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Diagnostic Postural reactions

Diagnostic Postural reactions. Vojta 의 자세 반응 검사. Traction reaction Landau reaction Axillary hanger reaction Vojta reaction Horizontal-Collis reaction Peiper-Isbert reaction Vertical-Collis reaction. Diagnostic - Traction Response.

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Diagnostic Postural reactions

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  1. Diagnostic Postural reactions

  2. Vojta의 자세 반응 검사 • Traction reaction • Landau reaction • Axillary hanger reaction • Vojta reaction • Horizontal-Collis reaction • Peiper-Isbert reaction • Vertical-Collis reaction

  3. Diagnostic - Traction Response • People have used this test for years indiagnostics, where the infant was pulled from supine to the upright sitting position. The head was observed. • Here the infant is taken into an oblique position (approximately 45 degrees to the horizontal). • It is possible in this labile position to observe the reactions throughout the entire body including the extremities.

  4. One must ensure to utilise the palmar grasp reflex. • For this, a finger is inserted into the infant's hand from the ulnar aspect. The other fingers fasten around the distal end of the forearm, ensuring that the dorsum of the hand is not touched. This information may inhibit the grasp reflex. • Starting position: Supine with the head in midline.Implementation: The infant is brought slowly up to a 45 degree inclination.

  5. 1st phase from the 1st until the end of the 6th week. • The head lags behind. • In the neonatal period the legs are flexed and slightly abducted. • Following the neonatal period: • the legs are inertly flexed (similar to that seen in the Axillary suspension and Landau reactions in the first trimester.)

  6. 2nd phase from the 7th week until the end of the 6th month • The head is actively flexed accompanied by flexion of the entire trunk and the legs are actively drawn toward the trunk - again flexion. • At 3 months: • The head comes in line with the trunk. The neck and upper trunk lie in a straight line. • The legs are only beginning to draw toward the trunk. • End of the second phase: • The head is maximally ante flexed - the chin is drawn against the chest. • The legs are maximally drawn toward the trunk.

  7. 3rd Phase from the 8th until the 9th month • After the 7th month the active flexion seen at the head, the trunk and the lower limbs gradually decreases. • In this time span one sees an active impulse of the infant to raise itself up. • The diminishment in flexion can best be seen at the knee joint (the knee is now semi-extended). • Through this the buttocks become the point of support and the centre of gravity is actively shifted in this direction.

  8. 4th phase from the 9th/10th month until the 14th month • The infant raises itself actively. • The head remains in line with the uppertrunk. • Flexion occurs now essentially only in the region of the lumbosacral junction. • The legs are abducted and the knees are extended. • Comment:To best observe the 3rd and 4th phase, the child should be in good spirits. When the child is distressed, it frequently throws it's head backwards and arches back.

  9. Traction reaction 비정상 반응 • 다리가 굴곡자세를 취하면서 대퇴가 외전 • 다리가 내전, 첨족, 내회전, 교차되는 신전자세 • 각 단계가 반사 나이보다 지연 • 머리와 다리의 단계가 일치하지 않는다 • 체간의 후궁반장자세(opisthotonus) • 8-9개월이후 다리 외전, 신전하면서 체간을 떨면 소뇌성 운동실조(cerebellar ataxia)의미 • 3기 이후 파악력 변화가 많을 때는 무정위운동(athetosis)을 의미

  10. Diagnostic - Landau Reaction • Landau, A.(1923 ) • Implementation:The child is held prone under the stomach upon the flattened hand of the examiner, strictly in the horizontal plane.

  11. 1st phase from the 1st until the 6th week • The head falls slightly. • The trunk is lightly flexed over the hand. • The arms and legs assume a flexed posture.

  12. Comments • In the implementation and evaluation of this postural reaction, one must ensure that the infant is calm. If distressed, there sulting extension of the lower limbs or the opisthotonic-like posture of the trunk make the evaluation invalid.

  13. 2nd phase from the 7th week until the 3rd month • Neck extension up to the line of the shoulders, head midline. • Slight flexion of the trunk. • Flexion of the arms and legs.

