Retained Primitive Reflexes and the Visual System
Every PT knows that retained primitive reflexes can undermine motor development and functional movement. What fewer PTs know is that several key reflexes are tightly linked to the visual system, and that addressing the reflex without addressing the visual component produces incomplete results.
The Reflexes That Matter Most for Vision
Four primitive reflexes have direct, clinically significant connections to the visual system. If you are working on reflex integration and progress is slower than expected, the visual component may be the limiting factor.
Motor impact PTs already know: Interferes with midline crossing, bilateral coordination, and functional movement patterns that require the arms to work independently of head position.
Visual connection: When retained, ATNR directly interferes with eye-hand coordination, midline crossing of the eyes, and binocular vision. The head-turn reflex disrupts the eyes' ability to work together across the body's midline. A child or adult with a retained ATNR will struggle with any task requiring the eyes and hands to work across the body's midline, including reading, writing, catching, and reaching across the body.
What this means for PT: If you are working on bilateral coordination and midline crossing, but the visual system cannot maintain binocular alignment when the head turns, your motor training has an unstable sensory foundation.
Motor impact PTs already know: Affects the ability to dissociate upper and lower body movement. Retained STNR can present as difficulty with crawling patterns, transitions between positions, and tasks requiring head flexion or extension independent of limb position.
Visual connection: Retained STNR directly affects the ability to shift focus between near and far (accommodative flexibility). When the neck flexes to look down, the arms want to flex and the legs want to extend, and the eyes want to lock at near point. When the neck extends to look up, the reverse occurs. This presents as "can't copy from the board" in children or screen fatigue in adults.
What this means for PT: If your patient struggles with near-far transitions in functional tasks, the STNR-accommodative link may be the underlying mechanism, not just a motor coordination issue.
Motor impact PTs already know: Directly affects balance, spatial orientation, and postural control, the exact outcomes you target in vestibular and balance rehab.
Visual connection: The TLR integrates vestibular input with the visual system to establish gravitational security and spatial awareness. When retained, the patient's sense of where "up" is becomes unreliable. This disrupts the ambient visual system's ability to calibrate spatial orientation, compounding any visual midline shift or spatial processing deficit.
What this means for PT: If balance training plateaus and the TLR appears integrated on motor testing but the patient still cannot maintain spatial stability, the visual-vestibular integration component of the TLR may be the unresolved piece.
Motor impact PTs already know: When retained, keeps the nervous system in a heightened startle response. Contributes to hypersensitivity, difficulty with sensory modulation, and fight-or-flight dominance.
Visual connection: A retained Moro reflex contributes to light sensitivity, visual overwhelm, and anxiety in visually complex environments. The patient's visual system stays alert to everything, unable to filter threats from non-threats, causing constant anxiety and fatigue. The autonomic nervous system stays activated, which in turn impairs visual processing efficiency.
What this means for PT: If your patient reports anxiety, overwhelm, or avoidance of visually busy environments, and you suspect a retained Moro reflex, the visual system is both a contributor and a victim. Addressing only the motor-reflex component without the visual component leaves the sensory overload unresolved.
Understanding the Vision-Reflex Connection
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Meet a student who jumped two full reading grade levels, an adult who finally overcame a lifetime of anxiety, and the neuroscientist who trusts Dr. Graebe with her own clients.
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"What I thought was social anxiety was actually a vision problem. Now new places and new people don't faze me."
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Dr. Brynn Dombroski, Ph.D., M.Ed., BCBA, LBA
Neuroscientist & Referring Clinician
"My son jumped two full reading grade levels — and finally believes he can do the work."
Miles' Story
A 3rd Grader's Breakthrough in Reading & Confidence
"What I thought was social anxiety was actually a vision problem. Now new places and new people don't faze me."
Jo's Story
Overcoming Motion Sickness, Anxiety & Depth Perception Issues
"As a neuroscientist, I'm 100% confident referring my clients to Dr. Graebe — I watch their vision and confidence transform."
Dr. Brynn Dombroski, Ph.D., M.Ed., BCBA, LBA
Neuroscientist & Referring Clinician
Why Addressing Reflexes Without Vision Falls Short
The reflexes above are sensorimotor loops. The motor component, which PTs address, is only half the loop. The sensory input, much of which comes from the visual system, is the other half. If the visual system is providing inaccurate or inefficient information, the reflex integration work has an unstable foundation.
Retained primitive reflexes are like a cracked foundation. You can build on top of it, but everything you build will be compromised. If the visual system is also impaired, you are building on a cracked foundation during an earthquake. The foundation needs to be repaired (reflex integration) and the shaking needs to stop (visual system efficiency) before anything built on top can be stable.
When both halves of the loop are treated concurrently, neuroplastic change happens faster and is more durable. The PT's reflex integration work is more effective because the visual system is providing accurate input. NVPI's Neuro-Visual Performance Training is more effective because the motor foundation is being stabilized by the PT.
