ArticleBrain sciences2026
Primitive-Reflex Profiling After Sport-Related Concussion: An Athlete-Centered Framework for Testing a Candidate Behavioral State Marker.
Article in Brain sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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3 authors.
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Abstract
Direct prospective evidence that primitive-reflex expression changes after sport-related concussion (SRC) is currently very limited. This Perspective therefore proposes a deliberately restricted context of use: standardized primitive-reflex profiling as an experimental, low-cost candidate behavioral state marker to be tested within athletes across recovery, not as an established diagnostic biomarker or a return-to-sport criterion. The standardized 18-reflex protocol underlying this framework demonstrated excellent inter-rater (κ = 0.912-1.000) and intra-rater (κ = 0.912-0.983) reproducibility in the reported 565-participant validation sample; however, athlete-specific reliability, responsiveness to SRC, construct validity, prognostic utility, and treatment sensitivity remain unestablished. We distinguish three testable candidate mechanisms-fronto-subcortical stopping-network dysfunction, altered sensorimotor/afferent gating, and vestibular-reticulospinal dysregulation-and specify findings that would support or weaken each account. A staged research program begins with sport-specific reliability and feasibility, proceeds to prospective within-athlete change beyond measurement error, and only then evaluates mechanistic convergence, incremental prognostic value, and intervention sensitivity. The full 18-reflex profile (30 bilateral or non-lateralized measurements) should remain the primary level of analysis. A summed primitive-reflex burden is retained only as a descriptive summary and must not substitute for reflex-specific analysis. Palmar grasp and Babkin-related responses provide a focused, falsifiable test case for relating lateralized reflex expression to premotor and supplementary motor hemodynamics during force-matched grasping. Progression between stages requires prespecified success criteria, independent replication, and explicit stopping rules. Until those conditions are met, primitive-reflex profiling should remain an experimental outcome embedded within guideline-concordant concussion care.
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