Turn your head while reading these words.

Despite your head moving, the page doesn’t appear to fly across your visual field.

Stand up, tilt your head, or walk across a room and your nervous system automatically makes countless adjustments to keep you oriented, balanced, and visually focused.

You don’t consciously make these corrections.

They happen through an extraordinary network of visual, vestibular, postural, and neurological reflexes connecting the eyes, inner ear, brainstem, cerebellum, spinal cord, and cerebral cortex.

These reflexes begin developing extremely early in life. Some primitive reflexes are expected to become inhibited as the brain matures, while other reflex systems—particularly those controlling gaze and balance—remain essential throughout adulthood.

When these responses are absent, exaggerated, asymmetrical, fail to integrate, or unexpectedly reappear, they can provide clinicians with important information about how the nervous system is functioning.

At Hope Brain & Body Recovery Center, understanding the relationship between the brain, eyes, balance system, and body is an important part of evaluating complex neurological symptoms.

What Is a Neurological Reflex?

A reflex is an involuntary response produced by the nervous system following a particular stimulus.

During infancy, many primitive reflexes are largely mediated through the brainstem and lower neurological centers.

These early responses support important functions such as:

• Feeding
• Protection
• Grasping
• Early movement patterns
• Orientation to gravity
• Sensorimotor development

As the cerebral cortex matures, the central nervous system progressively inhibits many primitive reflexes while voluntary motor control becomes increasingly sophisticated.

According to the clinical reference, this integration typically occurs across the first months and years of life, depending on the particular reflex.

But the neurological importance of reflexes doesn’t end in childhood.

In adults, abnormal primitive reflexes, eye-movement responses, and vestibular reflexes can provide clues about dysfunction affecting different parts of the nervous system.

Primitive Reflexes Are Part of Early Brain Development

Primitive reflexes begin emerging during gestation and are well established in full-term newborns.

Different reflexes perform different functions.

Rooting and sucking support feeding.

The Moro reflex provides an early protective response.

Palmar and plantar reflexes create automatic grasping patterns.

Other reflexes help regulate posture and the body’s relationship with gravity.

As the brain develops, voluntary movement gradually replaces dependence on these automatic responses.

That transition is an important marker of neurological maturation.

The clinical reference notes that failure of primitive reflexes to integrate is associated with neurodevelopmental disorders, although no single universally accepted primitive-reflex assessment instrument exists.

For families concerned about developmental function, Hope Brain & Body Recovery Center provides individualized assessment through its Neurodevelopmental Disorders program.

ATNR: Connecting Vision, Head Movement and the Body

One particularly interesting developmental reflex is the Asymmetric Tonic Neck Reflex (ATNR).

When an infant lying on the back has the head turned to one side, the arm and leg on the side toward which the face is pointing extend while the opposite limbs flex.

This produces the classic “fencer’s posture.”

ATNR appears during gestation and normally integrates during early infancy.

What makes ATNR particularly relevant to vision is the relationship it establishes between head position, limb movement, and visual attention.

Turning the head brings the hand into the infant’s visual field.

This early pattern contributes to developing relationships between vision and movement.

According to the clinical reference, ATNR has relevance to eye-hand coordination and midline crossing, while retained ATNR may interfere with aspects of visual function such as saccades and binocularity.

Interestingly, ATNR can also re-emerge pathologically in adults following loss of higher cortical inhibition, including in some cases of post-stroke spastic hemiplegia.

STNR: When Vision, Posture and Head Position Work Together

The Symmetrical Tonic Neck Reflex (STNR) appears later in infancy.

When the neck flexes, the upper limbs flex while the lower limbs extend. When the neck extends, the opposite pattern occurs.

The source describes STNR as relevant to activities requiring simultaneous visual and postural control.

This includes activities such as:

• Sitting
• Swimming
• Ball play
• Eye-hand coordination

STNR normally integrates during infancy.

When the pattern re-emerges pathologically in adulthood, the source associates it with upper motor neuron lesions, brainstem dysfunction, diffuse cerebral pathology, and abnormal postural tone following stroke.

TLR: Your Earliest Relationship With Gravity

The Tonic Labyrinthine Reflex (TLR) is especially fascinating because it is a true vestibular primitive reflex.

It is influenced by the position of the head relative to gravity and mediated by the otolith organs—the utricle and saccule—within the inner ear.

In the prone position, the infant demonstrates increased flexor tone.

In the supine position, extensor tone increases.

The reflex therefore represents an early neurological relationship between the vestibular system, gravity, and whole-body muscle tone.

The source notes that retained TLR in children can be associated with problems involving muscle-tone regulation, balance, and motion sickness.

Persistence or re-emergence in adults may occur in association with cerebral palsy, brainstem lesions, and vestibular dysfunction.

The Landau Reflex and Postural Development

Another developmental response involving posture and vestibular function is the Landau reflex.

When an infant is held horizontally in a prone position, the head, spine, and legs extend upward.

It appears at approximately three months and integrates later than many of the earlier primitive reflexes.

