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Melillo RJ, Leisman G, Machado C, Carmeli E. Identification and reduction of retained primitive reflexes by sensory stimulation in autism spectrum disorder: effects on qEEG networks and cognitive functions. BMJ Case Rep 2023; 16:e255285. [PMID: 38154865 PMCID: PMC10759118 DOI: 10.1136/bcr-2023-255285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 12/30/2023] Open
Abstract
Several authors have reported finding retained primitive reflexes (RPRs) in individuals with autism spectrum disorders (ASD). This case report describes the reduction of RPRs and changes in cognitive function after transcutaneous electrical nerve stimulation (TENS) of muscle. Three individuals were examined in a study at the Institute for Neurology and Neurosurgery in Havana, Cuba. Two child neurologists, not involved in the study, conducted clinical examinations on each participant and diagnosed each with ASD based on DSM-V criteria and the Autism Diagnostic Interview-Revised (an autism evaluation tool). Each child with ASD possessed a triad of impairments in three domains: social interaction, communication, and repetitive behaviour. Individuals were evaluated by quantitative electroencephalographic measures and tested by standardised cognitive function tests before and after 12 weeks of intervention. These interventions were associated with reduced ASD symptoms in the three domains, significant changes in qEEG network connectivity and significantly improved performance on standardised cognitive tests.
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Affiliation(s)
- Robert John Melillo
- Movement and Cognition Laboratory, Department of Physical Therapy, University of Haifa Faculty of Social Welfare and Health Sciences, Haifa, Israel
| | - Gerry Leisman
- Movement and Cognition Laboratory, Department of Physical Therapy, University of Haifa Faculty of Social Welfare and Health Sciences, Haifa, Israel
- Institute for Neurology and Neurosurgery, Universidad de Ciencias Medicas de La Habana, La Habana, Cuba
| | - Calixto Machado
- Clinical Neurophysiology, Instituto de Neurologia y Neurocirugia, La Habana, Cuba
| | - Eli Carmeli
- Physical Therapy, University of Haifa, Haifa, Israel
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Harjpal P, Kovela RK, Qureshi MI. Promoting Survival and Primitive Reflexes to Prevent Brain Imbalance in Premature Infants: A Scoping Review of New Insights by Physiotherapists on Developmental Disorders. Cureus 2023; 15:e43757. [PMID: 37727176 PMCID: PMC10506688 DOI: 10.7759/cureus.43757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/19/2023] [Indexed: 09/21/2023] Open
Abstract
Survival reflexes, originating from the brainstem, are involuntary motor responses that are present at birth and facilitate the survival of the neonate. The age of the baby is critical enough to give information about the maturation of these reflexes. In the case of preterm babies, the delayed maturity of these reflexes may pose a threat to the life of the newborn. One can perceive what the baby can feel, taste, smell, see, and hear through reflex maturation. The objective was to identify and understand the role of survival reflexes and primitive reflexes and their importance in premature children. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest, The Cochrane Library, Scopus, and Web of Science were the electronic databases used from January 2017 until November 2022. We included the original articles, reviews, and randomized clinical trials that focused on the importance of survival reflexes. Later on, all the articles were systematically arranged as per the information they provided, and 101 titles were selected, of which 32 met the inclusion criteria. Various articles were written regarding the present literature about primitive reflexes, but none promoted them in the neonatal intensive care unit (NICU). This review is regarding the use of survival reflexes to improve the outcomes of neonates, specifically in the NICU. Simple interactions with the environment are made possible by primitive reflexes, which also serve as the foundation for early movement. This review presents a better understanding of the maturation of survival reflexes and primitive reflexes and provides further insight into how a physiotherapist can concentrate on the early identification and development of these reflexes to prevent further complications. Assessing the primitive reflex in the NICU will help in the early identification of developmental delay and further help us predict reflex maturation. Promoting them will provide positive outcomes in terms of neonatal development. A physiotherapist can play a vital role starting from the NICU to get the baby into an environment similar to the mother's womb and therapy to get the early maturation of the reflex.
