Reach Us +44-1904-929220

Use of a Neurosensorimotor Reflex Integration Program to Improve Reflex Patterns of Children with Down Syndrome

Svetlana Masgutova1,2*, Ludwika Sadowska3, Joanna Kowalewska1, Denis Masgutov1, Nelli Akhmatova4* and Henryk Filipowski3

1International Dr. Svetlana Masgutova Institute, Poland

2Svetlana Masgutova Educational Institute®, USA

3Department of Developmental Rehabilitation and Physiotherapy, Faculty of Health Sciences of Medical Academy by PiastowSlaskich in Wroclaw, Poland

4Mechnikov Scientific Research Institute for Vaccines and Serums.Moscow, Russia

*Corresponding Author:
Svetlna Masgutova
Svetlana Masgutova Educational Institute®, 6028 Bent Pine Dr., #2910, Orlando, 32822, Florida, USA
Tel: +1 (720) 544-1166
E-mail: masgutovas@msn.com
Nelli Akhmatova
Mechnikov Scientific Research Institute for Vaccines and Serums, 5A MalyKazennypereulok, Moscow, 105064 Russia
Tel: +7 (495) 916-07-74
E-mail: anelly@mail.ru

Received Date: September 23, 2015; Accepted Date: December 28; 2015; Published Date: December 31, 2015

Citation: Masgutova S, Sadowska L, Kowalewska J, et al. Use of a Neurosensorimotor Reflex Integration Program to Improve Reflex Patterns of Children with Down Syndrome. J Neurol Neurosci. 2016, 6:4. DOI: 10.21767/2171-6625.100059

 
Visit for more related articles at Journal of Neurology and Neuroscience

Abstract

A novel and non-invasive method for evaluating and improving neurodevelopmental delays in children with Down syndrome was evaluated. Changes in the reflex patterns of children (6 months to 18 years old) (n=54) with Down syndrome were used as objective measures for comparing before and after participation in a Neurosensorimotor Reflex Integration exercise program. Majority number of reflex patterns showed substantial improvement after children’s completion of the exercise program, although not to the level of development comparable to that of children with typical development. This success indicates that the neurodevelopment and overall functioning of Down syndrome children is not static and can be improved with this novel Neurosensorimotor Reflex Integration (NRI) exercise program. This research also show the fact that the changes in reflex patterns happen in children with mild, moderate and severe disabilities on significant level.

Keywords

Down syndrome; Neurosensorimotor reflex integration; Reflex pattern; Developmental disabilities

Introduction

Down syndrome is caused by chromosome 21 abnormalities and is the most commonly identified genetic form of intellectual developmental disorder [1]. The prevalence of Down syndrome appears to be increasing, and current estimates are that about 1 in 700 live births are affected. A number of morphological, health, and neurodevelopmental disorders are associated with Down syndrome. Most children with Down syndrome have reduced muscle strength and tone (hypo-tonicity), excessive/hyper-motor rotation range in joints, and other neurodevelopmental, motor, and cognitive deficiencies [2]. Down syndrome children also have other developmental disabilities, including delayed psychomotor development, learning disabilities, deficient communication skills, and neurobehavioral and psychiatric problems that manifest as behavioral problems. Behavioral problems include aggression, disruptive behavior, attention deficit disorders, and obsessive-compulsive disorders [3]. While improvements in medical care have led to increased life expectancy for those with Down Syndrome [3], therapies for cognitive disabilities often emphasize pharmacologic strategies [4]. Consequently, there is a need for alternative or complementary therapies for addressing the neurodevelopmental deficiencies of children with Down syndrome.

Neurosensorimotor Reflex Integration (NRI) therapeutic modality is a novel and non-invasive method of improving developmental delays and central nervous system function in children with a variety of developmental disabilities [5]. This method addresses disorders with a neurologic component, and it is based on the concept that unconditioned reflexes are not static and facilitate adaptation to the external environment, while becoming the foundation for physical, emotional, and cognitive development [6,7]. Unconditioned reflexes, such as Babkin Palmomental, Babinski, Spinal Galant, and Perez are innate, genetically-based traits that are required for survival by all individuals [8]. In contrast, conditioned reflexes, are learned voluntary responses that require recruitment of unconditioned reflexes [9-13]. Conditioned reflexes such as Leg Cross Flexion-Extension, Bauer Crawling, and Symmetrical Tonic Neck are the basis for most unconscious habits and skills [6,9].

