VT Works

In Part Five, we explored the Symmetrical Tonic Neck Reflex and the developing relationship between the upper and lower body, posture, and vision. STNR gave us an opportunity to think about something that eventually becomes remarkably automatic: the ability to look up and down while the rest of the body continues doing whatever the task requires.

With the Spinal Galant Reflex, we’re going somewhere different.

This time, we’re going to touch the back. Stroke along one side of a young infant’s spine and the trunk and hips typically curve toward the side being stimulated. Stroke the other side and the response changes direction. This lateral movement of the trunk is known as the Spinal Galant Reflex, or sometimes simply the Galant response or truncal incurvation.

It’s a remarkably simple relationship:

Something touches the side of the back and the body moves toward it. Eventually, though, the nervous system needs considerably more choice than that. Clothing will touch the back. A chair will touch the back. Someone may brush past us. We twist, bend, walk, run, crawl, reach, rotate, and move through environments filled with sensory information. Most of the time, our nervous system notices what matters and allows the rest to fade into the background, which gives us an interesting question for the next part of our conversation:

What happens when sensory information that should become background information continues to influence movement?

What Is the Spinal Galant Reflex?

The Spinal Galant Reflex is a primitive response present during early infancy. It can be elicited by stroking the skin along one side of the spine while the infant is supported in a prone or ventral position. The expected response is lateral flexion, or incurvation, of the trunk toward the stimulated side, often accompanied by movement of the pelvis. The response can be seen in premature infants and becomes more consistent as neurological development progresses toward term. During typical development, its influence diminishes during the first several months of life.

As we’ve discussed throughout this series, however, diminishes or becomes increasingly regulated may be more useful concepts than imagining that the nervous system simply deletes the reflex. The important developmental change isn’t necessarily that stimulation along the back can no longer influence movement; of course it can. Touch something hot and you’ll move, feel an insect crawling across your back and you’ll probably respond, have someone suddenly poke you in the ribs and your trunk may move before you’ve had much time to think about it. The nervous system should respond to meaningful sensory information, but it should also be able to decide when a response isn’t necessary.

Perhaps that’s where Spinal Galant becomes interesting.

The Trunk Is More Than Something Between the Arms and Legs

We’ve spent a lot of time in this series talking about the head, arms, legs, eyes, and hands. Spinal Galant brings us directly to the trunk, and the trunk is doing an enormous amount of work. It provides a relatively stable foundation from which the arms and legs can move. It rotates when we walk. It bends when we reach. It helps us maintain balance. It participates in weight shifting. It connects movements of the upper and lower body. It helps us orient ourselves in space, but eventually, the trunk needs both stability and mobility. It needs to move when movement is useful, and it needs to remain relatively quiet when movement isn’t.

Think about reaching for something beside you: the arm moves, but the trunk may also rotate. Walk across the room and the trunk participates in the reciprocal relationship between the shoulders and pelvis. Turn around in a chair and the trunk helps organize the movement. Catch a ball outside your base of support and the trunk adjusts to keep you from falling. These movements aren’t reflexes. They’re increasingly sophisticated motor responses organized around what the person is trying to accomplish. That’s a very different idea from:

“Something touched my back, so my trunk moved.”

The Physical Side of a Retained Spinal Galant

If the Galant response continues to be readily elicited beyond the developmental period when we would expect it to diminish, the first thing worth observing is exactly what the reflex involves:

Stimulate one side of the trunk. What happens? Stimulate the other. What happens?

Does the trunk curve? Does the pelvis move? Does one hip elevate? Is the response symmetrical from side to side? Is there only a subtle muscular contraction, or does the stimulation produce a larger movement?

Now, change the situation.

Can the patient maintain a stable position while sensory information is introduced along the back? Does the response become more noticeable in quadruped? Does it change in standing? Does it change when the patient is balancing? Does adding a visual or cognitive task change the response? Once again, context matters.

A small response that can be elicited under very specific testing conditions is not necessarily the same thing as a motor pattern interfering with daily function, and that distinction is important.

What About the Child Who Can’t Sit Still?

This is where discussions about retained Spinal Galant often become much more speculative. Search for Spinal Galant online and you’ll quickly find lists connecting it with fidgeting, difficulty sitting still, sensitivity to waistbands or chair backs, poor concentration, bedwetting, scoliosis, gait problems, and a variety of learning or behavioral difficulties. Some contemporary clinical references repeat several of these associations, but we need to be careful. The existence of a plausible mechanism doesn’t prove the clinical claim.

Could persistent sensitivity along the back make contact with clothing or a chair more noticeable? Possibly. Could a child who finds that sensory input uncomfortable move more frequently? Certainly. Does that mean a retained Spinal Galant is the reason a particular child fidgets? We can’t make that assumption.

There are many reasons a child might move in a chair. The chair might be uncomfortable, the task might be difficult, the child might be bored, they may be seeking movement, they may be tired, they may be trying to maintain attention, or they may simply be a child who moves a lot. And, of course, there may be other sensory, motor, developmental, or medical factors involved. So rather than seeing a child moving constantly and thinking:

“Spinal Galant.”