  14. Comments • At the end of the 2nd phase, the child in prone is capable of supporting itself symmetrically on both elbows with corresponding neck extension and the spine held in midline. Any asymmetry of the trunk must be taken notice of.

  15. 3rd phase until the 6th month • Additional to the neck extension the trunk is now extended down to the thoraco-lumbar junction. The spine is in midline. • The legs are slightly abducted with flexion of the knee and hip to 90 degrees. • The arms are flexed.

  16. Comments • At the end of the 3rd phase the spine is straightened along it's entire length. • At this same time the child must already be grasping with a radially orientated hand and in prone, able to support itself on one elbow with the other hand free to reach and grasp infront of itself.

  17. 4th phase until the 8th month • In the 7th developmental month the legs remain flexed to 90 degrees. The child is however, due to the emerging "stranger danger phase" often disquieted and arches it's head and back upwards. The legs are also then extended into the horizontal plane. • Landau had also observed this and saw it necessary to passively flex the child's head under again. With this the legs return to a flexed posture.

  18. If the head is then let go the neck and trunk can be observed to be held in a straight line in the horizontal plane. • When the child reaches the 8th developmental month, the flexed posture of the legs diminishes. • At 8th month in the same starting position, the legs are held in supple extension. • The arms are flexed like in the other phases.

  19. Landau reaction 비정상반응 1. 팔이 retraction되고 몸이 한쪽으로 휘어지면서 머리와 몸통이 비대칭적인 자세를 취한다. 2. 팔이 retraction되고 다리를 신전자세를 취하면서 머리는 후궁반장식 자세를 취한다. 3. 머리가 눈에 띄게 밑으로 쳐져 있고 몸통이 힘없는 자세를 취하면서 동시에 다리를 뻗치며 경우에 따라 팔을 retraction된다. 4. 고개가 신전되지 못하고 팔이 앞으로 뻗치면서 주먹은 쥐고 다리는 신전자세를 취한다.

  20. Diagnostic - Axillary suspension response • Implementation:Vertical position. The child's trunk is held. The head is above and the child's back is towards the examiner. • It must be observed that:your hands aren't hanging the child by it's shoulders.that the examiner doesn't allow their thumbs to touch the lower border of the child's Trapezius muscle otherwise extension of the lower limbs is provoked through this proprioceptive stimulus.

  21. 1st Phaseuntil 3rd month • The legs are held in an inertly flexed posture similar to the 1st phase of the Landau Reaction and the Traction Response immediately following the perinatal period.

  22. 2nd Phase until 7th month • The legs actively draw towards the trunk -flexor synergy of the lower limbs. This posture is similar to that seen in the Landau Reaction and the Traction Response in the 2nd Phase. The lower limb flexor synergy diminishes from the 8th developmental month.

  23. Comments • Flexion of the legs towards the trunk, seen in the 2nd phase, corresponds to the developmental stage where the child lying supine spontaneously lifts and pulls it's legs towards the trunk with the feet grasping one another

  24. 3rd Phase • The legs are held in an extended position. The feet are dorsiflexed. By implementing the Pendulum Test the legs move equally.The extension pattern is similar to that in the Traction Response (4th Phase) and the Landau (4th Phase).

  25. Comments • The 3rd phase corresponds to the stage the child spontaneously shows preparedness for standing - the standing reaction

  26. 비정상 반응 • 진자반응 ;겨드랑이 걸치기 반응의 2-3기에 도달한 아기를 수동적으로 약 30-40도 앞뒤로 흔들면 병적 발달에서는 다리의 흔들림이 뚜렷하게 정상에서 벗어난다. 1. 겨드랑이 걸치기 반응에서 양 쪽 다리가 뻣뻣하게 신전자세를 취하면 진자반응에서는 더욱 심해진다. 2. 한쪽 다리가 진자반응으로 더욱 뻣뻣해지고 흔들리는 범위에 미치지 못하면 편마비로 발달되어가는 중요한 표시이다. 3. 흔들리는 정도가 양쪽 또는 한쪽이 눈에 띄게 크면 소뇌장애가 있다는 중요한 표시이다.

