2019 KPIBA

ROLE OF B.G IN MOTOR CONTROL

• IMPORTANT FOR CONTROL OF MOVEMENT – THE MAIN BUSINESS OF THE BG IS TO REFINE
INFORMATION TRANSFERRED TO THE ASSOCIATION CORTEX AND MOTOR AREAS OF THE CORTEX .

• ARE IMPORTANT EXECUTORS IN THE INTENSITY OF CORTICAL OUTPUTS, NOT THE INITIATION OF
MOTOR COMMAND. THEY ENSURE SMOOTH INTEGRATION OF PROGRAMMED MOVEMENTS AND
POSTURES.

• THEY SEEM TO BE IMPORTANT FOR THE CONTROL OF AUTOMATIC BACKGROUND ACTIVITY.

• COMPARATOR ACTION LIKE THE CBLL

- SCALE THE AMPLITUDE OF MOTOR EFFORTS
- HELP IN THE IMPLEMENTATION OF MOTOR PLANS.
- PLAY AN IMPORTANT PART IN GOAL DIRECTED ACTIVITY.
• INITIATE AND TERMINATE VOLUNTARY MOVEMENT
• TURN ON AND TURN OFF FOR NEXT MOVEMENT
• REGULATION OF MUSCLE TONUS & STRENGTH
• BODY ORIENTATION IN THE SPACE
• MOTIVATION
• AUTOMATIC EXECUTION OF A LEARNED MOTOR TASK

⇒ PREPARE THE POSTURE

POSTURAL SET : START ON MIDLINE
MAX. H Y P E RTO N I A
W I T H I . T. S

C H O R EO. A

PURE. A
NORMAL
WITH S PA S T I C I T Y

MAX. H Y P O RTO N I A
• MOBILE SPASM : ALTERNATION, WRITHING LIMB MOVEMENTS; ATHETOID DANCE

• FLEETING, IRREGULAR, LOCALIZED CONTRACTIONS : UNPREDICTABLE PATTERNS :

GRIMACING, DISTAL DIGIT MOVEMENTS ; LIKE TWITCHES, IF WEAK

• INTERMITTENT TONIC SPASMS(DYSTONIA) : DEPENDENT ON CHANGE OF HEAD

POSITION; CHILD MAY BE FIXED IN TOTAL AND/OR ASYMMETRIC PATTERN, PREDICTABLE

IN PATTERN, NOT IN TIMING

 • UNSTABLE EMOTION
• POOR HEAD AND EYE CONTROL
• POOR MIDLINE ORIENTATION(AXIS)
- POOR SUSTAINED AXIS
- POOR POSTURAL SET AND POSTURAL CONTROL
• FLUCTUATING TONE
- POOR BODY SCHEME
• INVOLUNTARY MOVEMENT
• POOR GRADING OF MOVEMENT
- L ACK OF PROXIMAL STABILITY TO MOVING PART
- L ACK OF CONTROL OF MOVEMENT
- ESPECIALLY IN MIDLINE POSITION & MOVEMENT
• TEND TO MOVE IN TOTAL PATTERNS
- VERY ASYMMETRY
- FROM HEAD TO FEET
• ASSOCIATED PROBLEMS
- VISION
- OROMOTOR CONTROL(EATING, DRINKING)
- BREATHING, SPEECH, COMMUNICATION
- HANDS FUNCTION(EYE-HAND COORDINATION)
• POOR HEAD AND EYE MOVEMENT

• ABNORMAL POSTURAL TONE

- FLUCTUATION, INVOLUNTARY MOVEMENTS

• POSTURAL PATTERN

- VERY ASYMMETRIC; POOR ALIGNMENT; VERY POOR HEAD AND TRUNK CONTROL

- DIFFICULTY OR INABILITY TO MAINTAIN ANY POSTURE

• INSUFFICIENT PROXIMAL STABILITY TO MOVING PARTS

• INSUFFICIENT GRADING OF POSTURAL AND VOLUNTARY MOVEMENTS

• POOR POSTURAL CONTROL

- AN AXIS OF THE HEAD AND BODY IS DIFFICULT TO MAINTAIN

• ASSOCIATED PROBLEMS
- COMMUNICATION AND BREATHING
 DYSARTHRIC; CANNOT COORDINATION VOCALIZATION WITH BREATHING

 SPEAKS ON INSPIRATION

 DIFFICULT TO SUSTAIN SOUND; SPEECH OFTEN EXPLOSIVE

- OROMOTOR CONTROL(EATING AND DRINKING)