NVPI evaluates how retained reflexes interact with the visual system using comprehensive neuro-visual assessments. This includes testing binocular coordination, accommodative flexibility, visual-vestibular integration, and autonomic nervous system regulation. The assessment identifies the specific visual components that are compounding the retained reflex pattern.
Sensory processing is where the brain interprets and integrates multi-sensory information. This is the overlap zone, addressed by both NVPI and PT working together. PT handles motor output through motor retraining and reflex integration. NVPI handles sensory input through Neuro-Visual Performance Training. The feedback loop, driven by neuroplastic adaptation, is supported by both providers working in concert.
The brain creates new, lasting neural pathways through targeted practice. Like riding a bike, once a pathway is established, it lasts a lifetime. These pathways can be
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The Sensorimotor Loop
Retained primitive reflexes are sensorimotor loops. The motor component is only half the equation. Here is how the full loop works, and who addresses each part when PT and NVPI collaborate.
Sensory Input
Vision provides spatial data, midline reference, and environmental awareness to the brain.
Addressed by NVPISensory Processing
The brain interprets and integrates multi-sensory information. This is the overlap zone.
NVPI + PT TogetherMotor Output
Executes movement based on sensory data through motor retraining and reflex integration.
Addressed by PTFeedback Loop
The brain evaluates the result and adjusts. Driven by neuroplastic adaptation.
Supported by BothNVPI's Integrated
Treatment Approach
NVPI's Neuro-Visual Performance Training program is built on three core pillars. Each one targets a specific aspect of the visual system that directly supports and enhances the physical therapist's work on retained primitive reflexes.
Multisensory Training
Integrates auditory, vestibular, and proprioceptive inputs with vision. Directly addresses retained primitive reflexes at the sensory-motor intersection. This is where NVPI's work most closely supports and complements PT reflex integration.
Perceptual Training
Enhances the brain's ability to interpret complex visual information, including visual memory, visualization, spatial awareness, contrast sensitivity, and speed of recognition. Builds the processing efficiency that retained reflexes compromise.
Vision Therapy
Physical therapy for the eyes. Targets eye teaming, focusing, and tracking exercises that address the root causes of visual discomfort. Restores the binocular coordination and accommodative flexibility that retained reflexes disrupt.
Frequently Asked Questions About Retained Reflexes and Vision
Several key reflexes have direct connections to the visual system. The Asymmetric Tonic Neck Reflex (ATNR) affects binocular vision and midline crossing of the eyes. The Symmetric Tonic Neck Reflex (STNR) impacts accommodative flexibility, which is the ability to shift focus between near and far. The Tonic Labyrinthine Reflex (TLR) disrupts vestibular-visual integration and spatial orientation. The Moro Reflex can cause light sensitivity and visual overwhelm. When these reflexes remain active, they interfere with eye teaming, tracking, and focusing abilities that are critical for learning and daily function.
Think of it like building a house on a cracked foundation. If a child's retained STNR causes their eyes to lose coordination every time they look down at a desk, no amount of core strengthening alone will fix the visual breakdown that happens during near work. The visual system is part of the sensorimotor loop: sensory input (vision provides spatial data), sensory processing (the brain interprets multi-sensory information), motor output (movement based on that data), and feedback (the brain evaluates and adjusts). Addressing only the motor component without treating the visual component produces incomplete and often temporary results.
NVPI provides a neuro-visual assessment that evaluates the visual skills most affected by retained reflexes, including eye teaming (binocular vision), focusing flexibility (accommodation), eye movement control (tracking and saccades), and visual processing speed. When a PT identifies retained reflexes, NVPI can address the visual component through Neuro-Visual Performance Training while the PT continues reflex integration work. This concurrent approach treats both the motor and visual sides of the sensorimotor loop for more complete and lasting outcomes.
Neuro-Visual Performance Training at NVPI is built on three integrated pillars. First, Multisensory Training integrates auditory, vestibular, and proprioceptive input with the visual system to strengthen the brain's ability to combine sensory data. Second, Perceptual Training develops visual memory, spatial awareness, and processing speed so the brain can interpret visual data more accurately and efficiently. Third, Vision Therapy works on the mechanical skills of eye teaming, focusing, and tracking. Together, these three pillars address the full visual processing chain, not just isolated eye skills.
If a child shows head tilting, covers or closes one eye, has difficulty with balance or coordination that does not respond to typical PT intervention, complains of headaches after reading, loses their place while reading, or shows poor depth perception, these may indicate an underlying visual dysfunction. A child who has 20/20 visual acuity may still have significant functional vision problems. NVPI offers a complimentary phone consultation to help PTs determine if a visual assessment is warranted for their patient.
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