An assumption of the NRI therapeutic modality is that if the reflex arc of sensory input, brain processing, and motor response is complete, and the various reflexes are neurologically mature (myelinated), then physical, emotional and cognitive functions will function normally [12,14]. Alternatively, emotional outbursts, cognitive deficiencies, or atypical movement patterns may occur if there are deficiencies in the interpretation of sensory information or motor responses are abnormal. This appears to be true for autism, where sensory disorders appear to be more frequent and prominent than in children with normal development [15]. Motor disorders are also present in autistic children at birth, and these disorders may be useful for diagnosing autism at a young age [16,17]. The NRI therapeutic modality considers reflex deficiencies as diagnostic of developmental pathology also in children with Down syndrome and other developmental disabilities, as well as clinical targets for correcting deficiencies that can favor improved behavior, emotional stability, and physical control. It also promotes the importance of an early intervention program.

The NRI Assessment separately evaluates 24 basic reflexes that were empirically selected from well-established reflexes [5,16,17]. This evaluation is based on measurement of motor responses because direct measurement of sensory and brain processing is not currently possible. Each reflex receives a single score on a continuous scale of 0-4 using the sum of scores for five parameters: 1. direction of motor or postural response, 2. sensory-motor coordination in a reflex pattern, 3. intensity or strength, 4. response time and its duration, and 5. symmetry [5,16,17]. Clinically, each reflex evaluation is used to develop an individualized, home exercise program that is intended to correct dysfunctional reflex function. Individualized exercise programs are established based on the patient’s reflex deficiencies. These programs are developed at NRI training conferences where patients are assessed and parents or caregivers are trained to perform neurosensorimotor exercises at home. The conferences offer six different neurosensorimotor training sessions each day. Although neurosensorimotor training sessions are selected based on the patient’s needs (Appendix 1), each training session is based on the same neurosensorimotor concepts.

Improved reflex scores following use of Neurosensorimotor Reflex Integration has anecdotally been observed to correspond with improved behavior, emotional stability, and/or physical control. Consequently, improved reflex scores are objective measures of improved function following use of the NRI programs. Statistical comparisons of improved reflex scores require integration of 24 reflex evaluations into a single score (Zc) that represents overall function. Therefore, an ANOVA was developed that incorporates reflexes grouped by functional body movement planes [18].

This study of 54 children with Down syndrome documents the effectiveness of NRI for improving the functioning of children with Down syndrome. Improved reflex scores were used as objective measures for before and after comparisons. This study evaluates the efficacy of NRI for improving the functions of the sensory motor sphere of children with developmental deficiencies.

Material and Methods

Study design

This study documented improvement in 54 children (6 months to 18 years old) with Down syndrome; 21 females (9 children of 0-5 years, 8 children of 6-12 years, and 4 children of 13-18 year old age) and 33 males (12 children of 0-4 years, 11 - of 6-12 years, and 9 of them of the age of 13-18). 50 children were diagnosed by genetic analysis as trisomy disorder and 4 as mosaic disorder (mixed). The level of severity of disability was determined based on their diagnosis of the IQ as the main criteria accepted in medical and psychological evaluations [19-21]. 33 children with Down Syndrome were checked as follows: 13 children with mild disorder (IQ: 50-70), 16 of moderate disorder (IQ: 35-50), and 4 children with severe disorders (IQ: 20-35). 21 children other were not checked for levels of severity of the symptoms due to the challenge of testing their intellectual retardation at their younger ages.

The research group of children (Study Group) attended at least one NRI training conference held during the 2011 and 2012 calendar years versus the control group of 30 individuals with Down Syndrome (the same age of 6 months to 18 years old; females and males) (Control Group 1) and also individuals with neurotypical development (Control Group 2). Conferences were held in Warsaw, Poland; San Francisco, New Jersey, and Florida, USA; and Vancouver, Canada. Group sizes at these multiple day conferences were 12-24 participants. Inclusion criteria included: completion of a Reflex Parameters Assessment before (pre-test) and after (post-test) attendance at a training conference (8 days: 4 days of intense training, one day rest, followed by another 4 days of training), and completion of six 50-minute training sessions during a training conference (total 64 therapy hours). Training session topics included: Neurostructural Reflex Integration; Tactile Integration; Dynamic and Postural Reflex Re-patterning; Visual and Auditory Reflex Integration and Oral-Facial Reflex Integration; Proprioceptive and Vestibular Skills Development, Lifelong Reflex Integration; and Archetype Movement Integration. Receipt of informed consent was received from all participants’ parent or legal guardian. Assessments were conducted and therapy administered by Specialists or Core Specialists in Training who have successfully completed a specific set of courses and clinical hours in NRI.

