Jackson - hypothesized - reflexes are
present in early development and
present again after damage to the
CNS. Therefore these reflexes are
considered normal and precede
purposeful movement.
Brunnstrom believed the damaged
CNS reverts back to these old patterns of movement.
limb synergy patterns
can occur in flexion
and extension
LE Flexor Synergy: hip flexion &
abd & external rotation, knee
flexion, ankle dorsiflexion &
inversion, toe extension
LE Extensor Synergy: hip add &
extension & internal rotation, knee
extension, ankle plantar flexion and
inversion, toe flexion
Muscles in pattern are linked,
cannot be isolated. If one
muscle in the flexor pattern is
stimulated, they all activcate.
Extensor: scap abd & depression,
shoulder add & internal rotation,
elbow extension, forearm pronation,
wrist & finger flexion or extension.
primitive reflexes
TNR's
tonic lumbar reflex
TLR
Reappear and normal
deep tendon reflexes
become exaggerated.
TREATMENT & METHODS
GOAL: Pt. progress through the stages
Changes in head & body
position can elicit early
motor patterns (reflexes).
Stimulating the skin can elicit a
synergy. Rubbing the skin or tapping
of the biceps can elicit a flexor synergy
A stretch of a muscle can cause
a contraction and inhibit its
antagonist. Providing resistance
also facilitates contraction.
Use of mirrors and videos
provide visual feedack.
Bed Positioning: place pt.
in the position opposite of
the pattern they exhibit.
Bed Mobility: log roll towards affected side.
Trunk Movement & Balance: pt's.
tend to lean to affected side.
Therapist disturbs the pts. balance
to elicit balance response.
(SAFELY)
as pt. progresses have them attempt
positions that displace their center of
gravity (ie: bending over, trunk rotation.)
Shoulder ROM: achieve/maintain pain-free ROM at
the glenohumeral jt. Pendulum exercises.
Shoulder Subluxation: slings, used to help hold
shoulder in place, but do NOT increase muscle
strength.
Upper LImb Training: goal is for pt. to achieve voluntary control
of the synergy patterns. Achieved by REPETITION, assist of
the therapist, tapping, verbal cues and stimulation applied to
skin (vibration).
Hand Training: 1st goal - Achieve a gross grasp.
UPPER LIMB trainings to
promote the progression
from stage 3 to 4
1. Hand to chin
2. Hand to ear on the same
side & opposite side
3. Hand to opposite elbow
4. Hand to opposite shoulder
5. Hand to forehead
6. Hand to top of head
7. Hand to back of head
8. Stroking movements from top to back of
head & from dorsal side of forearm to
shoulder on unaffected side.