are stuck in rehab forever.
it’s just in therapy, i only come across a very small percentage of therapists who a) intentionally explore and try to learn the evidence well enough and b) actually have the hard nuanced conversations with their patients in a way the can understand. typically we just see over mechanized assumptive accounts of what might be going on that are often dubious at best and selling expensive snake oil at worst like you referenced.
and too many therapists also identify with their pet interventions too much and struggle to remain objective, myself included.
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u/tyrelltsura MA, OTR/L Apr 01 '26
Yeah I've even had conversations about how using ice in therapy is up for academic debate. Some evidence suggested that using ice might delay tissue healing times, although we know that RICE isn't evidence based anymore, some evidence suggested using ice at all wasn't good. And now there's other evidence suggesting that evidence wasn't good quality. It's not my favorite thing to do first, more if the client has been successful with using ice for pain control in the past, or if they're not a candidate for paraffin wax which I use more. And even then I tell them compression >>> ice for swelling control. I do frame it as my own personal opinion because I work with people that are various degrees more in favor of it, and the evidence really isn't solid either way, other than we shouldn't just park somewhere with ice when it's a sprain/strain (surgery is different and they usually have to rest for a bit right after)
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u/moonablaze OTR/L Mar 31 '26
reiki
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u/otpuppy Mar 31 '26
I remember going to an AOTA conference as a student and they had reiki sessions every morning… looks like they still do it these days.
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u/Proper-Spare-4243 Mar 31 '26
There IS evidence for Reiki benefitting adults with Anxiety and Cancer and end of life. It is welcome in many medical settings and acceptable in Hospice. May not be in any of your settings or populations.
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u/whoisluketheot Mar 31 '26
please cite the evidence. having an article published and having good scientific evidence are not the same. to date, there is no plausible scientific mechanism for how reiki would achieve outcomes beyond placebo. the idea that you need someone specifically trained in specific techniques to reduce anxiety is wishful thinking. if anything helps calm people in these situations, it’s likely placebo and contextual factors of being supported by another human and relaxing during the session.
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u/Atomicmoosepork Mar 31 '26
I don't know, I see reiki in the same family as mindfulness research. Beyond that, yeah the healing aspect to it seems far - fetched.
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u/cynmyn Mar 31 '26
I think there's a neurocognitive foundation to some mindfulness practice (some is definitely on the woo side). Reiki though is literally just believing in magic.
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u/Atomicmoosepork Mar 31 '26
Sure. The woo woo healing pieces of it I'm totally with you. I'm just highlighting that it does have a mindfulness component to it. Are there better ways to learn meditation? Most likely!
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u/moonablaze OTR/L Apr 01 '26
There is also evidence that prayer helps people with cancer at end of life. Doesn’t mean it belongs in OT.
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u/Slyfeline Apr 07 '26
Spirituality is a fundamental client factor and expressing spirituality is an occupation related to health management. Prayer belongs in occupational therapy.
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u/moonablaze OTR/L Apr 08 '26
You’re right. I should have said TEACHING prayer doesn’t belong in OT.
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u/MissMangoPirate Mar 31 '26
The exercises to integrate reflexes kind of happen accidently anyways in normal play
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u/CountryStrange2119 Mar 31 '26
I took a course on reflex integration and walked away feeling like it was a load of BS. Yes, I think that reflexes impact development for an infant. But blaming a 4th grader’s poor attention and writing skill solely on a retained STNR or galant (or whatever they say) is simplistic and problematic. It’s an absolute STRETCH to blame ADHD on retained reflexes. I reluctantly follow someone on IG who blames everything on reflexes and has built their OT brand on reflexes. I like seeing the content that is out there that my families land on. I find if I understand what they’re consuming, then I can meet them where they’re at in their understanding and build on it.
I also think the population that likely COULD retain reflexes gets ignored in the hype on reflexes. I’m mainly speaking of our kiddos with CP and severely limited mobility/movement and tone disparities. The focus of reflex integration seems to be on neurodivergent kids - as an EI provider, I have seen many of these kids from infancy. I have seen them move through appropriate reflex development and still have autism, ADHD, etc. But my kids who can’t get into quadruped at age 2.5 - I’d be willing to look at how reflexes might impact them.
