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The clutching reflex in the feet when standing and walking Author: Dr. Sigrid Graumann-Brunt Primitive movements of the body may also occur in later life.and, when they do, usually go unnoticed and cause some confusion. Our knowledge of this stems primarily from the work of Dr. Temple Fay, who observed movements of this kind in patients with brain damage for whom he subsequently developed methods of treatment. Even though there is still relatively little scientific evidence to support claims that Fay´s approach can bring about the desired success, results obtained during the course of therapeutic practice have shown that the principle of going "back to the beginning" and "catching up"on what has been missed is one to be recommended here and there. We are lucky to have this opportunity at all, to be able to go back and recover lost ground. But the desired effect will only be achieved if the prescribed exercise resembles as closely as possible and in as many different ways as possible the one nature originally intended.us to perform. When doing so, it is absolutely essential that the eyes are closed to allow the "non-image-forming light" access through the eyelids. This enhances receptiveness to the exercises; practice has shown that light absorbed in this way seems to be a crucial factor in the recognition and acceptance of a compensatory movement. Attention here is focussed on the persistence of a primitive reflex that triggers a grasping action in the feet (and toes). It was Dr. Cramer many years ago (who had already retired at the time) who impressed upon me to pay closer attention to the feet. We got onto the subject when discussing KISS syndrome, one aspect of which was the recurrent observation of foot malposition and abnormal gait. Taking up "Dr.Cramers´s cause", I should like to present some observations of my own here. The term "grasping", though firmly established and widely accepted over the course of many years, is not entirely accurate. The word "grasping", by definition, implies that some object or other is being reached for; it is intentional and has us assume that an intentional component is present. There is, however, a primitive grasping motion of the feet which is related to the clasping of the hands and which could be more accurately described as a "clutching" or "clinging" movement. Like the clutching of the hands, the clutching of the feet at this early age is not in any way abnormal. It is important to note that the persons under consideration here are not those in need of a differential diagnosis because of some serious neurological illness ( see Bronisch´s classic example); these are people who, while able to cope perfectly well with everyday life, still fall prey to untimely recurrences of "intrusive" primitive functional patterns that cause interference. A very simple and practical criterion that indicates that it is essentially a persisting primitive reflex one is dealing with is that the reaction can be seen to diminish in intensity after a few exercises and there is evidence of progress. Everyone knows that a succession of failed attempts means it is time to reconsider the matter in hand. If one assumes, as we do here, that the primitive clutching/grasping action of the feet in some way resembles that observed in the hands, it will, like the hands, be under the force of compulsion. It will be just as exceptionally strong, protracted and just as impossible to control voluntarily as the clutching of the hands; the involuntary nature of this action will therefore also defy any attempt to correct the body´s action in the manner practised in sports training sessions. If triggered by a stimulus to the sole of the foot, not only will the foot bend and the toes clutch, the knee will also buckle and even the hip will be seen to move slightly ( abduction and lateral rotation). The feet visibly strive to move closer together in a co-ordinated fashion. When an individual is on his feet in an upright standing position, the triggering of this primitive clutch reflex will not only cause a degree of instability, but may also in extreme cases cause the kind of momentary disorientation often induced by a sudden recurrence of primitive patterns of movement. Problems arising when standing and walking mount up over time and may result in significant long-term health conditions; as its adverse effects may not be felt for years or even decades to come, the role played by the persisting clutch reflex is overlooked. When an individual afflicted with this persisting reflex (person "A") is standing or moving, they will always try (not consciously of course) to counteract the clutching reflex by bending the knees and displacing the hips, thereby adopting a posture even less conducive to a firm footing and harmonious gait. When this person is walking or running, they should be in cross pattern mode, with (in simple terms) one leg flexed and the other leg extended. Person "A", by contrast, will be endeavouring in vain to cope with two conflicting demands - the cross pattern mode and the compulsion to clutch - being made at the same time on the feet, the knees and the hips. The impossibility of the task is obvious. One and the same leg cannot be flexed and extended at the same time. If one observes the gaits of those affected, the effort required in attempting to meet the demands of forward motion while performing the act of clutching at the same time is plain to see. Among the many variations are the classic ones where both legs remain extended or both legs remain flexed.at the same time. A toe walking gait may also be observed in this connection. There is nothing of the lithe and graceful gait of the kind one likes to see. Often the individuals concerned complain of a pain in the knee, even children. The feet often appear to be rigid, stiff and lacking in vitality; they are sometimes even deformed. The heel to toe rolling motion when walking requires a great deal of effort. This is hardly surprising bearing in mind that the primitive clutch reflex with its undifferentiating and compulsive flexing of the foot takes time to subside and cannot therefore correspond to the rhythm of the foot when walking. The convergence of the feet towards one another shifts the burden of weight to the outer rim. It is obvious that, in such cases, it is not only the joints that suffer from th strain; the plantar venous pump that assists in transporting venous blood back to the heart also has to work harder, which may have long-term consequences. Those affected are also less likely to enjoy going for long walks or to go running, with all the effects a lack of fun in exercising brings with it. It is easy to determine if the feet are still clutching by gently stimulating the ball of the foot when the person is lying down. One should wait a moment because there may be a latent period prior to any reaction. When doing so, both feet should be observed, but also the hands and the mouth as this may shed light on the extent to which the movement pattern is still "jumping" (often up to a point where something akin to the milk tread motion sets in, in which all extremities and the mouth are activated). It is also worth measuring the pulse and the blood oxygen level in the process if a reliable instrument is at hand because there are children that react extremely sensitively to stimulation of the feet. If the patient looks in a different direction, this is often a sign that they are not conscious of the movements. As has already been said, there are good reasons why it is not easy to treat the persisting primitive clutch reflex using traditional methods. The exercise suggested here is a very simple one. This is quite intentional because experience has shown that exercises must be simple to have any chance of being performed at all. It must be said, however, that this exercise, like so many others directed at persisting primitive reflexes, will need to be repeated quite often to ensure any lasting improvement. But it will have an immediate mitigating effect and is therefore one that patients readily perform. The clutching is done with eyes closed. Both feet are clutched. All the better if the hands are also clutched. Incline the head towards the clutching feet (and hands). The feet point upwards at an angle of 90deg; to the ankle. A downward pointing of the toes must be avoided at all costs. Clutch all toes. The knees are bent. There is also a movement of the hip. This is an exercise that can be done quite simply by anyone without the help of others. Young infants can be made to clutch hands and feet firmly by placing each of two fingers of one hand in each of their palms and each of two fingers of the other hand on the ball of each foot. The children should be lying down, the head slightly raised resting on a pillow. Pulling on a rope may also be used to trigger the clutching action. Ensure that it is more than just a momentary clutching. It is also useful to have the child say to itself by way of rehearsal under its breath while doing so: "hold tight, hold tight.... let go" Having done the exercises in the therapy room, children will also find that they will have the occasional opportunity to do the exercise at school without needing to take off their shoes. They don´t appear to have any problem closing their eyes for a moment while doing so. Two other general points worthy of note: The act of clutching could also affect the posture adopted when sitting because it was observed that children no longer sat between their legs (German "Zwischensitz ") as they had done before performing the exercise. The effect of the persisting clutch reflex in the feet, felt when attempting the popular task of trying to balance on one leg, can be reduced and offset by doing the prescribed exercise beforehand. © Dr. Sigrid Graumann-Brunt |
