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Reflex Integration Exercises

These exercises are meant to be used in conjunction with direct occupational therapy intervention and not in replace of it

Asymmetrical Tonic Neck Reflex (ATNR)

ATNR is a reflex that develops in utero and becomes integrated around six months of age. It is triggered when the infant turns its head to one side. This triggers the limbs on that side to straighten while the opposite limbs bend.

Indicators that this reflex is not fully integrated:


  • difficult crossing midline

  • difficulty developing a hand dominance

  • difficulty looking while listening

  • trouble with focused and peripheral vision

  • trouble with ball skills - throwing and catching

  • difficulty with handwriting 

  • trouble with eye tracking

  • difficulty with attention, focus, memory and thinking

Symmetrical Tonic Neck Reflex (STNR)

STNR is a reflex that develops in utero and is integrated around 10 months of age.  It is triggered when an infant is in quadruped or on their hands and knees.  When the head bends forward, it causes the arms to bend and well.  When the head and neck are extended, the arms extend as well.  This reflex is the precursor to crawling.


Indicators that this reflex is not fully integrated:


  • "W"-sitting

  • Difficulty staying seated in a chair (child may need to wrap their legs around the legs of the chair)

  • Fidgety when seated

  • Difficulty learning to pump a swing

  • Reading and writing are easier on the floor with their legs extended

  • Cannot maintain a hands and knees position

  • Difficulty learning to swim

  • Poor visual tracking

Moro Reflex

The moro reflex is ellicted by a sudden change in the infants head position, usually backwards.  It triggers an extension of the arms and legs and a deep breath in.  After which the infant exhales and flexes inward into a ball, often times crying. This reflex usually integrates around 4 months of age.

Indicators that this reflex is not fully integrated:

  • over sensitivity to non-noxious events

  • dysregulation

  • poor balance and equilibrium

  • uncomfortable tilting head back (like when rinsing soap out of the hair)

  • irrational behavioral patterns-excessive anxiety, timidity, dependency

  • fear having feet off the floor 

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