Perhaps we should ask:

What changes when sensory information along the trunk is introduced?

That’s something we can actually observe.

Sensory Information and Movement

Spinal Galant also gives us an opportunity to think about something we haven’t discussed very much yet in this series: the nervous system is constantly deciding what sensory information deserves a response. Right now, your clothing is touching your body, the chair may be touching your back, your feet may be touching the floor. There may be sounds in the room, light is entering your eyes, your vestibular system is providing information about where your head is relative to gravity, and your proprioceptive system is providing information about your joints and muscles. Yet somehow, you don’t consciously respond to every piece of information. If you did, you probably wouldn’t accomplish much.

Some sensory information becomes important, while some becomes background. Some produces movement and some doesn’t. This isn’t unique to Spinal Galant, and we should be careful not to turn a Primitive Reflex into a grand explanation for sensory processing. But Galant does give us a very simple developmental example of sensory input producing an automatic motor response.

Touch and movement.

Later development gives the nervous system considerably more options. Perhaps the question isn’t whether the person feels the stimulus, perhaps the question is whether the nervous system can feel it without allowing it to unnecessarily reorganize everything else.

And Then There Is Vision

At first glance, Spinal Galant may seem considerably less relevant to Vision Therapy than Moro, TLR, ATNR, or STNR, since there isn’t an obvious eye movement built into the reflex. Turning the head isn’t the stimulus, looking up or down isn’t the stimulus, the eyes aren’t directly involved in eliciting the response, and it’s important that we say that. There is not good evidence that retained Spinal Galant directly causes a particular binocular vision disorder, accommodative problem, ocular-motor dysfunction, or visual-perceptual deficit, so why should Vision Therapists care about it?

The easy answer is the eyes still belong to a moving body, and that body needs a trunk.

A Stable Place From Which to Look

Imagine trying to maintain fixation while someone repeatedly moves the chair beneath you, or trying to perform precise eye-hand coordination while your trunk continuously shifts, or trying to track a moving target while simultaneously adjusting your balance. The visual system can function during movement (we do that all the time) but movement changes the problem the visual system has to solve. When the trunk rotates, the head may move. When the head moves, the visual scene changes relative to the eyes. When balance changes, postural and vestibular systems become involved. When the body shifts position, the relationship between the person and the visual target changes. That does not mean Spinal Galant causes poor tracking or fixation. Important to recognize, though, is that if stimulation along the trunk produces movement, and that movement changes the patient’s ability to perform a visual task, then we have learned something.

Not necessarily about the eyes, but about the system.

What Might This Look Like in the Vision Therapy Room?

Perhaps the simplest approach is the one we’ve used throughout this series: change one variable and observe. Have the patient maintain fixation while sitting comfortably, then introduce a postural demand. Have them maintain fixation in quadruped: add reaching, add trunk rotation, add balance. Introduce appropriate tactile input along the trunk while the patient maintains another task. What changes? Does the trunk move? Does the pelvis shift? Does the head move with the trunk? Does fixation change? Does the patient stop the hand task? Does one side respond differently from the other? Does the patient become distracted by the sensory input? Does performance change when several systems are required to work together? Again, none of those observations prove that a retained Spinal Galant caused the difficulty, but they may tell us how well the patient can maintain a goal-directed visual or motor task while the nervous system processes competing sensory information.

And that’s a useful thing to know.

What About Reading and Attention?

Here again, we have to resist an easy story. Primitive Reflex persistence has been studied in relation to motor development, cognition, reading, spelling, mathematics, and attention. A 2026 systematic review found associations between persistent Primitive Reflexes and several motor and cognitive outcomes, but there is an important detail. The reflexes most frequently represented in that literature were ATNR, STNR, and TLR, while Spinal Galant has received considerably less direct study. That matters. We shouldn’t take evidence involving Primitive Reflexes generally, or ATNR specifically, and quietly transfer those findings to Spinal Galant. Association isn’t necessarily transitive, and evidence isn’t necessarily transferable from one reflex to another.

A small pilot study involving school-aged children did include Spinal Galant among several reflexes assessed while examining clock-reading difficulties, but studies like this examine multiple reflexes and small samples and do not establish that Spinal Galant itself causes a particular academic problem. So can we say:

“Retained Spinal Galant causes reading difficulties?” We cannot.

“Retained Spinal Galant causes attention problems?” We cannot.

“Retained Spinal Galant causes a child to fidget?” Not from the evidence we currently have.

What we can do is observe whether sensory or postural demands seem to compete with the task the patient is trying to accomplish. That’s a much smaller claim, and it’s also a much more defensible one.

What About Bedwetting?

We probably need to talk about this one because almost every discussion of retained Spinal Galant eventually gets there.

Bedwetting, or nocturnal enuresis, is frequently listed as a symptom of retained Spinal Galant. The proposed explanation is usually that stimulation near the lower back somehow contributes to bladder emptying or interferes with nighttime bladder control.

