3. Understanding Impairments, Treatment Planning & Treatment Progression for the Neurological Patient

Question 1

💡 what do you do next?

For each identified activity limitation…

Answer 1

Identify the missing components

Question 2

Motor control generally develops in cephalo-caudal direction and

Answer 2

proximal to distal

Question 3

💡 primitive reflexes

what are the tonic and phasic primitive reflexes

Answer 3

• Tonic Reflexes:
  
  • ATNR – asymmetrical tonic neck reflex
  • STNR – symmetrical tonic neck reflex
  • ATLR – asymmetrical tonic labyrinthine reflex
  • STLR – symmetrical tonic labyrinthine reflex
• Phasic reflexes:
  
  • Extensor Thrust
  • Flexor Withdrawal
  • Crossed Extension Reflex
  • Grasp Reflex

Question 4

Flexion of the neck results in flexion of the arms and extension of the legs; extension of the neck results in extension of the arms and flexion of the legs.

Answer 4

Symmetric Tonic Neck Reflex

(a tonic reflex)

Question 5

Head rotation to the left causes extension of left arm and leg and flexion of right arm and leg; head rotation to the right causes extension of right arm and leg and flexion of left arm and leg

Answer 5

Asymmetric Tonic Neck Reflex

(a tonic reflex)

Question 6

Prone lying position facilitates flexion; the supine position facilitates extension. The reflex can also be thought of as inhibition of extensor tone in the prone position.

Answer 6

symmetrical tonic labyrinthine reflex

Question 7

name of reflex

This is initiated by a change in the position of the upper trunk with respect to the pelvis. Rotation of the trunk to the right results in flexion of the right upper extremity and extension of the right lower extremity; rotation of the trunk to the left results in extension of the right upper extremity and flexion of the right lower extremity.

Answer 7

Tonic Lumbar Reflex

Question 8

Resistance applied to abduction or adduction of the nonaffected lower extremity evokes a similar reaction in the affected limb.

Answer 8

Raimiste’s Phenomenon

Question 9

Flexion in the UE causes flexion of the ipsilateral LE

Answer 9

Homolateral Limb Synkineses

Question 10

developmental progression

supine developmental progression

Answer 10

Supine → hooklying → bridging → side lying → sidelyin on elbows → sydelying on hands → long sit → short sit

Question 11

prone developmental progression

Answer 11

pivot prone → prone on elbows → prone on hands → quadruped → kneeling → 1/2 kneeling → standing

Question 12

motor task requirements

the ability to demonstrate adequate mobility of all tissues involved in a movement (joint, soft tissue, neural, fascia, etc). It also refers to the ability to initiate a contraction.

Answer 12

MOBILITY

Question 13

motor task requirements

the ability to initiate a movement/transition (a contraction) for the transition to another posture

Answer 13

Transitional Mobility a subcategory of MOBILITY

Question 14

motor task requirements

the ability to maintain postural stability and orientation with the center of mass (COM) over the base of support (BOS) and the body at rest. Proximal stability is needed for distal mobility.

Answer 14

STABILITY (static postural control)

Question 15

motor task requirements

movement is now added to a previously static posture – movement of the proximal components over a fixed (weight bearing) distal component. The COG moves over the fixed BOS. ie: weight shifting while in quadruped, shifting weight in standing, etc

Answer 15

CONTROLLED MOBILITY (Dynamic Postural Control)

Question 16

motor task requirements

The distal component is moving while the proximal musculature provides dynamic stability to guide the limb in space. Activities have two functions: manipulation and exploration of the environment

Answer 16

SKILL

Question 17

what is the reaction of the asymmetrical tonic labyrinthine reflex on a patient sidelying on the left side?

Answer 17

• extension tone on the weight bearing side
• flexion on the non weight bearing side

Question 18

what is the reaction of the symmetrical tonic labyrinthine reflex on a patient lying in the supine position?

Answer 18

extension