Speaker 1 0:44

All right , hello everybody and happy Thursday night live . We are pre-recording this on a Friday so if you are an A-Way Circle member , you can join us live . Please post your comments below throughout this talk so we can address you If you're watching this as a recorded version . Please join the membership so you have early access to these talks and you get to join us live and interact with our speaker . I have the pleasure today of having Joshua Madsen . Will you please introduce yourself to everybody ? You are an Instagram sensation , but not only that . What you do for your patients is just incredible and we're so

Introduction to Dr. Josh Madsen

Speaker 1 1:25

excited to have you here with us today .

Speaker 2 1:28

Yeah , for sure . You know , and my name is Dr Josh Mattson , I own Infinity Functional Neurology , soon to be renamed to Infinity Neuromotor Development Center . We have a clinic in Iowa and then this year we're opening Denver and also Minnesota . So we got a couple of clinics . We got awesome , awesome staff . So a lot of the interestingly enough , a lot of the stuff you guys see on Instagram no longer is necessarily me working with them , it's usually my staff .

Speaker 2 1:53

Now , you know , I might do some initial exams , I might do some of that type of stuff , but we've developed a system to help these kids and now we're trying to expand that to multiple different locations .

Speaker 2 2:02

So and we've been in practice about eight years now Um , we have probably 30 or 40 staff , um , about probably 25 , 30 in Iowa and then the rest in um going to be in the other locations . But , uh , we are a mixture of chiropractors , pts , ots and now speech paths . So we have , uh , a cool little integration that's working really well for helping kids . And I'm going to talk a lot about primitive reflexes today , neurodevelopment , how that plays into what you guys do , how , what you into what we do , to give a little bit of context there . But I'm really excited because this is something that I've been working with and looking at not necessarily like I don't look at airway to the extent that you guys do , but it is a huge aspect that plays into how we work with the kid and making sure that we get them to a referral , like you guys . That makes a massive difference in their care . So I'm really excited to chat about that a little bit .

Speaker 1 3:00

Yeah , it sounds like you have the dream team over there in the airway fieldway field we always talk about . Oh my gosh , can you imagine if we had like a group with a chiropractor , a myofunctional therapist ? Uh , we'll gotta add an ent like dr zaggy we're just talking about him there . Uh , pt ot speech . Oh , my goodness , you know that's why the mayo clinic is so successful . It's because they have so many different specialties and professionals looking at the same patient .

Speaker 2 3:29

And it's it's so nice to have those different perspectives . For sure , and we all , you know , we all learn functional neurology , we all learn developmental neurology , like that's a big aspect of , like that's , that's the initial training that we do for everyone , no matter what their background is . So that way we're all , we're all looking through a similar lens , but but you know , with from different perspectives .

Speaker 1 3:50

A hundred percent .

Speaker 2 3:50

All right , let's get started . Okay , Let me see if I can figure out how to share my screen here . Um hope I can do this .

Speaker 1 4:01

Oh , I got it and everybody listening . You guys are welcome to post your questions right here in the chat box . I'm just going to make sure you're able to . Yes , you can message everyone , and please let us know what your specialty is and where you are watching this from .

Speaker 2 4:26

Hope he's going to let me share this . Okay , here we go . Now I'm in , okay yeah .

Speaker 1 4:32

Oh amazing , there we go .

Speaker 2 4:36

Okay , so again , dr Ashmat , I'm a fellow of the International Board of Functional Neurology . So functional neurology for anyone that doesn't know what that is , it's simply like the study of current neuroscience applying it to your patients and it's a lot into like neurorehabilitation . Simply put , our office is a little bit different because we focus more on that pediatric neurodevelopmental aspect than adults or something along those lines . So our practice is about 97% pediatrics , maybe a little bit more . We see kids from all over the world . This week we have kids from Chile and Canada and pretty much every state from the UK or not every state , but all around the United States and from the UK this week alone . So we see them from kind of everywhere . We do an intensive model , so we see kids two to four hours a day for a week to a month straight , depending on what's going on and how delayed they are in their development .

Speaker 2 5:32

Again , we have chiros , pts , ots , speech paths , and we're in Iowa , soon to be Denver , minneapolis and we focus on chiropractic care , physical therapy , functional neurology , functional medicine , low-level light therapy is a big thing . We use hyperbaric oxygen therapy and some different oxygen therapies as well during care . But first things first what I want to start with . So also , I can't see any comments . So if there is any comments , please speak up too , so I can make sure I answer those as we go . I prefer to answer them as we go along , you know , really to broaden that conversation . So the more we can add in , the better .

Speaker 1 6:09

But I will . I'll manage those as you're going through .

Speaker 2 6:13

Yes , please do so . I'm going to give you just a quick rundown of how the brain actually matures and develops , and that's going to set a foundation for you know everything that you guys are , everything I'm going to talk about today . So when we're born , really the only area of the brain that's developed to an extent is our actual brainstem , and that brainstem is what houses our respiratory rate , our heart rate , our you know all of our cranial nerves that go to our face , but also houses a set of primitive reflexes , and these reflexes are reflexes that help to develop the rest of our brain . So , if you guys remember , when you hold an infant , you stick your finger in hand , they grasp down . That's a palmar grasp reflex . It's a primitive reflex . Everyone's born with it or should be born with it . You stick your finger in their hand , they grasp down . They grasp down , they start firing up all these muscles and what happens is they fire up those muscles . It fires to their higher cortex and gets their brain to start to mature and start to develop . And there's a whole bunch of these different reflexes . There's like 30 of them . I'm going to talk about three that you guys can check today . That'll play a lot into facial stuff and just range of motion , their cervical spine and things along those natures . But what happens is we start activating this higher cortex , our frontal cortex develops and then our frontal cortex comes in and inhibits these reflexes or shuts them down . So as our brain develops , our brain comes down to our brainstem and shuts these down . And this is also why , like you see , an infant and their heart rate is elevated , the respiratory rate is elevated and as their brain matures they start to regulate and their heart rate starts to come down , the respiratory rate starts to come down . That's called frontal inhibition , that's your frontal lobes developing and regulating that .

Speaker 2 7:48

But primitive reflexes are also housed in here and when they don't develop appropriately they create a lot of dysfunctions . They'll create motor dysfunctions , they'll create movement dysfunctions . There's like , for example , the rooting reflex . It's a huge one that plays into muscle tone of the mouth and movement of the mouth , appropriate articulation of the mouth for speech and feeding and stuff like that which we can jump into . A couple of those more specific ones , but I want to start with the ones you're going to see on a lot of kids and they also play a lot into muscle tone and alignment .