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Affiliation(s)
- Pallavi Harjpal
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rakesh K Kovela
- Physiotherapy, Nitte Institute of Physiotherapy, Nitte (Deemed to be University), Mangalore, IND
| | - Moh'd Irshad Qureshi
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Melillo R, Leisman G, Machado C, Machado-Ferrer Y, Chinchilla-Acosta M, Melillo T, Carmeli E. The Relationship between Retained Primitive Reflexes and Hemispheric Connectivity in Autism Spectrum Disorders. Brain Sci 2023; 13:1147. [PMID: 37626503 PMCID: PMC10452103 DOI: 10.3390/brainsci13081147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/20/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) can be identified by a general tendency toward a reduction in the expression of low-band, widely dispersed integrative activities, which is made up for by an increase in localized, high-frequency, regionally dispersed activity. The study assessed ASD children and adults all possessing retained primitive reflexes (RPRs) compared with a control group that did not attempt to reduce or remove those RPRs and then examined the effects on qEEG and brain network connectivity. METHODS Analysis of qEEG spectral and functional connectivity was performed, to identify associations with the presence or absence of retained primitive reflexes (RPRs), before and after an intervention based on TENS unilateral stimulation. RESULTS The results point to abnormal lateralization in ASD, including long-range underconnectivity, a greater left-over-right qEEG functional connectivity ratio, and short-range overconnectivity in ASD. CONCLUSIONS Clinical improvement and the absence of RPRs may be linked to variations in qEEG frequency bands and more optimized brain networks, resulting in more developmentally appropriate long-range connectivity links, primarily in the right hemisphere.
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Affiliation(s)
- Robert Melillo
- Movement and Cognition Laboratory, Department of Physical Therapy, University of Haifa, Haifa 3498838, Israel
| | - Gerry Leisman
- Movement and Cognition Laboratory, Department of Physical Therapy, University of Haifa, Haifa 3498838, Israel
- Department of Neurology, University of the Medical Sciences of Havana, Havana 10400, Cuba
| | - Calixto Machado
- Department of Clinical Neurophysiology, Institute for Neurology and Neurosurgery, Havana 10400, Cuba
| | - Yanin Machado-Ferrer
- Department of Clinical Neurophysiology, Institute for Neurology and Neurosurgery, Havana 10400, Cuba
| | | | - Ty Melillo
- Northeast College of the Health Sciences, Seneca Falls, New York, NY 13148, USA
| | - Eli Carmeli
- Movement and Cognition Laboratory, Department of Physical Therapy, University of Haifa, Haifa 3498838, Israel
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Wang M, Yu J, Kim HD, Cruz AB. Attention deficit hyperactivity disorder is associated with (a)symmetric tonic neck primitive reflexes: a systematic review and meta-analysis. Front Psychiatry 2023; 14:1175974. [PMID: 37484683 PMCID: PMC10361412 DOI: 10.3389/fpsyt.2023.1175974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Investigation on the association between attention deficit hyperactivity disorder (ADHD) and primary reflexes is in the initial stage, with considerable differences in the findings. This study evaluated the association between ADHD and primitive reflexes using systematic review and meta-analysis. Methods Data were obtained from PubMed, Cochrane Library, Web of Science, EBSCO (Medical Literature Analysis and Retrieval System Online, American Psychological Association Psyclnfo, and Education Resources Information Center), Embase, Scopus, and ProQuest. Articles were searched from the date of inception of the respective databases to January 01, 2023, and StataCorp Stata (version 15) was used for the analysis. Results Four articles with 229 samples were included in the meta-analysis. Results showed a significant positive and moderate correlation between ADHD and primitive reflexes, particularly asymmetric tonic neck reflex: summary r value = 0.48, 95% CI = 0.27-0.64; symmetric tonic neck reflex: summary r value = 0.39, 95% CI = 0.25-0.52. Overall, findings from the sub-group analysis indicate that the behavioral problem measuring tool (Conners' scale), sex, and primitive reflex test could significantly moderate the relationships between ADHD and ATNR and STNR primitive reflexes. Conclusion ADHD symptoms in children are closely related to the non-integration of (a)symmetric tonic neck primitive reflexes. Longitudinal or experimental studies should be conducted to reveal the causal relationship between ADHD and primitive reflexes in the future.