The source identifies absent or abnormal Landau responses during infancy as potentially significant in cerebral palsy and describes re-emergence in adults as a sign associated with diffuse CNS dysfunction.

Together, ATNR, STNR, TLR, and Landau demonstrate just how closely early neurological development connects vision, gravity, posture, movement, and the vestibular system.

What Are Frontal Release Signs?

Some primitive neurological responses that are normal early in life can become clinically significant when they reappear in adults.

These are often called frontal release signs.

Normally, higher cortical centers inhibit these primitive responses.

When cortical inhibition becomes impaired because of neurodegeneration, vascular disease, or structural neurological lesions, some of these responses may re-emerge.

The clinical reference discusses several important examples.

Glabellar Tap or Myerson Sign

The examiner repeatedly taps the area between the eyebrows.

Normally, blinking quickly habituates.

When the person continues blinking with repeated taps, this is called a positive Myerson sign.

The source identifies this finding in clinical contexts including Parkinson’s disease, frontotemporal dementia, and progressive supranuclear palsy.

Palmomental Reflex

Firm stimulation of the palm near the thumb produces contraction of the mentalis muscle in the chin.

Brisk bilateral responses can strengthen evidence for frontal neurological pathology.

Snout Reflex

Tapping the upper lip produces puckering or protrusion of the lips.

According to the source, the snout reflex can have greater specificity for frontal lobe lesions than some other release signs.

Adult Grasp Reflex

Pressure on the palm causes involuntary finger flexion or grasping.

Re-emergence in adulthood may indicate dysfunction involving the frontal lobe or premotor cortex.

The source associates it with frontotemporal dementia, Alzheimer’s disease, and frontal-lobe strokes.

These findings are not diagnoses by themselves. They are neurological signs that must be interpreted within the person’s overall clinical presentation.

Patients experiencing progressive neurological changes can learn more about Hope Brain Center’s Neurodegenerative Disorders program.

The Vestibulo-Ocular Reflex: Why the World Doesn’t Blur When You Move

One of the most important reflexes operating every second of your waking life is the vestibulo-ocular reflex, or VOR.

Imagine staring at a letter on the wall while quickly turning your head left and right.

Your eyes automatically move in the opposite direction of your head.

This keeps the image stable on the retina.

Without an effective VOR, everyday activities such as walking while looking ahead could cause the visual world to blur or bounce.

The VOR therefore represents a critical neurological connection between the inner ear and the eyes.

How Is the VOR Tested?

One bedside method is the Head Impulse Test (HIT).

During this test, the patient looks at a target while the examiner produces a rapid, small-amplitude head rotation.

When the VOR is functioning normally, the eyes remain fixed on the target.

When vestibular function is impaired, the eyes may move away from the target and then generate a rapid corrective or catch-up saccade.

According to the source, a corrective saccade can indicate peripheral vestibular hypofunction on the side toward which the head was rotated.

This may be relevant in conditions such as:

• Vestibular neuritis
• Labyrinthitis
• Acoustic neuroma
• Other peripheral vestibular disorders

When Dizziness May Be Coming From the Brain

One of the most important challenges when evaluating sudden severe vertigo is determining whether symptoms originate in the peripheral vestibular system or the central nervous system.

The clinical reference discusses the HINTS examination, which incorporates the Head Impulse Test, assessment of nystagmus, and testing for skew deviation.

In the appropriate acute clinical setting, a combination of a normal HIT, direction-changing nystagmus, and skew deviation can suggest a central cause such as stroke or a cerebellar lesion.

This is particularly important because acute vestibular symptoms can sometimes resemble a benign inner-ear problem while actually reflecting a neurological emergency.

Sudden severe vertigo—particularly when accompanied by weakness, speech changes, severe headache, new coordination problems, or other neurological signs—requires urgent medical assessment.

Hope Brain & Body Recovery Center also provides specialized Stroke Treatment and neurological rehabilitation for patients recovering from neurological injury.

VOR Suppression: The Cerebellum’s Role

The brain doesn’t simply need to activate the VOR.

Sometimes it must suppress it.

Imagine holding your thumb in front of your face and turning your head and thumb together.

To continue looking at the thumb, your brain needs to temporarily suppress the normal vestibulo-ocular response.

This ability is known as VOR suppression (VORS).

The flocculonodular region of the cerebellum plays an important role in this process.

Failure to appropriately suppress the VOR can therefore provide evidence of central neurological dysfunction, particularly involving the cerebellum.

The source associates abnormal VOR suppression with cerebellar ataxias, brainstem and supratentorial lesions, and multiple system atrophy.

Your Brain Has to Know Which Way Is Up

The vestibular system does more than detect head rotation.

It also tells the brain about gravity and vertical orientation.

The utricle and saccule—the otolith organs—help detect linear acceleration and the orientation of the head relative to gravity.

Several neurological tests can examine how accurately the brain processes this information.

Ocular Tilt Reaction and Skew Deviation

An Ocular Tilt Reaction (OTR) involves a characteristic combination of:

• Lateral head tilt
• Vertical misalignment of the eyes, known as skew deviation
• Ocular counterroll

These findings reflect an imbalance within otolith-ocular and otolith-spinal pathways.