Speaker 2 8:22

I'm not going to go through all this . I'm primarily going to talk about primitive reflexes today . This is an adaptation from another talk that I did , but I actually had a daughter this last Monday so I didn't have a chance to make a whole new presentation . I've been on dad mode so let me jump into .

Speaker 2 8:41

But developmentally , the things that we look at is number one is primitive reflexes . We look at muscle tone alignment , proper sensory integration , balance and vestibular function , ocular integration , motor planning and then cognitive skills . But simply put , if we do not develop this foundation appropriately , this primitive reflex foundation , appropriately , muscle

Brain Development Fundamentals

Speaker 2 9:02

tone alignment appropriately , we can't efficiently develop these other systems . It's really as simple as that . And what we do primarily for kids is , when they come to us , every kid I've ever seen that has delays still has primitive reflexes . And when we get rid of those primitive reflexes , a lot of these other systems will start developing on their own . I'm going to show you just a couple examples of the effects of primitive reflexes , because on both of these kids or these different cases here , the only thing we did was work on primitive reflexes and integrate those . So this kid came to us not walking at all . This kid came to us not walking at all , had to have a walker in school . This is after his first intensive . He's had a second intensive . He now doesn't use a walker anymore . He can walk two 300 steps without any balance issues . The only thing we did was get rid of his primitive reflexes and we did a lot of photobiomodulation and other therapies to help with that , to get his brain functioning better . But these motor skills , if we still have retained primitive reflexes they can't develop like . It's as simple as that . And that plays into your guys is like oral facial aspects too .

Speaker 2 10:19

Because when we think of like movement of the mouth and we think of movement of the tongue , that's really a fine motor movement and from a brain development standpoint we have to develop . When we look at the cerebellum from the back , we develop the midline aspect first , when an infant's developing . Then we develop our intermediate areas , then our lateral areas and that's why those midline aspects are a gross motor development and then we start developing it from the midline out , which the lateral areas are our fine motor coordination of our hands , also articulation , fine motor movements of our mouth . And if we don't develop gross motor skills we can't develop these finer movements appropriately . So that's why you don't typically see a kid start to talk until they start to walk . They have to develop that gross motor as a foundation in this motor strip for their fine motor to develop .

Speaker 2 11:08

So if you have a kid that you're trying to work on a lot of these fine motor movements , tongue movements , these oral , facial things and they're not quite developing , it might be just because they don't have the gross motor aspects of their brain developed first that need to be in place for these fine motor aspects to develop . And that's the importance of hitting these sequentially or the , you know , taking care of some of these gross motor aspects and these reflexes that affect those gross motor aspects . First , this one came to our office for three weeks Can you hear that , if I play that from Alaska ? He was struggling with motor skills , learning skills , attention issues , behavioral issues . He was diagnosed with high-functioning autism . He had a lot of things going against him . He had a lot of struggles going on . So what we found from a developmental perspective is he had a lot of primitive reflexes .

Speaker 1 11:57

That's a symmetrical tonic neck reflex .

Speaker 2 11:59

He didn't have the balance that was well-developed . He couldn't track his eyes appropriately . He also had a lot of restrictions in how he moved . Literally I couldn't even turn his head when he started . He had really poor core stability when he started and what we got to work on in the first week is we worked on rehabbing his movement and getting rid of his primitive reflexes , which made a substantial difference in how he could move and how he could function . Even after the first week they were able to go to church for the first time in years and be able to sit through without him getting extremely anxious and having to leave right away , which was awesome . But then in the following weeks we got to work on his vestibular system and retraining his balance centers . We had to work on getting his eyes and his balance centers to integrate appropriately together . And the funny thing is these guys are actually only planning on coming for like a week or two . They ended up staying for three weeks because the results that they were getting in those first couple weeks were so outstanding and they hadn't gotten before , and even though they've been doing traditional therapy for years on end doing PT OT speech .

Speaker 2 12:57

But when we approach it from a developmental aspect . These kids can get a significant change , and especially with the intensity of the model that we have when otherwise they may not be able to get that same amount of change . So you see a younger kid , you see an older kid , these older kids , every single time you see a kid that has autism , diagnosed with autism , adhd , sensory processing , speech delays . They're going to have primitive reflexes and the reason for that is simple . These are all neurodevelopmental delays . If our nervous system is delayed in its development , these primitive reflexes are going to still be there because they're trying to activate our brain and but also , when that's going on , these reflexes are in the way of that normal maturation .

Speaker 2 13:40

Um , I don't remember what's on this what's up for two week intensive to work on helping her to learn to walk . She's actually seen OTs and PTs for the last couple of years to try to get her to walk and the maximum she'd ever walked was eight steps , and that was only one time and that was with supports on her ankles called AFOs . She was diagnosed with cerebral palsy after having a hypotic ischemic event and what we did with her is we actually worked on getting rid of her primitive reflexes . We worked on retraining her vestibular system or her balance centers , and as we did that , you actually see , we got her to walk multiple different times over 25 steps . I think the max we got her to was 27 steps and a multitude of other times we got her to walk 14 , 15 steps , and we simply did that by working on redeveloping the things that should develop first , like reflexes . As we worked on those , then we can start working on her vestibular system and as these systems started to develop , her motor skills got better and her walking got much better .

Speaker 2 14:45

So , work on motor to learn to walk . All right , all these just played at the same time . That was weird . Yeah , that's okay .

Speaker 1 14:56

Okay , any questions yet by chance oh my goodness , I have so many questions already . I don't want to mess up your flow , oh you're . I really think that primitive reflexes are the thing that we're the most excited about right now . You know , we have so many speakers come talk to us , but this is really the missing link I believe that not everybody is aware of , and I love that you mentioned about these kids . They cannot , you know , develop their fine motor skills if these gross motor skills are not in place . We have so many patients that come to us that are a little bit younger . You know , to my functional therapy we don't really start until age four or or later . But younger patients come to us because the parents learn that , oh my goodness , their mouth breathing , mouth breathing , is not good for them . What do we do ? And then we look and we're like it's not really my functional therapy that you need . You know you have to start over here first . So I'm just so excited you can keep going .

