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Fetal Tuck Reflex

There is research to support the theory that primitive reflexes and movement patterns (like the ones seen in babies) re-emerge in late stage Alzheimer’s disease.  It’s not that the reflexes “come back”, because they never really went away.  It’s because as we grew, we learned more sophisticated movement patterns, and these skills were mastered and stored in higher centers in the brain.  These newer movement patterns are more susceptible to cell death in Alzheimer’s disease, just like newer memories are “weaker” than older ones.  Without the more sophisticated movement patterns to dampen the primitive ones, Alzheimer’s patients show some of the postures and movement patterns seen in babies.

This one particular movement pattern is my own personal theory- I can’t find the research to support it but it sure makes sense in practical application.

Did you ever notice that when you pick up a baby under the arms, his legs tuck up closer to his body?  It’s almost like the baby is posed to fit tight against your hip without even having to plan for that specific movement.  It’s a reflex known as the fetal tuck reflex.

Conversely, that same baby can crawl over to the coffee table and pull himself up with his arms- and his legs extend to take the weight.

I’ve witnessed countless caregivers scoop up late stage Alzheimer’s patients from their wheelchairs by hooking their arms under the patients’ armpits and dragging them to another surface.  Those patients almost never bear weight on their legs, further convincing the caregivers that they are unable to help with transfers.  This puts everyone at risk for injury, and further deprives the patient of the opportunity to stand and bear weight.

I’ve had great success in improving standing tolerance and transfers by allowing the patients to pull themselves up.  When the arms are actively engaged, and the brain has time to plan this entire highly familiar movement, the patient is frequently able to pull to stand, or at least a partial stand.  What makes this a functional and meaningful task is that the patient has the opportunity to bear weight, the patient has the opportunity to engage the mind and body in a motor planning sequence, and the caregiver is better able to take care of toileting, hygiene, and dressing matters.

A young therapist I know had been having moderate success with this approach, helping the patient to achieve 1-2 partial stands using lots of demonstration and encouragement.  She texted me this today:

“I just got 5 great stands with Mrs. C at the sink.  All I had to do was turn the water on and she stood right up!  Go me!”

For all my great theorizing and anecdotal evidence, my young protege reminded me of one simple principle… make it functional.  Turning on the water added meaning to the task, rather than attempting a pointless standing trial at a dry sink.

My disclaimer applies here: this is only anecdotal evidence based on observation and personal experience.  It is in no way intended to be a recommendation or a substitute for your own judgment or for that of your physician.


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  1. I love your ideas for allowing reflexes to emerge in patients with dementia… It’s so good to see therapist in our field making a commitment to the older generations. I had to add something that I just had success with today (not that it’s a reflex but yet more of an imprinted behavior) I have a patient with dementia who is fully capable of walking but motor planning to transfer surfaces and sit to stand is lacking… when I heard that he was a former choir singer and had loved singing to his kids as a younger adult I went with it…. some of the other patients in the room think I’m crazy but we sing and sing…. today I threw some new lines into “if you’re happy and you know it” (if your happy and you know it stand right up…..) and he did – pulling to stand of course just like you mentioned 🙂 Ooohh and to get him into forward flexion to assist with sit to stand I sing put your head on my shoulder to him 🙂 I love these people!!!!It

    • Cindy, after a 6 month hiatus, I am back! I just found your comment and am so excited to see that you share my passion for this population. Great idea with the songs… keep sharing your ideas!

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