The research also presents study data on a control group of 46 individuals with Down syndrome (Control Group 2, the same age of 6 months to 18 years), who did not go through NRI training. Among them there were 19 females (9 children of 0-5 years, 6 children of 6-12 years, and 5 children of 13-18 year old age) and 27 males (11 children of 0-4 years, 9 children of 6-12 years, and 9 children of 13-18 years). Forty-one children were diagnosed as trisomy disorder and five as mosaic disorder (mixed). The severity levels of 26 other children with Down syndrome was as follows: 13 children with mild disorder (IQ: 50-70), 10 moderate disorder (IQ: 35-50), and 3 children with severe disorder (IQ: 20-35). Twenty children were not checked for symptom severity levels due to their younger age. The pre- and post-test of reflex patterns were carried out within the same time frame of 9 days.

The third group that participated in research were children with neurotypical development (780 individuals from 6 to 19 years; 421 females and 359 males [some of this data was reported at international conferences and was published previously]); 356 children of 0-5 years, 265 children of 6-12 years, and 159 children of 13-18 years). They did not go through the NRI training. The pre- and post-test of reflex patterns were carried out within the same time frame of 9 days.

Ethical approval

Institutional Review Board (IRB) approval was granted by the New England IRB (85 Wells Avenue, Suite 107, Newton, MA 02459) (IRB ll-173). The New England Institutional Review Board is a central institutional review board for sponsors, CROs and individual researchers across North America (http://www.neirb. com). The IRB ensures the safety of human subjects in clinical trials by committing a thorough and ethical IRB review process. The New England IRB is registered with both the FDA and the Office for Human Research Protections (OHRP) under IORG Number IORG0000444, and has Full Accreditation status from the Association for Accreditation of Human Research Protection Programs (AAHRPP). Adverse effects (new or worsening medical conditions of any kind) were promptly investigated and reported to the IRB. All participants were assigned codes to protect anonymity.

Measures

The primary outcomes of interest were changes in the reflex patterns of children with Down syndrome. Reflex Pattern Assessments were conducted prior to (pre-test) and after conferences (post-test) and compared. Evaluations of motor and cognitive patterns considered the child’s age, neurologic abnormalities, and status of inborn reflex patterns. Briefly, this entailed grading 24 reflexes (Diagnostic Quality Features coded X1-X24) using five criteria: reflex pattern (or sensory-motor circuit), direction of a response (or movement), strength of reaction, time of reaction, and symmetry. Grades were assigned on a continuous scale of 0-4, with 4 indicating full display of a parameter, and 0 indicating the parameter’s absence. This results in a maximum score of 20 for each reflex (Table 1). Summary scores of 11-20 represent varying degrees of partially or fully integrated reflex patterns, scores 0-9 reflect varying degrees of abnormal development, and scores of 10 to 11.75 are marginal. Scores 16-17.75 represent the norm. Reflex patterns were further categorized according to body movement planes, with eight reflex patterns each corresponding to sagittal, horizontal, and dorsal body movement planes [5].

Normal Function Dysfunction/Pathology
Points Level of reflex integration Points Level of reflex dysfunction
20 Full / Complete integration 10-11.75 Marginal pathology and dysfunction
18-19.75 Mature and integrated 8-9.75 Improper light dysfunction
16-17.75 Properly developed-normal 6-7.75 Dysfunction
14-15.75 Proper, but low level of development 4-5.75 Severe dysfunction
12-13.75 Proper, but very low level of development 2-3.75 Pathology
10-11.75 Marginal pathology and dysfunction 0-1.75 Severe pathology

Table 1: Clinical assessments of Reflex Pattern Assessment scores.