Speaker 2 15:56

Yeah , yeah , and even , like you know , with cause . I know you guys see a lot of kids that have speech delays and things like that and cause they have low tone in their mouth and whatnot . But like this last well , I wasn't here this week cause the baby , but last week the uh , we had two kids that came back . They were both nonverbal . Uh , autistic kids . Um , in both of them are talking . We didn't do a single thing with speech and so they came back to their second intensive and not one single thing with speech . We just worked on getting rid of primitive reflexes . They could start developing these motor systems appropriately . Then from there , their speech motor systems and those more fine , detailed things start to develop on their own , like we don't do anything with them and we see it all the time . And so like the importance of that is getting those foundational systems developed is super , super important .

Speaker 1 16:48

This is interesting that you said that . My son is four now , but whenever he was 16 months old , everything was very delayed . When he was 16 , he might've had a concussion at one and a half , we're not sure but at 16

Primitive Reflexes and Motor Development

Speaker 1 17:00

months old we started speech because I knew that it was already delayed . It was always going to be delayed , and in a year maybe we got 10% better . So I stopped speech and we did OT and PT which they were working on , reflex integration , and his speech just went .

Speaker 2 17:14

Yep , yep , it happens all the time . It's wild , I mean , we get such massive changes in speech , feeding , just all those fine motor skills , handwriting skills , and we never work on them , not once . And you know , like it's just , it's nuts how much that changes just by getting a foundation set . I'm going to show you guys a few different reflexes , probably the three most common ones , the ones that create the most symptoms , and that's going to be this asymmetrical tonic neck reflex , symmetrical tonic neck reflex . And then I'm going to show you how to test the moral reflex . I'm going to show you how to test them , what they mean and why they're important . But this chart gives you the moral reflex , the purpose of the reflex when it appears , when it should start to integrate or go away by , and the most common signs of retention . So when you see a kid that has hypersensitivity , hyperactivity , poor impulse control , sensory issues , social-emotional immaturities , typically they will have a moro , and I would add to this anxiety and also motion sickness . They'll typically have a moro or a startle reflex , which this is going to be the last one I'm going to show you . First I'm going to show you is this asymmetrical tonic neck reflex . This one should go away right around six months of life it plays . It's a reflex that you see an infant when they turn their head and their arm starts to straighten on that side and their other arm flexes . This is called the fencer position . You'll see an infant when they're laying in bed . You'll see that position all the time . That's that reflex starting to develop , but it should go away right around six months of life so we can hit crawling motor milestones on time . So to crawl you have to be able to turn your head , extend your arm on the opposite side . Well , if you turn your head this way and this arm drops out , you're not going to be able to create a cross crawl pattern and therefore they're not going to typically crawl . They'll usually walk either early , right around 9-10 months , or they'll walk really late , around 16 months when they have that . One other common symptoms with the atnr is difficulties learning to uh . So crawling , riding a bike , tying their shoes , handwriting and reading , because it affects your eyes , affects how your affects everything that crosses midline . So if your eyes , as they cross midline , you'll see big skips and jumps in their eyes and I'll show you an example of that . And then the symmetrical tonic neck reflex should go right around nine to 11 months . This one plays a lot into slumped sitting postures , poor muscle tone , poor hand-eye coordination and inability to sit and concentrate for long periods of time , and a lot of the learning issues is because they can't converge and diverge their eyes appropriately , so they get double vision a lot , which , again , I'll show you some , some aspects of that . But those are the three I'm going to teach you guys about so and show you how to test them , because they are the most prevalent ones and they're the ones that when you get rid of them , they make the biggest change for the the child for sure .

Speaker 2 20:05

Okay , so theNR . There's two different ways to test it . The first one is on their hands and knees and what you're going to see is I'm going to turn his head one direction . His arms should be able to stay straight the entire time . What you'll see with this one is when I turn his head , like towards you , his opposite arm will drop , will drop out , and I turn his head the opposite direction is this arm will drop out . So I'll show it to you . So arm drops , arm drop , and the more you do it , the worse it'll get when it's a true reflex , if it's just neck tightness . The more you do it , the better it'll get . So you can I'll do that . Run that through one more time . So you want to make sure their low back is dropped because they can compensate for . Want to make sure their low back is dropped Because they can compensate for it if they round their low back .

Speaker 2 20:55

This one is the STNR is what I was checking for there , but I'll show you that one in a separate video and then you can also test it standing . So you haven't put their arms straight out in front of them , drop their wrists down , close their eyes and you instruct them say , keep your arms straight out in front of you and they should be able keep their arms straight out in front of them , drop their wrist down , close their eyes and you instruct them say , keep your arms straight out in front of you and they should be able to keep their arms straight out in front of them and turn their head . So you put his arms straight out in front of him , turn his head and you'll see his whole body rotates with it . That's abnormal . He should be able to turn his head without his entire body rotating , entire body rotating . So what you're actually seeing is , sorry , too close to the camera . But when you turn his head this way , this arm is wanting to bend , the opposite arm is wanting to straighten and his whole body is rotating .

Speaker 2 21:40

And when you still have this ATNR , you don't develop the ability to use your head independent of your body or your eyes independent of your head appropriately . So as we turn his head , his whole body rotates with his , with his head , instead of being independent movements , which makes developing gross motor skills not very easy , because every time we turn his head , his whole body moves instead of him developing appropriate range of motion .

ATNR: Asymmetrical Tonic Neck Reflex

Speaker 2 22:04

And again , these , when we think about it from like what you guys are dealing with , is these reflexes develop our brainstem . Well , in out of our brainstem comes all of our cranial nerves that go to our trigeminal nerve , our facial nerve , our hypoglossal nerves . Those all come in to help to develop all this . Well , if we don't develop these primitive reflexes , we don't develop our brain semi efficiently , we don't develop our brain semi-efficiently , we don't develop our cranial nerves or vagal system appropriately . So that's why it's really important is these have to go away to start to set that foundation for all those cranial nerves to function appropriately .

Speaker 2 22:42

Okay , so for me this is one of the most important ones . It plays a lot into appropriate muscle tone , which you guys are dealing with kids that have low tone all the time , not only in their face but also in their whole body . Plays a lot into hand-eye coordination , balance issues , eye tracking abilities from side to side , ability to cross midline Helps us get out of the womb . Originally Plays a lot into army crawling , cross crawling and walking . So when we have delays in this , it's typically because of this reflex .