  27. Vojta Reaction • Vojta (1966/ 67/ 69) • Implementation : A quick tilt of the child laterally from the vertical into the horizontal position.

  28. 1st Phase : 1 - 10Weeks • For clinical use, evaluation of the upperlying extremities is more important • Moro - like "embrace" pattern of both arms. • Hands open. • Flexion of the upper lying leg at both the hip and knee joints with dorsiflexion at the ankle joint. • Pronation of the foot and toe extension with fanning. • Extension of the underlying leg with dorsiflexion at the ankle joint, supination and flexion of the toes.

  29. 1st Transitional phase: 11- 20 Weeks • The "embrace" like posture of the arms diminishes, the arms are still abducted with the hands open. • Nearing the end of the 1st transitional phase: • The arms are held flexed at the elbow (It is only on repeat manoeuvres that the Moro-like extension at the elbow is seen ). • The earlier differentiated postures of the legs disappears. Both legs become gradually more flexed. • The toes of the upper lying foot are no longer fanned open.

  30. 2nd Phase from around 4. 5 month until the end of the 7th month • All extremities take up a flexible flexed posture. • The hands are open or loosely closed. • The feet are dorsiflexed and for the most part supinated. • The toes lie in neutral between flexion/extension or flexed.

  31. 2nd transitional phase from the 7th until the end of the 9th month • Initially the arms are flexed, and later extend forward and abduct away from the body. • The legs are extended in front of the body - there is flexion at the hip whilst flexion at the knee diminishes. • The feet are dorsiflexed. • The toes are in neutral.

  32. 3rd phase from the 9th until the 13th/14th month

  33. Important Before carrying out the manoeuvre one must ensure that the child's hands are open. Failure to do so especially in the perinatal period or in early infancy, can result in a stereotypic flexed posture of the arms. The upper lying arm would therefore demonstrate an abnormal pattern, which must then be evaluate dartificially as abnormal.

  34. 주의: • 18개월 이상이 되면 보이타 반응은 의미가 없다. 이시기는 아이가 의식적으로 자기 머리를 움직이기 때문이다. • 검사 전에 반드시 아기의 손을 편다. • 비정상 반응 1. 위쪽의 팔이 주먹을 쥔채로 뻣뻣하게 굴곡된다. 2. 어깨가 retraction 되면서 위쪽의 팔이 뻣뻣하게 굴곡된다. 손은 펴질수도 있다. 3. 위쪽 다리가 내회전 되면서 신전된다. 4. 위쪽 다리가 늦게 굴곡된다. 5. 몸통이 저긴장 상태이다.

  35. Diagnostic - Horizontal suspension response according to Collis • Collis (1954).(Collis horizontal, modified by Vojta) • Implementation:The child is fastened by the upper lying arm close to the shoulder joint and the ipsilateral thigh close to the hip joint. • To avoid over-stretching the joint capsule of the shoulder, one must wait until a feeling of tension occurs around the joint - a "compactness". ie. as though the arm is pulling toward the body.

  36. 1st phase from the 1st until the 12th week • In the first 6 weeks the free arm shows a Moro-like "embrace" pattern.

  37. In the 7th - 9th week the Moro-like extension/abduction pattern in the free arm is seen.

  38. In the 10th - 12th week a lightly flexed posture of the free arm is observed. • Comments:Flexible pedaling movements of the free leg are normal at this stage.

  39. 2nd phase from the 4th until the 6th month • The child is able to pronate the forearm that is free and at the end of the 2nd phase supports itself on the opened hand. • The free leg remains flexed. Possible pedaling movements show differentiation.

  40. Comments • 2nd phase - pronation occurs in the free forearm - it begins, when the child is able to spontaneously support itself on both elbows in prone with the head midline and the cervical spine physiologically extended. • Pronation of the forearm is always associated with an extension at the wrist and an opening of the fisted hand position. • Perfect hand support is impossible at this stage (without stiffened extension of the elbow). • It is not seen until the palmar grasp reflex has disappeared and the child is able to radially grasp.

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