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PubMed1975

The tonic ambulatory foot response. A clinical and electromyographic study.

Three cases with "pyramidal" symptoms in which standing and/or walking evoked a tonic flexion of the toes and sole of the affected foot, have been studied from the clinical and electrophysiological standpoint. The phenomenon, for which the definition of tonic ambulatory foot respone (TAFR) is proposed, appeared to be triggered by cutaneous stimuli travelling along fibres lying in the range of nociceptive afferents, and to depend on a background of complex sensorimotor patterns of standing posture and/or stepping movements against resistance. The relationship of TAFR to other flexor foot responses described in the literature is discussed.

Cerebrovascular Disorders↗
PubMed1975

Early neuromuscular development of the premature infant.

A case study is presented which documents the neuromuscular development of a premature infant (34-35 weeks gestation) during the first eight weeks of postnatal life. The development of postural tone, spontaneous activity, and responsiveness to stimulation is described and compared with that of the full-term infant. This information is of value to physical therapists involved in evaluation and therapeutic intervention programs for high risk infants.

Humans↗
PubMed1981

Reevaluating the theoretical model underlying the neurodevelopmental theory. A literature review.

The purpose of this paper is to evaluate the foundations of prevalent physical therapy technique based on the current research on motor control. The conceptual framework of the neurodevelopmental theory, as described in the writings of the Bobaths, is presented. Their explanations of central nervous system disorders and recommendations for intervention are based upon a unidirectional model of the nervous system in which postural and voluntary motion become two separate and distinct entities. Systems theory is an alternative model of nervous system structure. In systems theory, the organism is a circular network of interacting yet autonomous subsystems, rather than a vertical structure of descending controls. Relevant research that supports the systems viewpoint is discussed and applied to the theories in the neurodevelopmental approach. Thus, another model is offered for understanding the functioning of the central nervous system when it is intact and when it is in a pathological state.

Animals↗
PubMed1984

Electromyographic results of inhibitory splinting.

The purpose of this study was to compare the integrated EMG activity of spastic muscles in brain-damaged patients before and during splint application. Eight patients with spasticity that produced limb posturing were systematically monitored for EMG activity during a two-hour interval without a splint (Nonsplinted Condition), and during a subsequent two-hour period while wearing the splint (Splinted Condition). The goniometric measurement of the limb position also was taken during the two conditions. The limb postures monitored were ankle plantar flexion, wrist flexion, and elbow flexion. A paired t test showed a significant (p less than .001) increase in the position of the limb into extension in the Splinted Condition compared with the Nonsplinted Condition. No significant reduction in integrated EMG activity occurred during the Splinted Condition compared with the Nonsplinted Condition. Despite the significant change in joint position and elongation of spastic muscles produced by the splinting, the muscle groups accommodated to the position as evidenced by the lack of significant change in EMG activity. Therefore, splinting can effectively control postural defects caused by spastic limb posturing without significantly increasing muscle tone. Implications of the results and the use of EMG measurement to help identify patient candidates for splinting are discussed.

Adolescent↗
PubMed1986

Postural reactions in infants with Down syndrome. Relationship to motor milestone development and age.

I examined the emergence of automatic postural reactions (righting, equilibrium, and protective reactions) in a group of infants with Down syndrome and in a developmentally matched group of nonhandicapped infants. I assessed the relationship of postural reactions to chronological age and to motor milestone development (as measured by the Bayley Scales of Infant Development). The relationship of postural reactions to chronological age was weaker in the infants with Down syndrome; a regression analysis revealed a slower rate of postural reaction development evident at an age of about five months and older in infants with Down syndrome. The association between postural reactions and motor milestone performance was remarkably similar for both infant groups in degree of association and pattern across the span of motor development tested. The results indicated that, even though the rate of development differed, the association between postural reactions and motor milestones was similar in normal and delayed development. These results support the current rationale that promotes intervention efforts focusing on the facilitation of postural reactions to enhance motor milestone development in infants with Down syndrome.

Age Factors↗
PubMed1990

Balance performance on the postural stress test: comparison of young adults, healthy elderly, and fallers.

The purpose of this study was to compare the postural responses of three groups of individuals--healthy young adults (n = 42; age, 20-40 years); healthy, community-dwelling, elderly individuals (n = 66; age, 60-102 years), and elderly individuals with a history of frequent falls (n = 10; age, 66-95 years)--using the postural stress test (PST). The PST is a simple, clinically applicable, quantitative measure of an individual's ability to withstand a series of graded destabilizing forces applied at the level of the subject's waist. Elderly fallers tend to score lower on the PST than elderly nonfallers, but age-related differences in postural responses during the PST have not been established. Each subject underwent the PST using a method and scoring procedure described previously. Results of this study confirm previous findings that elderly fallers score significantly lower on the PST than either young adult or nonfalling elderly individuals. This study also showed that there was no difference in balance strategy scores between the young adults and the healthy elderly subjects. Therefore, it appears that poor performance on the PST cannot be attributed to age alone, but may be predictive of pathological processes that predispose an individual to frequent falls.