Speaker 2 23:10

Torticollis is another really common one where you'll see this on one side but not the other side . So , like a unilateral issue , you'll start to see a lot of torticollis . That's actually how I get rid of torticollis is I use this reflex to get rid of it . So like , for example , if they're rotated in this position and they can't turn their head to the left , I'll use this reflex , I'll straighten this off my opposite arm and opposite leg and I'll bend this one and I'll start just slowly working on range of motion , cause now we have a reflex , it's getting elicited , it's wanting us to turn our head in that direction . So then you can just slowly rehab that . So I'll use this reflex a lot early on to get normal range of motion in the cervical spine , which then you don't get as many of these abnormal facial torsions and these palates that are dropped on one side and you know all those cranial dysfunctions that you guys often see , I'm sure .

Speaker 2 24:06

Any questions on that before I go to the stnr anybody think we're good okay um , okay , the stnr this is also the symmetrical tonic neck reflex should go right around 9 to 11 months . Um , what you do is you drop their low back , first and foremost on all fours again , and then you're going to see me bring his head down and up . So when we bring his head up , his arms want to extend . We bring his head down , both arms will collapse out . Um , let me see , it's the same kid that we I showed the video of earlier . So as soon as we bring his head down , his arms drop out and you can tell , like , when they truly have this , you got to make sure you drop their low back . When they truly have that , you can tell them I'll give you 20 bucks if you keep your arms straight . They can't do it . Like it's . It's a true neurological reflex , just like if you , you know , hit your knee , your , your leg comes up . It's a true reflex , so you can't stop it . Um , true reflex , so you can't stop it . And I'll do that a lot just to show the parents , because the parents are like , oh , he's just playing . I'm like , no , he's not . I'll give you an Xbox if you keep your arms straight . And they can't do it . So it's a true reflex .

Speaker 2 25:20

Atnr helps the baby start to lift their head , starts to help them to diverge their eyes , to look far distances , bring their head down , their eyes converge . It plays a lot into developing our convergence and divergence of our eyes , extension of our cervical spine . So these kids , you see that , are always in a really poor posture . A lot of times they'll still have this reflex retained because every time they bring their head down they reflexively contract their pecs on both sides , their arms get flexed in , so they're constantly kind of stuck in that quote-unquote fetal position . You'll see a lot of squirming , moving , poor posture , slouching , a lot of tension , headaches , because they're constantly activating these anterior muscles and bringing their head forward . So they get all that , that tension through their cervical spine difficulties with reading , writing , convergence issues , saccadic eye movements .

Speaker 2 26:08

And another thing that plays a lot into this is with the work that you guys do . If a kid has a tongue tie and has a restriction from that in their upper cervical spine , they won't be able to appropriately flex their chin . But we have to have that movement to develop these reflexes because we develop

STNR: Symmetrical Tonic Neck Reflex

Speaker 2 26:28

. It's called the Cephalic Caudal Law where basically we develop from the top down .

Speaker 2 26:34

So as an infant , the first thing you start to see is their heads start to move and their necks start to move and then start to develop that range of motion . Then you start to see them start to roll and use their shoulders and their pecs and then you start to see them army , crawling and using their lower body , then get up on their hands and knees . But we start all of our development from appropriate range of motion of our cervical spine . So if we have adhesions in our mouth , if we have restrictions in our upper cervical spine , we're not going to develop these reflexes appropriately . So you know , that's why getting those addressed early on is quite helpful for a lot of this .

Speaker 1 27:13

Okay , I have a quick question about that . Can I yeah About the poor posture so many of our patients have forward head posture and shoulders rolled forward and of course , whenever we're doing our evaluation we're looking at everything the whole body . Um , that is why it's so beneficial for us to have a community like ARA circle . We get to hear from all these different perspectives so we know when to refer the patients , because , of course , we're not trained to do anything specific to that . Um , as an adult , can you have this reflex still retained ?

Speaker 1 27:52

And is there something you can do .

Speaker 2 27:54

Yeah , yep , same as a kid , you can still have it retained . For example , every person on this call has a primitive reflex , has primitive reflexes . Typically , our brain is functioning well enough to inhibit the reflex . If you were to get a concussion tomorrow , you know , knock on wood , if you were to get a concussion tomorrow , your primitive reflexes would likely come back because your brain can no longer function well enough to inhibit the reflex . So you're going to see them come back . Even stuff like food sensitivities or neurological autoimmunity or gut infections , that can create enough neural inflammation to where we can't inhibit these reflexes appropriately , and that's the or lack of oxygen because you're not breathing . That's another big reason . So looking at blood flow and things like that is important . But that's why looking at a big picture for getting rid of primitive reflexes is so important , because we have so many kids that do you know MNRI or they , do you know all the ? Not saying those are bad by any means , but doing all these other therapies for reflex integration , but they're not looking at the big picture . Be doing that for three years , but come to me , they still have them . We'll take gluten out of their diet or dairy , whatever they're sensitive to . Maybe they're anemic , we get them some , some , some iron and the reflex are gone in two weeks . Well , it's because the brain wasn't functioning well enough to inhibit the reflex in the first place , and it's not that they necessarily didn't do the movement enough .

Speaker 2 29:24

Um , it's that your brain needs three things to develop . It needs stimulation , which they're doing with MNRI or with other reflex integration , just doing the exercises you're doing . But you have to have oxygen and you have to have ATP or energy . And if they're eating just a crap diet that has no nutrients , has no B vitamins , has not enough appropriate fats , they can't produce ATP . Not enough appropriate fats , they can't produce atp . And then if , on top of that , they have abnormal breathing and they're they're hypoxic , now they don't have oxygen . And so with those two things , you can do all the stimulation in the world , but you're not going to get anything to connect because you don't have the basic nutrient or resources to make it happen . And that's why I look at a bigger picture of like well , how's metabolic function playing into this is really important because you know that family quote unquote they wasted three years where they could have a kid , could be in so much different place if they would have just had some labs ran and check some oxygenation , put a pulse ox on them .

Speaker 1 30:25

You know , had some of this airway stuff addressed first um , you know , had some of this airway stuff addressed first . So 100 and I apologize , I didn't call you . I just read your name earlier and they say dr madison um , we have another . Good as an adult . Do you see turning the paper to the side during writing with an ?

Speaker 2 30:42

18 with this retained reflex yeah , so I don't have a piece of paper here , but okay , if I'm looking straight on , turn my head this way . My arm wants to straighten because I have an ATNR . My hand wants to open , so it makes it really hard to articulate a pen or pencil . So what they'll do is they'll rotate their head this way , which creates flexion on this side , allows them to grip a pen or a pencil easier , and they'll write sideways .