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Affiliation(s)
- Meng Wang
- Department of Physical Education, Keimyung University, Daegu, Republic of Korea
| | - Jing Yu
- College of Sports Science, Shenyang Normal University, Shenyang, China
| | - Hyun-Duck Kim
- Department of Sport Marketing, Keimyung University, Daegu, Republic of Korea
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Hazzaa N, Shalaby A, Hassanein S, Khattab A, Metwally N, Naeem F. Balance functions and primitive reflexes in dyslexic children. HEARING, BALANCE AND COMMUNICATION 2023. [DOI: 10.1080/21695717.2023.2176657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Nagwa Hazzaa
- Audiology Unit, ORL Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amany Shalaby
- Audiology Unit, ORL Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sahar Hassanein
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Khattab
- Phoniatrics Unit, ORL Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nancy Metwally
- ORL Department, Abou El-Monagga Central Hospital, Ministry of Health, Cairo, Egypt
| | - Fathy Naeem
- Audiology Unit, ORL Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Leisman G, Melillo R. Front and center: Maturational dysregulation of frontal lobe functional neuroanatomic connections in attention deficit hyperactivity disorder. Front Neuroanat 2022; 16:936025. [PMID: 36081853 PMCID: PMC9446472 DOI: 10.3389/fnana.2022.936025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/29/2022] [Indexed: 12/21/2022] Open
Abstract
Frontal lobe function may not universally explain all forms of attention deficit hyperactivity disorder (ADHD) but the frontal lobe hypothesis described supports an internally consistent model for integrating the numerous behaviors associated with ADHD. The paper examines the developmental trajectories of frontal and prefrontal lobe development, framing ADHD as maturational dysregulation concluding that the cognitive, motor, and behavioral abilities of the presumptive majority of ADHD children may not primarily be disordered or dysfunctional but reflect maturational dysregulation that is inconsistent with the psychomotor and cognitive expectations for the child’s chronological and mental age. ADHD children demonstrate decreased activation of the right and middle prefrontal cortex. Prefrontal and frontal lobe regions have an exuberant network of shared pathways with the diencephalic region, also having a regulatory function in arousal as well as with the ascending reticular formation which has a capacity for response suppression to task-irrelevant stimuli. Prefrontal lesions oftentimes are associated with the regulatory breakdown of goal-directed activity and impulsivity. In conclusion, a presumptive majority of childhood ADHD may result from maturational dysregulation of the frontal lobes with effects on the direct, indirect and/or, hyperdirect pathways.
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Affiliation(s)
- Gerry Leisman
- Movement and Cognition Laboratory, Department of Physical Therapy, University of Haifa, Haifa, Israel
- Department of Neurology, University of Medical Sciences of Havana, Havana, Cuba
- *Correspondence: Gerry Leisman,
| | - Robert Melillo
- Movement and Cognition Laboratory, Department of Physical Therapy, University of Haifa, Haifa, Israel
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Melillo R, Leisman G, Machado C, Machado-Ferrer Y, Chinchilla-Acosta M, Kamgang S, Melillo T, Carmeli E. Retained Primitive Reflexes and Potential for Intervention in Autistic Spectrum Disorders. Front Neurol 2022; 13:922322. [PMID: 35873782 PMCID: PMC9301367 DOI: 10.3389/fneur.2022.922322] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
We provide evidence to support the contention that many aspects of Autistic Spectrum Disorder (ASD) are related to interregional brain functional disconnectivity associated with maturational delays in the development of brain networks. We think a delay in brain maturation in some networks may result in an increase in cortical maturation and development in other networks, leading to a developmental asynchrony and an unevenness of functional skills and symptoms. The paper supports the close relationship between retained primitive reflexes and cognitive and motor function in general and in ASD in particular provided to indicate that the inhibition of RPRs can effect positive change in ASD.