It’s an interesting hypothesis, but a hypothesis is not evidence.

There is not strong clinical evidence establishing retained Spinal Galant as a cause of nocturnal enuresis, and bedwetting is a medical issue with multiple possible developmental, physiological, sleep-related, genetic, and urological contributors. So if a parent tells us that a child wets the bed, use caution when responding:

“That’s the Spinal Galant.”

The reflex finding is one observation, and the bedwetting is another. Connecting the two requires evidence we don’t currently have. That doesn’t mean Spinal Galant couldn’t be one contributing factor in some children; it means we shouldn’t assume it is the only factor, or even the primary one, simply because both are present. Bedwetting can have many possible contributors, and a retained Spinal Galant may be one piece worth considering within the larger clinical context, but truly, if the bedwetting is persistent or concerning, that’s a conversation for the child’s doctor. Vision Therapists must use caution in attempting to explain bedwetting through a reflex finding alone. Understanding the whole person also means understanding our scope.

What Happens After Brain Injury?

This section is a little different in how it relates to Spinal Galant. With Moro, TLR, ATNR, and STNR, we could at least discuss relationships among head movement, posture, vision, vestibular function, and the kinds of problems commonly seen after concussion; however, with Spinal Galant, the evidence is thinner. Neurology has long recognized that primitive responses may become more apparent when higher-level inhibition is disrupted by brain disease or injury. But the classic adult “frontal release signs” described in neurological practice are responses such as grasp, rooting, snout, palmomental, and glabellar reflexes, not necessarily the developmental Spinal Galant response. So we need to be particularly careful here.

We know traumatic brain injury can disrupt balance, vestibulo-ocular function, postural control, sensory tolerance, attention, and the coordination of multiple systems. We do not have good evidence that concussion routinely causes Spinal Galant to “come back.” If a patient following brain injury demonstrates unusual trunk responses to sensory stimulation, that’s worth observing. If tactile information that previously seemed irrelevant now becomes distracting or produces movement, that’s worth observing. If trunk movement changes visual performance, that’s worth observing. But the appropriate conclusion isn’t necessarily: “The injury reactivated Spinal Galant.”

Perhaps the more useful question is:

Has the injury changed the nervous system’s ability to process sensory information without unnecessarily disrupting posture, movement, or the task the patient is trying to accomplish?

That’s a considerably broader question. It’s also one the evidence allows us to ask without pretending we already know the answer.

What Does the Research Actually Tell Us?

Spinal Galant may be one of the best examples in this series of why we need to separate what is well established from what is frequently repeated. We know the Galant response is a normal primitive response in newborns and young infants, and we know unilateral stimulation along the back normally produces lateral trunk incurvation toward the stimulated side. We know the response becomes less prominent during early infancy, and we know persistence or abnormality of primitive reflex profiles, including the Galant response, has been used as part of neurological assessment in infants at risk for significant neurological disorders such as cerebral palsy. There is also emerging research examining persistent Primitive Reflexes in older children, and Spinal Galant has been included in some assessment batteries and observational studies. But compared with ATNR, STNR, and TLR, the direct research base for retained Spinal Galant in otherwise typically developing older children is relatively small.

We do not currently have sufficient evidence to say:

• Retained Spinal Galant causes ADHD
• Retained Spinal Galant causes poor concentration
• Retained Spinal Galant causes reading difficulties
• Retained Spinal Galant causes a binocular vision disorder
• Retained Spinal Galant causes poor tracking or fixation
• Retained Spinal Galant causes scoliosis
• Retained Spinal Galant causes nocturnal enuresis
• Retained Spinal Galant explains why a child fidgets
• Integrating Spinal Galant will treat any of those conditions
• Concussion routinely causes developmental Spinal Galant to return

Some of those ideas may have plausible proposed mechanisms, and some may eventually prove worthy of further study, but plausibility and repetition aren’t the same thing as evidence. It seems this reflex, more than any we’ve discussed so far, reminds us of that.

What Should the Vision Therapist Take Away?

Spinal Galant begins with something remarkably simple: touch the back and the trunk moves. But development eventually asks the nervous system to do something much more sophisticated: feel the touch and decide whether it matters.

And, in the meantime, keep doing what you’re doing.

The trunk should be able to move when movement is useful and remain stable when stability is useful. Sensory information should be able to guide movement without automatically controlling it. Vision should be able to continue doing its job while the body processes information coming from somewhere else.

Perhaps that’s the larger developmental story: the goal isn’t to create a nervous system that doesn’t respond, the goal is a nervous system with choices. A retained Spinal Galant is not a diagnosis. It doesn’t explain every sensory, postural, attention, learning, visual, or behavioral difficulty we see.

It’s another observation; another piece of information.

And perhaps another opportunity to ask how well the person sitting in front of us can distinguish between sensory information that requires action and sensory information that can simply be allowed to fade into the background.

Stay tuned for Part Seven: Head Righting and the developing relationship between the head, gravity, posture, and vision.

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References

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