Speaker 1 31:10

I'm going to be watching everybody in the next conference that we go to , by the way , yeah .

Speaker 2 31:15

And then , if you have , it's really interesting If you have them take this paper , put a line on it , have them write their name or whatever , then turn their head and have them write their name again . Turn their head the opposite direction have them write their name again it gets their .

Speaker 2 31:34

Their handwriting gets really wonky , really . So we keep the paper the same place , we just have them turn their head to write yep , they need to be able to see it . So they have to be , you know , obviously be able to see it . But all you have to do is just turn their head just slightly , just slightly , so you can check it that way too , and they're like kids that have handwriting issues . If you check that with them , they'll you'll turn their head one direction that looks really good . It's really the opposite direction and it gets like much bigger , much less efficient .

Speaker 1 31:52

So that is so cool . I'm doing that with my kids tonight . Thank you , let's see .

Speaker 2 31:59

I don't know what this one is let me see this guy . He came to us oh this is a good one .

Speaker 2 32:03

Pretty big reading difficulties at a young age . Many times these are related back to what are called primitive reflexes and lack of eye tracking . So so I'm going to show you that here In this first video . What we're actually showing you is when he goes on his hands and knees there and I bring his head straight down and his arms drop out . That's something called a symmetrical tonic neck reflex . It should go right around eight months of life .

Speaker 2 32:22

Then , when I turn his head from side to side , what you see is , as I I turn inside this way , on the upside his arm drops out , because the other way his arm drops out . That should weigh right right around six months of life and it plays a line to how the eyes side to side . I put it out on my finger and , as we have him record his eye movements , what you see is big skips and jumps in his vision as we track side to side and can't keep his eyes on the target . In the second again , that is from the atnr primarily so , when we track side to side we'll see big skips and jumps . When we track up and down and we start seeing big skips or jumps , jumps or a convergence issue . Excuse me , that's more related to that symmetrical tonic neck reflex video .

Speaker 2 33:02

You'll see that when I turn his head or bring his head straight down , his arms don't drop out , it's just three days later those primitive reflexes have been inhibited , but at the same time , what you're actually seeing is a massive improvement in how his eyes track , an ability to keep his eyes stable as his eyes track from side to side and up and down . That plays a lot into reading , because you need to be able to track a line efficiently without your eyes skipping or jumping or kind of going all over the place as those reflexes get better and as their eye trident get better now you can see learning and see tracks you can follow there's a huge link between those basic , foundational skills

Speaker 2 33:33

higher cognitive learning centers . Kid jumped three reading levels in a month . No way , yeah , because you couldn't . You couldn't follow the line . I mean , it's just , it's basic physiology if you can't follow a line , you can't read like it's . And that's what you see so often is like when their eyes , when you get rid of the reflex , now their eyes can track the line , now the reading improves a ton . So when you're doing your case histories and you start seeing , oh , we have a lot of learning issues , just simply put a dot on your finger , be at least 18 inches away and just see if they can track your eye , your , your dot . Can they follow your dot at all , or are they moving their whole head to do it ? Um , because again , that's going to be more like an atnr issue um , so making sure they can use their eyes independent of their head , their body , and if they can't , they very likely have an atnr or an stnr or both that is so interesting .

Speaker 1 34:26

I remember learning about the eye tracking some time ago and I have done with a few patients and it's like whoa , not knowing . You know knowing that , but not knowing exactly where to send them .

Speaker 2 34:38

I mean now we do .

Speaker 1 34:41

Sorry , go ahead .

Speaker 2 34:43

Start with the basics , start with primitive reflexes , then you can build up to eyes . But you just got to start there .

Speaker 1 34:48

Perfect Rose . Dr Rose is saying is there specific credentials ? I should look for ina chiropractor to make sure they work on primitive reflexes . My kids have been in OT , pt and visual therapy with prism lenses . I can see how receiving the scare would be important can see how receiving the scare would be important .

Speaker 2 35:14

Yeah , so it's a little bit tricky because the so there's functional neurologists , so that's what I would be considered is functional neurology , but there's what's the right words . There is different thought processes , right ? So there's the . There's a group that works on primitive reflexes .

Speaker 2 35:31

There's another one that that does a lot of um , a lot of adults , a lot of traumatic brain injuries , a lot of car accidents , stuff like that , and they won't necessarily look at primitive reflexes , and and that's because they're primarily working with a population that it's not as , but it's not as important for I should say , um , well , in their mind it's not as , not as important for I should say Well , in their mind it's not as important , for in my mind it's very important , but so it gets a little tricky . So what the questions I would ask is number one is do they have like ? I'm a fellow of the International Board of Functional Neurology , there's also a diplomate of the American Board of Chiropractic Neurology , but then I'd call them and say what percentage of your population is pediatrics ? To me that's the most important thing is , if they have a high percentage of pediatrics , they're probably going to be a great referral and they have those credentials . If they don't see very many pediatrics , they look at it completely different and they're not going to address primitive reflexes as often .

Speaker 1 36:31

And do they have a directory ?

Speaker 2 36:36

Yeah , the IBFN , the International Board of Functional Neurology , that would be what I would be through . And then there's a subset on there that is a fellow fellow of the international board of functional neurology and then it's like ND after it , like neurodevelopment . All of those will do primitive reflex stuff , um , the uh . But I'm not part of that . I'm I'm the , the fellow of the international board of functional biology , and then I'm just functional neurologist . Um , so I didn't , I don't , didn't do that . Well , I did that neurodevelopmental seminar but I didn't get my certification through that one , um , the uh .

Speaker 2 37:15

So those ones will all , if they say neurodevelopment , they all know about primitive reflexes , um , but even a lot of the other ones do as well . It just depends on what other training they've done . And then there's the , the american board of chiropractic neurology , and but you don't hear those ones talk as much about primitive reflexes . Not saying they don't , because there's probably a lot that do , but , um , I just don't . They just don't talk about it as much . From my experience but I could be again , I can be wrong it could be ones there that that's all they do . But so that those would be the places to kind of start .

Speaker 1 37:49

Perfect , perfect , thank you .

Speaker 2 37:51

Welcome .

Speaker 1 37:52

And is it usually ? Chiropractors are going to functional neurology .