Accidental Falls↗
PubMed1997

Advances in the treatment of vestibular disorders.

This article discusses the pathophysiology, evidence of treatment efficacy, and factors that contribute to improved treatment outcome in three different vestibular disorders. In patients with unilateral and bilateral vestibular loss, recent research suggests that customized, supervised exercises facilitate recovery of postural stability. These exercises are based on knowledge of normal vestibular function as well as on our understanding of the various compensatory mechanisms that can contribute to recovery. Recognizing the limitations of these compensatory mechanisms as substitutes for lost vestibular function is important in establishing treatment goals. Treatment of patients with benign paroxysmal positional vertigo (BPPV) is based on the identification of the specific canal involved and the anatomy of the labyrinth. Although patients with BPPV primarily experience brief episodes of vertigo, this disorder is also associated with postural instability, which may not resolve with remission of the positional vertigo.

Adaptation, Physiological↗
PubMed1991

The effect of physical therapy for children with motor delay and cerebral palsy. A randomized clinical trial.

Physical therapists recommend neurodevelopmental therapy for cerebral palsy, but its effectiveness has not been fully established. A randomized controlled trial was undertaken to compare the effects over 6 months, of weekly (intensive) and monthly (basic) neurodevelopmental therapy on the motor development of young children with suspected cerebral palsy. Subjects were no older than 18 months when referred for physical therapy because of a motor delay. All those meeting specified criteria were assessed on seven motor development tests: reflex activity, postural reactions, gross motor ability, fine motor skills, mental functioning, dominance of abnormal movement patterns and ability to participate in activities of daily living. The average proportional change in aggregate motor development for the 17 infants on the weekly (intensive) regimen was substantially better than that for the 12 on the monthly (basic) regimen, after adjusting for the child's age, whether the child was born at term or not, and mother's education. A statistical test led to an equivalent of a Student's t = 3.49, which with 24 df was associated with P = 0.0019 (two-sided).

Activities of Daily Living↗
PubMedDate not supplied

Idiopathic scoliosis and the central nervous system: a motor control problem. The Harrington lecture, 1983. Scoliosis Research Society.

An etiologic concept linking an impaired axial motor control system to the structural deformity of idiopathic scoliosis (ISc) is proposed. Postural studies reveal that during quiet stance, adaptation is marked in conditions associated with visual control of sway, particularly of lateral sway; during imposed perturbations of the body, destabilized postural reactions are pronounced in tests requiring visual-vestibular coupling. Observations of visual and/or vestibular generated eye movements indicate ocular instability among a high proportion of the ISc. Previously, the authors argued that a direct relationship exists between visual and/or vestibular functioning and a disordered axial motor system. This was attributed to an aberrant brain stem mechanism. In this presentation, however, we propose that a higher level CNS disturbance may be responsible for reports of EEG abnormalities, visuo-spatial impairment, motor adaptation, and learning deficits. Among the wide range of visual-vestibular variables studied, those representing processing of vestibular signals within the CNS yield the highest degree of correlation with the magnitude of the curve. Moreover, differences in vestibular processing between two subsets of ISc, namely ISc with (70%) and without (30%) normal academic achievement are significant. Variables referable to both vestibular and visual processing correctly classify 87% of the ISc with normal academic achievement and 100% of the ISc with a history of academic problems. The association between learning deficits, altered processing of vestibular information, and ISc suggest a unique syndrome complex, and an important role of cortical structures in the etiology of this disorder. The presence of a visuo-spatial perceptual impairment may be the common feature of ISc. In an attempt to restore perceptual dysfunction (by rearrangement), the ISc adopts a new axial and vestibular motor control strategy based upon recalibration or reinterpretation of proprioceptive signals arising from the axial musculature.

Adaptation, Physiological↗
PubMedDate not supplied

Management of increased intracranial pressure in the critically ill child with an acute neurological injury.

Increased intracranial pressure reflects the presence of mass effect in the brain and is associated with a poor outcome in children with acute neurological injury. If sustained, it has a negative effect on cerebral blood flow and cerebral perfusion pressure, can cause direct compression of vital cerebral structures, and can lead to herniation. The management of the patient with increased intracranial pressure involves the maintenance of an adequate cerebral perfusion pressure, prevention of intracranial hypertension, and optimization of oxygen delivery. This article reviews the neurological assessment, pathophysiology, and management of increased intracranial pressure in the critically ill child who has sustained an acute neurological injury.

Acute Disease↗