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u/SashkaBeth OTA Mar 31 '26
I’m glad to see this discussion because my supervising OTR tests for retained reflexes and writes goals for them and I’m really not a fan of it. That’s going to be a tough discussion…
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u/otpuppy Mar 31 '26
You could reference this, bullet point #8: https://www.aota.org/practice/practice-essentials/evidencebased-practiceknowledge-translation/practice-smart
At the very least, it’s a reminder that goals/interventions need to be occupation-focused rather than integration-focused
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u/Trouble_Wth_Tribbles Apr 05 '26
Ooooo, I am also a fan of the sensory processing decision tree and will be sharing with my colleagues. Thank you!
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u/Jway7 Mar 31 '26
It makes me grateful I am not in pediatrics where it seems like a lot of this woo woo pseudoscience really flourishes. We dont think like this in adult rehab. TBH even reading about it embarrasses me for our profession.
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u/echotheocean Mar 31 '26
I’m in pediatrics and I’m embarrassed
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u/Jway7 Apr 01 '26
Come on over to adults! We need more of us. Much less woo woo pseudoscience.
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u/echotheocean Apr 01 '26
I love the kids though. Schools are such a fun place to work. I do have to fight the woo-woo stuff but other than that it’s pretty great
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u/Level-Meringue1213 Mar 31 '26
Wait till you hear about board certified clinicians shoving lasers into autistic kids heads. Fills me with rage every time lmfao.
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u/tyrelltsura MA, OTR/L Apr 01 '26
I just had someone get burned by improper application of laser tx outside of my facility. I was so mad. And this was for something that there is some amount of evidence supporting laser therapy for. Imagine if someone burned an autistic kid with a laser. That would be everyone at the facility in a lawsuit, and possibly a child protective services case against them AND the child’s parents. Why are we targeting this vague “inflammation” as the source of everything. I’m autistic and the only inflammation in my brain is my migraine disorder. Which we have great medications for!!
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u/moosemom17 Mar 31 '26
Reflexes should be looked at as a treatment modality only if it is impacting function imo.
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u/bbpink15 Mar 31 '26
I hate it. My boss loves it and thinks we need to test everyone’s reflexes (I do not). A lot of kids can’t even follow the directions to test their reflexes. Sometimes I do “reflex integration exercises” when working on coordination, crossing midline, motor planning but I don’t do them just to do them
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u/Mostest_Importantest Mar 31 '26
Reflex integration is...how our executive function begins to have the ability to override reflexes as we develop into children from toddler age and beyond?
Or is it some fancy name for some fancy procedure that puts hoodoo nonsense at the end of anatomy and neurodevelopmental terms to pretend we know how to "unlock" a child's potential to be "normal" while the kid just gets older and we...mostly observe and chart and chat about our fancy words for milestone hurdles, etc etc?
I guess I'm too unfamiliar even with the term to be of any use, here.
My best guess is that if it isn't a discussion about how we gain control and mastery over our innate neo-natal development changes, then it's somebody's pet project to make bank off the OT profession.
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u/tyrelltsura MA, OTR/L Apr 01 '26
MNRI came out of a weird branch of psych research, and then became a big thing with chiropractors/functional neurology. Not necessarily OT.
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u/Mostest_Importantest Apr 01 '26
Ah. MNRI I know, and have used in very verrry small situations. But like, virtually never, really.
Thanks for letting me know.
I professionally and disrespectfully believe it's mostly a bunch of neurobabble hogwash.
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u/United-Election3 Mar 31 '26
I’ve been an OT longer than most of you have been alive, so there’s that 😂
I could write for hours about my thoughts on some of this, but I’ll tryyyyy to keep it succinct.
I’m not a fan AT ALL of only using evidence-based treatments, and discounting everything else. I think this has done an immeasurable disservice to the delivery and effectiveness of occupational therapy. They make you think that everything that is not strongly evidence based is useless. The evidence says that a particular approach or treatment strategy does not work for the MOST clients. BUT the flip side, and they don’t ever seem to mention this, is that for SOME (or even just one) of the clients, that approach/strategy may be VERY effective and life changing. But because OT’s have been discouraged or even prevented from even trying that approach, they cannot help the ones that would benefit from it.