Speaker 2 37:57

So functional neurology started out as chiropractic neurology , so the field of functional neurology is directly out of chiropractic neurology . And now there's the IBFN is the International Board of Functional Neurology , and that you can do as a chiropractor , a DO , an MD , a PT , an occupational therapist , like they can all take that training . So it's multidisciplinary nurse practitioners . It's actually taught by a nurse practitioner , dr or one of the courses taught by a nurse practitioner , dr Brock , and then Dr Karazian , who's a Harvard PhD as well , and then the other one's taught by a chiropractic neurologist , dr Malilo and Malilo I've heard of Malilo Yep , so he teaches the neurodevelopmental course . So that L of the International Board of Functionology and then ND would be his course .

Speaker 1 38:58

Perfect . Just this weekend we actually talked a lot about functional neurology . This weekend we were in San Francisco for the World Dental Facial Sleep Society meeting , but we had some incredible chiropractors there . I had treatment done by three of them two from Australia , one from California and like I was just oh my gosh , my house moving so freely and feeling so light and so good . These people are incredible , but one of them , dr Scott from Australia . I was asking him abouta patient that I have . She's a 14 year old girl who about a year ago started with crazy headaches and anything that touches her mouth she would gag , and he exactly told me that Look for somebody trained in functional neurology that knows the Malilo . I was trained with Malilo , so thank you for saying that .

Speaker 2 39:46

Yeah , for sure . Okay , I'm going to show you a couple of videos . Any other questions before I keep going on immoral Cause this is about an hour . Right , my , my correctness

Moro Reflex and Startle Response

Speaker 2 39:55

, Well , yes , yes , we can .

Speaker 1 39:57

We will continue that on our Instagram live .

Speaker 2 40:00

Okay , Sounds good , okay , so I'm going to show you a little girl here . This is a brain injury , but it's a really good example of what a moral or a startle reflex looks like . You'll see this in an infant , like my infant was just born . You'll see it look like this Um . But I'm going to show you also here an older kid . So , um , so you see that boom , that big moral or that big startle reflex . Um , that's a moral reflex . That's what it looks like in an infant . It doesn't look like that in an adult .

Speaker 2 40:31

So you can do the auditory portion or you can move them quickly and you'll see the same response . So if you're holding an infant , you kind of move fast , their arms will come out and a lot of times they'll start to cry . That's a startle reflex . It should go away right around two to four months . So that one when you pull them back and their arms come up , that's your startle reflex . So what you should see is , after that point you start developing what we call propping reflexes , so like when you have a kid sitting there and you tip them to the side and their arm goes to the side . You tip them back , their arms go back . That's what should happen . But if we still have a moral reflex that's not inhibited , we can't develop those appropriately . So , like in that kid that I pulled back his arms should have gone back to catch himself . That's a normal propping reflex , um . But when you see their hands come up , that's a startle reflex , um , that reflex will play a lot into um . It's an autonomic response to a sudden change in head position . Touch , sound , light , temperature creates instant arousal and puts them in a fight or flight response .

Speaker 2 41:34

So when you see kids that are chronically anxious , chronically in a fight or flight response , they have a hard time paying attention because anytime something moves they'll startle . What happens is when they startle they release adrenaline and cortisol which also plays a lot into like allergies . So a lot of these people have allergies because adrenaline and cortisol help us fight allergens . But if we're having an abnormal response , or at least constantly , we'll have issues with that .

Speaker 2 42:01

Increased breathing rate , increased heart rate , increased blood pressure is pretty common . You see this a lot in like those eight , nine , 10 , 12 year old girls that are chronically anxious . They typically have a pretty large startle response . They'll also have a lot of times they will also have like motion sickness and things along those lines . But also you'll see it in young kids that have a lot of behavioral issues because anytime they move or anytime they're in class and someone moves too quick , makes too loud or noise , they startle , people's dilate heart rate goes up and they get into a state of fight or flight . Eventually their whole their frontal lobes fatigue out and from trying to shut that down all the time and then they have big outbursts , usually right when they get home from school .

Speaker 1 42:47

My son had the moral not integrated and I know everybody's like freaking out over here on the comments and it's funny because growing up all of my friends always made fun of me of how I get startled so quickly , so easily . Gosh , we all need treatment , y'all . I remember like I at the end of the school day I had to go turn in a notebook over to the director and if I forgot it would be like , and everybody like how did what happened ? It's like I forgot the book . You know something so simple , but it's crazy how easily startled . Yeah , that's our best system .

Speaker 2 43:29

Yeah , so a lot of these things will like . When you have that going on , you will see a lot of these things like sleep disturbances , especially early on infants , um , difficulty sleeping , especially ones like wake up a lot because every time they roll over and move too quickly they startle themselves awake . Shyness , poor balance , coordination , poor stamina , motion sickness , poor digestion because it affects our vagal system . Um , so we'll have issues with our digestive system , immune system issues again because that vagal system asthma , allergies , infections , hypersensitivity , light , movement , touch , smell , vision , reading issues because it plays a lot into our central and peripheral integration of our visual system . Um , they get kind of stuck in a I don't know the right words for that but their vision gets kind of brought in . They don't have good peripheral vision , difficulty adapting to change , they don't like changing environments . Hyperactivity with fatigue , eventually with extreme fatigue . Yeah , easily distracted because of that . So those are the most common symptoms .

Speaker 2 44:38

Have a great question over here from Marge Can the moral reflex happened with past trauma ? Yeah yeah , so moral plays a lot into our vagal system . So like development of a vagal system . So what happens is if you read like Porges' book on , like polyvagal theory , you'll have your dorsal branch , which is your freeze response . So you come over a hill and you see a deer and the deer freezes . That's a freeze response . Usually that should start to go away inside the womb . Is what is supposed to happen . Is what's supposed to happen . Sometimes it doesn't , but that's supposed to happen as our intermediate branch develops , which is our fight or flight response or our moral reflex .

Speaker 2 45:14

Then from there we develop our ventral branch , which is our parasympathetic , calming , rest , digest , and that happens as our frontal lobe start to get developed and start to inhibit this and regulate this . And there's a lot of mechanisms there . But when we get in an extremely stressful environment our frontal lobe shut down and if those don't come back online appropriately , we can't inhibit this reflex appropriately anymore . So that's why stress is such a big deal is because of the effect it has on our frontal lobes and our lack of cortical inhibition . So basically our frontal lobes can't shut it down anymore , then you'll see the reemergence of this reflex pretty often with those types of events . You'll also see it a lot with kids that are adopted , kids that have had a pretty rough , not cared for appropriately in those first couple years . You'll see this reflex a ton in a really strong , severe one thank you yeah , because that lack of vagal development .