Importantly, the direction of the tilt can sometimes help clinicians localize where along the vestibular or brainstem pathway the dysfunction may be occurring.

Skew deviation is also an important component of the HINTS examination used in evaluating acute vertigo.

Subjective Visual Vertical: What Does “Straight Up” Feel Like?

Another fascinating test is Subjective Visual Vertical (SVV).

The patient is asked to align a line with what they perceive to be perfectly vertical.

A healthy vestibular system usually identifies gravitational vertical very accurately.

According to the source, a normal deviation is generally within approximately two degrees of true vertical.

Greater tilts can provide information about dysfunction affecting otolith-ocular pathways.

The direction and magnitude of the deviation may also help distinguish between different central and peripheral vestibular lesions.

This illustrates an important concept:

Balance isn’t simply about whether you can stand without falling.

Your brain is constantly calculating where your body exists relative to gravity.

Dynamic Visual Acuity: Can You See Clearly While Moving?

Another practical measure of vestibular function is Dynamic Visual Acuity (DVA).

A person may have excellent eyesight while sitting still but experience significant visual degradation once the head starts moving.

During DVA testing, visual acuity is compared at rest and during controlled head oscillation.

The clinical reference describes loss of more than two lines of visual acuity during head movement as a finding consistent with vestibular hypofunction.

Patients with impaired dynamic visual acuity may describe symptoms such as:

• Blurry vision while walking
• Difficulty reading signs while moving
• Visual bouncing or instability
• Dizziness with head movements
• Difficulty navigating visually busy environments

These symptoms demonstrate how tightly linked vision and balance truly are.

Why Neurological Reflex Testing Matters

No single reflex test provides a complete diagnosis.

Its value comes from understanding patterns.

A clinician may consider:

• Which reflex is abnormal?
• Is the finding symmetrical?
• Does it indicate peripheral or central dysfunction?
• Are eye movements normal?
• Is balance impaired?
• Does the patient have weakness or rigidity?
• Are there cognitive changes?
• Are primitive reflexes unexpectedly present?
• Does head movement destabilize vision?
• Can the cerebellum appropriately suppress vestibular responses?

Together, these findings can provide a much richer picture of neurological function than symptoms alone.

The Same Nervous System From Infancy Through Adulthood

Perhaps the most fascinating message from this clinical reference is that reflexes provide a neurological thread connecting the entire lifespan.

During infancy, primitive reflexes help the developing brain establish relationships between the body, vision, movement, and gravity.

As the cortex matures, many of those early reflexes become inhibited.

Throughout adulthood, sophisticated vestibular and visual reflexes continue operating automatically to stabilize our vision and balance.

And when higher cortical inhibition is lost because of neurological disease or injury, primitive patterns can sometimes re-emerge.

The reflex itself is therefore only part of the story.

What matters is when it appears, how it behaves, and what that tells us about the nervous system controlling it.

Looking Beyond Symptoms at Hope Brain & Body Recovery Center

A patient may arrive complaining of dizziness, blurred vision, poor balance, tremor, coordination problems, or difficulty walking.

Those symptoms tell us something is wrong.

But they don’t necessarily tell us where the dysfunction is occurring.

At Hope Brain & Body Recovery Center, neurological evaluation looks at how multiple systems interact, including eye movements, vestibular function, balance, motor control, sensory processing, and other aspects of brain-body communication.

When appropriate, findings can then guide an individualized Brain-Specific Rehabilitation program designed around the patient’s particular neurological presentation.

For patients with dizziness and balance difficulties, understanding these visual-vestibular relationships can be especially important.

Your Eyes and Balance System Tell a Neurological Story

We rarely think about the neurological reflexes that keep our world stable.

Yet every time you turn your head, walk across a room, focus on a moving target, or adjust your body to gravity, your nervous system is performing extraordinarily complex calculations.

When those systems stop working efficiently, the symptoms can be disruptive—but the abnormalities can also provide valuable clues.

Visual and vestibular reflex testing allows clinicians to look beyond the symptom itself and ask a more useful question:

Which neurological system isn’t functioning the way it should?

That question can be an important first step toward developing a more targeted approach to rehabilitation.

Experiencing Dizziness, Balance or Neurological Symptoms?

If you’re struggling with persistent dizziness, visual instability, poor balance, coordination difficulties, unexplained neurological changes, or symptoms that haven’t improved with conventional approaches, a more comprehensive neurological evaluation may help identify which systems are contributing to the problem.

At Hope Brain & Body Recovery Center, our team evaluates the interaction between the brain, eyes, vestibular system, and body to develop individualized neurological rehabilitation strategies based on each patient’s findings.

👉 Schedule your FREE 15-minute consultation with Hope Brain & Body Recovery Center and speak with our team about whether a comprehensive neurological evaluation may be appropriate for you.

📍 Our Location: 6 Dickinson Dr suite 310 Building 300, Chadds Ford, PA 19317, United States