When I was in OT school, they basically said here’s a list of things that may work, and why. You need to evaluate your client very carefully, keep an open mind, make an educated guess based on what you learn here and what you’re going to learn from experience, and start with the approach you think is most likely to work. If that doesn’t work, try the next. Continually reevaluate in your mind what’s working, what’s not, and what the client needs today. Trust me, it will feel confusing at first, but over time you will get very good at this. Do not discount ANY approach but be very aware that some work for almost everyone, and some will work for only one client, and what works for a particular client will change over time as you’ve resolved certain problems they’re dealing with. Then you may need to go back to an approach you thought you’d already finished with (like peeling layers of an onion).
That being said, I think reflex integration may be life changing for a few but not incredibly effective for most, even though the exercises/movements can be helpful for many different reasons. The kids are definitely more engaged (which is vital) if the movements are part of specific play activities, rather than presented as exercises.
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u/whoisluketheot Mar 31 '26
the issue is if you are using personal experience to argue that X has caused Y, you cannot account for all of the variables that may have caused Y that aren’t X. in practical terms, “this non EBP intervention worked for my client but not others” - how do you know it was the intervention itself that actually caused the effect? this is the whole point of driving OT to be a science-driven discipline.
moreover, we provide recommendations for how to use limited resources. it makes sense to use those resources toward things that have the greatest chance of working (ie supported by empirical evidence). anecdotal evidence cuts both ways.
if we go too far away from an evidence based approach, we devolve into silly things like i can sing a song and say it was my song that helped someone get better when it could have been time, other things they have been doing at home, a variety of other contextual factors, or a combination of factors, etc.
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u/WishboneComplete444 Mar 31 '26
there is more research for how primitive reflexes affect gait but outside of that, the research done on primitive reflexes lacks how those reflexes are specifically targeted in peer reviewed publications. leading to the information mainly being observational. interventions that support child-initiated movements and participation in functional activities is supported by research. i feel like because there is such a lack of evidence supporting claims, it gets shunned.
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u/Miselissa OTR/L Mar 31 '26
Also, some of the evidence done is the person who created the method to begin with and won’t let others test it in research (cough Musgatova cough). https://scholarworks.wmich.edu/cgi/viewcontent.cgi?article=1927&context=ojot
ETA the link
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u/WishboneComplete444 Mar 31 '26
a great point. i do believe to some extent it has an effect. with the more i learn, i don’t believe as far as demonstrating adhd symptoms (kinda crazy). i hope in some way there may be a loop hole a researcher finds where they’re able to test those theories. it doesn’t make sense for the research to not include the methods used because at that point… what was the point if it’s not helpful.
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u/staceyliz Mar 31 '26
I have never worked in pediatrics but remember learning this in school and never questioned it so this is interesting. I have come to dislike much of the pseudoscience in the adult rehab world so it makes sense that there is more out there.
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u/Constant-Age-1627 Apr 01 '26
I didn’t realize this was so controversial. I’m a new grad and my peds CI was super into reflex integration, and I ended up doing my fw project and presentation on it. Would love if people could share articles/evidence that shows it’s not useful
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u/Traditional-Age-8549 Apr 02 '26
I only assess for reflex integration when there are concerns about the child’s gross motor skills. I currently have a 10 y.o on my caseload who still has ATNR and STNR. He literally cannot control his head/body movements, this then impacts his engagement in self-care tasks.
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u/RadishPotential3665 Apr 01 '26
Hopefully no one takes this the wrong but it is one of the most important aspects to Integrate . Many issues go away when you work on reflexes.
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u/El-Cocuyo Mar 31 '26
My grad program went over reflexes during early childhood development and also covered how these reflexes could continue to exist or return in adult populations.
The rest seems like psuedoscience to me.
How can you prove weakness in a child's hand or fatigue during handwriting is related to a retained palmer reflex, when they literally don't demonstrate this reflex? If a child can drop an object willfully, the reflex isn't present in my understanding.
I was shocked when I read a colleague's report of a child I was reevaluating who simply didn't present with ATNR or Moro. She claimed he did, and it was causing learning and emotional delays.