Speaker 1 46:09

As your vagus nerve gets developed and functioning appropriately , it'll inhibit this reflex I wonder if lack of oxytocin has anything to do with this reflex integration . I don't know .

Speaker 2 46:21

The you know not getting enough affection whenever you're a newborn I have heard a correlation with that yeah , oh yeah , I yeah , and I mean there's studies , just overall brain development is less , and you know so I don't know the exact mechanism of that , but well , well-researched and well-known that when you're not getting appropriate stimulation early on , you're just not going to develop appropriately . Wow , let's see what this one is .

Speaker 2 46:50

This kid came to us with extreme behavioral issues , attentional issues , a lot of learning issues , and I want to show you guys the deficits that we see stnr and also we did an intensive with him , so I'm going to show you his primitive reflexes prior and after . So whenever kids come in with these deficits , we typically find a few different things . We find a few different primitive reflexes that shouldn't be there , we find balance issues and we typically find eye tracking issues . So I'm going to show you those here . So this first video we're looking at what's called an asymmetrical tonic neck reflex . We're turning his head and you can see his arms are dropping out on both sides there . When we go side to side , his arms drop out .

Speaker 2 47:25

He has a really strong 18 , six months of life after a four-day intensive . You can see now as we turn his head , his arms don't drop out anymore . That reflex , as it goes away , it plays a line to the ability for both sides of our brain to connect efficiently . It plays a lot into our eyes track efficiently from side to side . It plays a lot into our balance centers , plays a lot into like catching a ball and athletic activities . And then secondly , a reflex that plays a lot , a lot , a lot into like catching a ball and athletic activities . And then secondly , a reflex that plays a lot , a lot , a lot into behavioral issues is a startle reflex and this is what's called a moral reflex or a startle reflex . It should go away right around three to four months of life or turn into a more appropriate startle reflex called the Strauss reflex .

Speaker 2 48:02

You can see he has a big response to that and the second video . You can see that he no longer has that large response and meaning that he's that sensory stimulus isn't as large of a stimulus to his brain anymore . He's integrating that sensory information more appropriately . That's going to allow him in everyday life to integrate the sensory information coming in more appropriately . So the world isn't so bright and abrasive and overwhelming for him and long to produce better responses to his environment , or better behavioral responses to his environment , and you can also see here his balance is a really , really big challenge and with all the testing that we do here as well , you're going to see that that balance is a really big issue and as we go through this week of intensive , we're able to see that his balance is actually improving . With our objective measurements and also with our eye tracking objective measurements , you're seeing those systems start to improve and what we'll see over the next six weeks is is , behaviorally , things will start improving and he'll be able to better self-regulate as well wow this could be oopsies .

Speaker 2 49:02

Okay , questions on the morrow . Um , if not , I'm going to go to a couple things you can look for gatewise for atrR and SCNR that are pretty interesting , and also some things that you'll start noticing when you look at the mouth and stuff like that . Uh , some pretty interesting stuff . So any questions on that first .

Speaker 1 49:20

Um Marge said I was in a car accident several years ago and my airbag was deployed . It happened extremely fast and I was basically in shock for a while . To this day , if someone applies the car brake too quickly , I freak out and both of my arms and legs straighten out immediately in front of me for protection drives . My husband nuts when I do it uh , concussion can do that too .

Speaker 2 49:41

You probably had a concussion . Most likely you don't have to have . Like even a whiplash injury can create a concussion . So like then you don't have that frontal inhibition of those reflexes anymore . So that can definitely play into that .

Speaker 1 49:52

Okay , thank you .

Speaker 2 49:54

All right , yeah , okay . So there's a couple really interesting tests you can do to start looking for an ATNR and STNR . So when we don't develop these reflex appropriately , we don't differentiate our movement appropriately . So I often explain it simply like this we have what are called cortical maps in our brain and we have a map for this finger . So when I move this finger , there's an area of my brain that's activating and it's well differentiated from this finger and I can move those fingers independently because I have two different cortical maps . Well , if I

Reflex Testing and Abnormal Movement

Speaker 2 50:21

tape these two fingers together for the next couple weeks , I would no longer be able to use those independent because that cortical map would come , come together and I wouldn't be able to move them independent . I would have to retrain that to start to be able to do that again . That's neuroplasticity , that's differentiation of movement . But what I'm going to show you here is , when these reflexes don't go away , there's different movements . You can have them do to see if they haven't differentiated their movement .

Speaker 2 50:44

So in this first one , what I'm having this kid do is walk on the edges of his feet . What you'll see when he does that is his hands will roll in . So as he rolls in his feet , his upper body will roll in , which , again , shouldn't happen . He should have differentiated movement . He should be able to use his upper body independent of his lower body and his right independent of his left . So you can see in his mouth when you do that , how abnormal function he gets of his even his mouth . But you can see as we do that his hands roll in . That that shouldn't happen . It's called an ape walk um , and then when we have them I'll do this one out you can have them point their toes out and walk like a duck and what you'll see is their whole upper body will extend hope . This is a good video here and what you'll see is their whole upper body will extend Hope . This is a good video here . So to see his hands open up when he even just thinks about it .

Speaker 2 51:38

You can't . You'll see that open up and if you tell him , point your toes out , his hands will come back out again , even though his toes don't go out because he can't motor plan it . So the first one his feet are in . Yeah , he's walking on the edges of his feet . Okay , good , yep . So then you get this roll your hands in . Then when he points his toes out , when these reflex are present , you'll see their whole upper body rotate out , so extend out . So it'll look like I can't really do that . It'll look like their hands will roll out like this and then , when they point their toes in , their whole upper body will their arms will roll in . So this is an example of that one . So this is him . He's trying to point his toes in .

Speaker 2 52:18

Let me start here . He can't , couldn't motor plane it , so he couldn't do it and he had so much tightness . But you'll still see the effect in his upper body . All of this is rolled in . This is after a week intensive . So he still is rolling in after a week , but he can at least walk . Before he couldn't even motor plan it . Wow . So that still is abnormal . You shouldn't see that . You should see like a perfectly normal , like arm swing when you walk with your toes in , and they should be able to motor plan that really well . But if you start just simply by having your patients walk on the edges of their feet , walking with their toes out , walking with their toes in , you start seeing abnormal upper body movements with it . That's because they haven't differentiated that movement and therefore their motor system isn't differentiated . Therefore it can't get complex . Therefore you also can't develop your fine motor skills because you have to develop that gross motor differentiation before you develop that fine motor differentiation efficiently . You can develop that fine motor uh ability through a lot , a lot , a lot of rehab . But it's much easier if you just get the gross motor system functioning better first , like way easier .