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Affiliation(s)
- Robert Melillo
- Movement and Cognition Laboratory, Department of Physical Therapy, University of Haifa, Haifa, Israel
| | - Gerry Leisman
- Movement and Cognition Laboratory, Department of Physical Therapy, University of Haifa, Haifa, Israel
- Department of Neurology, University of the Medical Sciences of Havana, Havana, Cuba
| | - Calixto Machado
- Department of Clinical Neurophysiology, Institute for Neurology and Neurosurgery, Havana, Cuba
| | - Yanin Machado-Ferrer
- Department of Clinical Neurophysiology, Institute for Neurology and Neurosurgery, Havana, Cuba
| | | | - Shanine Kamgang
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Ty Melillo
- Northeast College of the Health Sciences, Seneca Falls, New York, NY, United States
| | - Eli Carmeli
- Movement and Cognition Laboratory, Department of Physical Therapy, University of Haifa, Haifa, Israel
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Pecuch A, Gieysztor E, Wolańska E, Telenga M, Paprocka-Borowicz M. Primitive Reflex Activity in Relation to Motor Skills in Healthy Preschool Children. Brain Sci 2021; 11:brainsci11080967. [PMID: 34439585 PMCID: PMC8394673 DOI: 10.3390/brainsci11080967] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/14/2021] [Accepted: 07/12/2021] [Indexed: 12/01/2022] Open
Abstract
Psychomotor development in the first year of life is possible due to activity and then integration of primitive (neonatal) reflexes. The presence of active primitive reflexes (APRs) in preschool and school-aged children indicates neuromotor immaturity. Studies show dependencies between the preserved activity of primary reflexes and developmental problems such as learning difficulties (problems with reading, writing, reduced mathematics skills, and dyslexia), difficulties with coordination, and attention deficit. The primary purpose of this study is to present the activity of three tonic reflexes in a sample of 112 Polish children aged 4–6 in relation to their motor skills. The children were examined for the presence of the asymmetric tonic neck reflex (ATNR), symmetric tonic neck reflex (STNR), and tonic labyrinthine reflex (TLR). Motor performance was examined with the MOT 4–6. Statistical analysis shows an inverse correlation between the score in the test of reflexes and motor efficiency (MOT 4–6) at p < 0.05 (−0.33). Children with increased reflex activity presented a lower level of motor efficiency. The multiple regression model showed that with the older age of the child and the decrease in the level of reflex activity, the motor skills of children improve. Thus, there is a need for early screening of primitive reflexes in children. Properly selected exercises and therapeutic activities aimed at integrating APRs in children with developmental difficulties can improve their motor skills, perceptual abilities, and emotional behavior.
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Affiliation(s)
- Anna Pecuch
- Physiotherapy Department, Faculty of Health Sciences, Wrocław Medical University, Grunwaldzka 2, 50-355 Wrocław, Poland; (A.P.); (M.T.); (M.P.-B.)
| | - Ewa Gieysztor
- Physiotherapy Department, Faculty of Health Sciences, Wrocław Medical University, Grunwaldzka 2, 50-355 Wrocław, Poland; (A.P.); (M.T.); (M.P.-B.)
- Correspondence:
| | - Ewelina Wolańska
- Department of Pediatrics, Division of Pediatrics and Rare Disorders, Wrocław Medical University, ul. Bartla 5, 51-618 Wroclaw, Poland;
| | - Marlena Telenga
- Physiotherapy Department, Faculty of Health Sciences, Wrocław Medical University, Grunwaldzka 2, 50-355 Wrocław, Poland; (A.P.); (M.T.); (M.P.-B.)
| | - Małgorzata Paprocka-Borowicz
- Physiotherapy Department, Faculty of Health Sciences, Wrocław Medical University, Grunwaldzka 2, 50-355 Wrocław, Poland; (A.P.); (M.T.); (M.P.-B.)
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