Statistical methods

Results of Reflex Pattern Assessments in children with Down syndrome were analyzed based on the multivariable function z=f(x) of directly non-observable phenomena [18]. Briefly, this function estimates the level of the reflex pattern integration Z as a function of the grading reflex patterns X1, X2,..., X24, with the assumption that this is a linear function. Consequently, variable ZS (sagittal) summarizes information from the first eight reflex patterns X1, X2,..,X8, variable ZH (horizontal body plane) summarizes the information from the second eight reflex patterns X9, X10,..,X16, and variable ZD (dorsal) summarizes the last eight reflex patterns X17, X18,..,X24. The level of the reflex pattern integration (ZC) is estimated by the measured reflex patterns (X1, X2,..., X24). In this case, instead of taking the 24 values with each of the scores (0 to 20) for each patient, we determine three values of reflex pattern integration by body plane symmetry and/or one value of the reflex pattern integration level z for values between 0 and 1. Mean values of ZC, ZS, ZH, and ZD were compared before and 11 days after participating in the NRI program using an ANOVA test developed for this type of analysis (IBM SPSS Statistics Grad Pack 22.0). Results were considered statistically significant where p<0.01 and not significant at p>0.05.

Part of statistical evaluations were performed also with the Mann- Whitney U-test, using Statistica (version 6.0; Stat Soft Inc, Tulsa, OK, USA). P values (M ± SD) less than 0.001 were considered significant and not significant at p>0.05.

Results

Initial reflex scores of children in Study Group ranged from severe dysfunction (4.5) to low levels of development (12) (Table 2). Significant number of their reflexes - 83,3% - showed substantial improvement after completion of NRI - Neurosensorimotor reflex integration -programs (Table 2), though not to the level of development comparable to that of children with typical development (Table 2 and Figure 1). 16,7% of reflex patterns (the Automatic Gait, Hands Supporting, Flying and Landing and Pavlov Orientation) didn’t show the statistical significance though positive changes were noticed particularly, in such patterns as: the Automatic Gait pattern - in more balanced manner and speed of walking; the Hands Supporting - movement orientation in space, strength of muscles. The means of all reflexes summarized by body plane symmetry (Z values) increased after completion of the NRI program, as did the cumulative ZC value (Table 3).