Speaker 2 53:27

Um , last things are just some balance different different balance tests . That we do , but not as important . But you can just see like , just by getting rid of primitive reflexes , the bigger the score , the worse function . So it's as you get better primitive reflex development , you start getting better and better function . There's just some standardized tests we do and some standardized eye tracking tests we do . Uh , this is a pretty good one just to show the actual what the eyes look like . These are infrared cameras that record this . So this is with primitive reflexes , wow . And then the second one is without primitive reflexes . Oh , the second one didn't move , did it ?

Speaker 2 54:12

But anyways , you can see the difference there when he tracks up and down how big these abnormal movements are side to side , how abnormal they are , how much tighter they get , just by getting rid of reflexes . That's incredible . This is a handwriting one , so this is from a long time ago , but I thought it was a good example . So this was November 2017 . Got rid of his reflexes . This was a long time ago , but you can see how much better handwriting can get and how much growth can happen in a matter of a short period of time , once they can actually start using their hands appropriately .

Speaker 2 54:56

That's from november 2 . Yeah , november 2017 to may 2018 . Wow , so , just by getting rid of reflexes . And then here's some different , in handwriting too . But this is from a long time ago , when I didn't do intensives , so getting rid of reflexes at this point would have taken me closer to three or four months , because I was doing like 30 minute sessions twice a week or something like that , versus two to three hours a day every day . So so the progress is a lot slower just because I , at that point , I didn't do an intensive model . I didn't even know it was a better model .

Speaker 1 55:23

So I actually have some questions about that . You want to ? Would you like to finish to ? Yeah , would you like to finish ? Go ahead , would you like to finish ?

Speaker 2 55:31

No , no , last part is just for chiropractors , so just just talking about different resources and stuff . So yeah , open it up to questions . I'll stop this , stop sharing .

Speaker 1 55:42

Oh , my goodness , what a wonderful presentation . First of all , thank you so much for taking the time out of your busy schedule to be here with us . I know that so many professionals and patients are going to benefit from this . One of my questions is you just mentioned intensive care .

Speaker 2 56:01

What does it ?

Speaker 1 56:01

look like , especially for these kids who live far away from you . What should they expect when they come to see you

Intensive Treatment Model for Integration

Speaker 1 56:07

?

Speaker 2 56:08

Yep . So they come here , we do the initial exam . It usually takes us about an hour , and then we do an hour to two hours of therapy that first day and then if we do hyperbarics on top of that , then that's an extra hour , and some kids that are older they can do three or four hours . But traditionally if it's a four or five-year-old we're probably going to be doing a couple hours a day of therapy and they're they do that every day , monday through Friday , and if they're here for a week it's one week If they .

Speaker 2 56:37

And our goal is the first week or two , depending how delayed the child is is get rid of primitive reflexes . That's number one , and also getting energy to the brain . So getting oxygen , getting ATP through laser therapy , through different oxygen therapies , that's really our goal in that first week . Second week is , um , working more on vestibular function . Third week could be more eyes . But again , if a kid's really delayed , like super , uh , uh , really severe autistic kid , it might take us two or three weeks to get rid of the reflexes , depending on the extent of delay in that maturation of the brain . So that's what it looks like is we just work through primitive reflexes , vestibular eye tracking and that's that's the foundation of our entire brain development , so that's what we really focus on .

Speaker 1 57:23

So usually a patient will schedule to come in and stay there several weeks , or do they go one week at a time ?

Speaker 2 57:31

If , for example , if it's a child that has autism , we'll recommend coming for at least two weeks the first time . If they're from , you know , the uk , like the ones that are here from the uk , they're here for a month , so they're gonna stay for a month . They were here probably four or five months ago and they were here for three weeks . So uh , but that's again a really delayed child and needs a lot of work . So other kids might if it's just a reading issue or something along those lines , like they may just come for a week and then we have them come three to six months later for another week if we need to . But we give a bunch of stuff to do in between .

Speaker 1 58:01

I mean even a lot of the lasers that we have , we send home with them and just give them resources to work on at home know I'm asking this for a friend , so I might bring my son to come to you guys . Um , but um , the laser was my other question that I noticed that you guys do a lot of this red laser . What is it exactly ?

Speaker 2 58:20

uh , known as photobiomodulation , has nearly 12 000 studies on it now . Um , it's what it does . Simply put , is , when we have an electron transport chain , we have something called cytochrome c oxidase on there and it upregulates cytochrome c oxidase . So what allows us to do is produce more atp . It allows us to produce more energy , which allows for increased healing , increased function number one and number two but also it increases blood flow to the area of the brain that we're trying , that we're working on . So if a kid has a cerebellar issue and they have , they have low core tone , they don't have good balance , they don't have good eye track and they still have primitive reflexes we're going to be lasering that cerebellum while we're trying to do other activities to activate it . Once we get more integration in the cerebellum , what's going to happen is their brain's going to start functioning better and start inhibiting these reflexes . So we use it to activate the brain . Simply put , amazing .

Speaker 1 59:12

Amazing , oh my goodness . Oh , thank you .

Speaker 2 59:16

Yeah , for any neurological issue , according to Harvard research , it should be the first thing to use because it doesn't have any side effects and it's extremely effective .

Speaker 1 59:26

Is it something only chiropractors can use ?

Speaker 2 59:29

So is it something only , uh , chiropractors can use ? No , chiropractors , pts , ots , speech baths can use them , like I mean , pretty much anyone can use them there . I get them for parents at home .

Speaker 1 59:38

So perfect . Oh , that sounds so wonderful . And how can people get in touch with your office ?

Speaker 2 59:46

Um , yep , uh , Iowa infinitycom is our , is our office , um , or if you go to drjoshmatsoncom , um , have blogs and we just built that page out , but it has access to our different clinics and stuff and um courses that I , I teach , and so I teach courses for parents , I teach courses for professionals , um , so those are all there too perfect .

Speaker 1 1:00:09

we cannot wait to hear more from you . We're going to do an Instagram live later on with my own move , so I'm super excited about this . Thank you so much . You have a wonderful weekend and we're so appreciative of your time . Thank you , dr Josh . Thanks for having me All right , bye , yeah .