Diagnostic Quality/ Feature Body Movement Plane Reflex Results of Assessment
Study Group (54 individuals with Down Syndrome) Control Group 1 (46 individuals with Down Syndrome) Control Group 2 (780 individuals with neurotypical development
Pre-test: Before Program Post-test:
After Program
Pre-test Post-Test
(in 9 days)
Pre-test Post-Test
X1 S Robinson Hands Grasp (RGR) 6,4 ± 0.5 8,2 ± 0.7* 6,2 ± 0.4 6,3 ± 0.3 17 ± 0.7 17 ± 0.7
X2 S Hands Pulling (HPR) 8,4 ± 0.4 9,2 ± 0.3* 8,1 ± 0.3 8,2 ± 0.5 16 ± 0.5 16,1 ± 0.8
X3 S BabkinPalmomental (BPR) 4,5 ± 0.5 5,4 ± 0.3* 4,5 ± 0.4 4,4 ± 0.6 16 ± 0.8 15,8 ± 0.9
X4 S Babinski (BR) 6,7 ± 0.4 7,3 ± 0.7* 6,7 ± 0.4 6,6 ± 0.3 16,5 ± 0.8 16,5 ± 1.2
X5 S Leg Cross Flexion-Extension (LCFER) 5,5 ± 0.6 6,9 ± 0.7* 5,3 ± 0.2 5,3 ± 0.3 17 ± 0.9 17,1 ± 0.7
X6 S Asymmetrical Tonic Neck (ATNR) 6,7 ± 0.3 7,4 ± 0.3* 6,4 ± 0.3 6,3 ± 0.2 15 ± 0.7 15 ± 0.9
X7 S Abdominal (AR) 8,2 ± 0.6 10,4 ± 0.4* 8,4 ± 0.6 8,3 ± 0.5 16 ± 1.0 16,1 ± 0.9
X8 S Bonding (BR) 12 ± 0.3 13,2 ± 0.7* 11,6 ± 0.5 8,9 ± 0.7 15,5 ± 0.7 15,5 ± 0.8
X9 H Thomas Automatic Gait (TAGR) 8,8 ± 0.3 9,3 ± 0.4 8,5 ± 0/4 8,6 ± 0.3 17,5 ± 0.9 17,4 ± 1.3
X10 H Bauer Crawling (BCR) 6,5 ± 0.5 9,4 ± 0.7* 6,6 ± 0.3 6,5 ± 0.5 15,5 ± 0.6 15,5 ± 0.8
X11 H Moro Embrace (MR) 11 ± 0.6 13,2 ± 0.7* 11,2 ± 0.7 10,9 ± 0.5 15,5 ± 0.6 15,5 ± 0.8
X12 H Fear Paralysis (FPR) 12 ± 0.5 13,4 ± 0.7* 11,8 ± 0.5 11,9 ± 0.6 14,5 ± 0.5 14,6 ± 0.7
X13 H Hands Supporting (HSR) 8,3 ± 0.3 8,9 ± 0.4 8.1 ± 0.3 8,2 ± 0.2 15,5 ± 0.7 15,5 ± 0.9
X14 H Segmental Rolling (SRR) 7,2 ± 0.4 8,1 ± 0.3* 7,4 ± 0.4 7,2 ± 0.5 15 ± 0.8 15,4 ± 1.2
X15 H Landau (LR) 6,4 ± 0.4 7,2 ± 0.2* 6,1 ± 0.3 6,1 ± o.4 15 ± 0.8 15,1 ± 1.1
X16 H Flying and Landing (FLR) 5,2 ± 0.4 5,8 ± 0.5 4,8 ± 0.4 4,9 ± 0.5 14,5 ± 0.7 14,5 ± 0.9
X17 D Trunk Extension (TER) 8,2 ± 0.3 8,8 ± 0.2* 7,8 ± 0.4 7,9 ± 0.6 16 ± 0.7 16,2 ± 0.8
X18 D Symmetrical Tonic Neck (STNR) 6,3 ± 0.7 8,4 ± 0.6* 6,4 ± 0.5 6,5 ± 0.6 16 ± 0.6 15,8 ± 0.9
X19 D Spinal Galant (SGR) 8,3 ± 0.7 11,2 ± 0.8* 8,5 ± 0.5 8,4 ± 0.6 15 ± 0.9 15 ± 1.2
X20 D Spinal Perez (SPR) 11 ± 0.4 12,3 ± 0.8* 10,4 ± 0.9 10,2 ± 0.8 16 ± 0.7 16,1 ± 1.2
X21 D Tonic Labyrinthine (LTR) 9,2 ± 0.7 11,2 ± 0.6* 9 ± 0.7 8,9 ± 0.5 16 ± 0.9 16,1 ± 1.1
X22 D Foot Tendon Guard (FTGR) 8,1 ± 0.6 10 ± 0.5* 8 ± 0.4 7,9 ± 0.5 15,5 ± 0.8 15,3 ± 1.2
X23 D Spinning (SR) 8,3 ± 0.8 12,4 ± 0.7* 8 ± 0.6 8,2 ± 0.5 15 ± 0.9 15,1 ± 1.7
X24 D Pavlov Orientation (POR) 6,6 ± 0.2 6,8 ± 0.3 6,7 ± 0.3 6,6 ± 0.5 18,5 ± 0.7 18,5 ± 0.9

Table 2: Diagnostic Quality Feature (X1-X24), body movement planes (S = sagittal; H = horizontal; D = dorsal), reflexes, and assessments before and after participation in neurosensorimotor reflex integration (NRI) conferences.

Variables Average values and standard deviations for three synthetic variables, ZS (sagittal body plane), ZH (horizontal), and ZD (dorsal)
Study Group
(54 individuals with Down Syndrome)
Control Group 1
(46 individuals with Down Syndrome)
Control Group 2
(780 individuals with neurotypical development
Before After ANOVA Before After ANOVA Before After ANOVA
  Mean S.D. Mean S.D. P< Mean S.D. Mean S.D. P> Mean S.D. Mean S.D. P>
ZC 0.3924 0.1884 0.6038 0.1790 0.001 0.4112 0.1912 0.4213 0.1619 0.05 0.2914 0.1782 0.3424 0.1672 0.05
ZS 0.4083 0.1890 0.5912 0.1940 0.001 0,3876 0.1812 0,3576 0.1872 0.05 0.3063 0.1680 0.2852 0.1662 0.05
ZH 0.3861 0.1792 0.6088 0.1754 0.001 0.4084 0.1712 0.4102 0.1692 0.05 0.2851 0.1572 0.2641 0.1585 0.05
ZD 0.4135 0.2076 0.5849 0.1853 0.001 0.3913 0.1893 0.3818 0.1953 0.05 0.3142 0.1265 0.3341 0.1357 0.05
Select your language of interest to view the total content in your interested language

Viewing options

Post your comment

Share This Article

Flyer image
journal indexing image
 

Post your comment

captcha   Reload  Can't read the image? click here to refresh