 ORAL HYPERSENSITIVITY ; TONGUE THRUST ; LIPS, CHEEK AND TONGUE RETRACTION
 INSUFFICIENT JAW STABILITY
- VISION
 MONOCULAR ; DIFFICULTY FOCUSING

 EYE MOVEMENT NOT INDEPENDENT OF HEAD MOVEMENT

 MAY HAVE NYSTAGMUS

- EMOTIONS
 UNSTABLE EMOTIONS, FLUCTUATION, CANNOT GRADE THEIR EMOTIONS
• ATHETOSIS WITH TONIC SPASM

• ATHETOSIS WITH SPASTICITY

• POSTURAL TONE
- FLUCTUATES TOO HIGH TO NORMAL RANGE
-
SPASTICITY IN PROXIMAL (SHOULDER & HIP)
• INVOLUNTARY MOVEMENT : MORE DISTALLY
• IMMOBILITY OF THE PROXIMAL PART
- ESPECIALLY SPINE
- SMALL & SLOW MOVEMENT THAN OTHER TYPES
• R/R, E/R
- NOT REALLY PRESENT
-
DEPENDENT ON DEGREE OF SPASTICITY
• DEFORMITIES
- DISLOCATION OF HIP, SCOLIOSIS
- FLEXOR CONTRACTURES OF HIP/KNEE, ELBOW
- PLANTAR FLEXION CONTRACTURES
• POSTURAL TONE
- SUDDEN CHANGE
-
FLUCTUATING HYPO-HYPER
• INVOLUNTARY MOVEMENT
- PROXIMAL PART : FLEXOR & EXTENSOR SPASM
-
DISTAL PART : SHOW TYPICAL WRITHING INVOLUNTARY MOVEMENT
• POSTURAL PATTERN
- VERY ASYMMETRY
- VERY POOR HEAD AND TRUNK CONTROL
- TEND TO MOVE IN TOTAL PATTERN
• RR AND ER
-
USUALLY NOT PRESENT
• DEFORMITIES : GREAT DANGER
- DISLOCATION DUE TO WINDSWEPT HIP & SCOLIOSIS
• CHOREO ATHETOSIS

• PURE ATHETOSIS
• POSTURAL TONE
- BELOW TO ABOVE NORMAL
• INVOLUNTARY MOVEMENT
- MOBILE SPASM MORE PROXIMAL
- ATHETOID DANCE
• RR AND ER
- OFTEN PRESENT BUT BADLY COORDINATED

- DELAYED, EXAGGERATED

• DEFORMITIES
- BE CAREFUL OF SUBLUXATION (HYPERMOBILITY)
• POSTURAL TONE
- LOW TO NEAR NORMAL

• INVOLUNTARY MOVEMENT
- MOBILE SPASM MORE DISTAL (FINGER)

• RR AND ER
- OFTEN PRESENT BUT BADLY COORDINATED

- DELAYED, EXAGGERATED

• DEFORMITIES
- BE CAREFUL OF SUBLUXATION(HYPERMOBILITY)
 POSTURAL TONE

• FLUCTUATION HYPO-HYPERTOUS
• INVOLUNTARY MOVEMENTS
- INTERMITTENT TONIC SPASM
- MOBILE SPASM
- LOCALIZED CONTRACTION, GRIMACING
• DISTRIBUTION : MORE HIGHER SIDE
• SPASTICITY ON PROXIMAL IN CASE OF MIXED WITH SPASTICITY
• INTERMITTENT SPASM INVOLVES WHOLE PART OF THE BODY
 POSTURAL PATTERN

• POOR HEAD AND EYE CONTROL

• ASYMMETRIC POSTURE AND MOVEMENT
• POOR GRADING OF MOVEMENT
• POOR SUSTAINED POSTURE BECAUSE OF POOR HEAD CONTROL
• MOVES TOGETHER : TOTAL HYPERTONIC PATTERN
• POOR HAND MOVEMENT
• DIFFICULT TO STAY STILL IN CERTAIN POSTURE
 ASSOCIATED PROBLEM

• PROBLEMS OF THE VISUAL, AUDITORY, VESTIBULAR SYSTEM

• FLUCTUATION OF EMOTION

• BREATHING, SPEECH, EATING

CONTRACTURE/ DEFORMITY

• HIGHER RIB CAGE WITH FLEXED SHOULDER

• HIP SUBLUXATION OR DISLOCATION

• FROZEN ANKLE OR MALALIGNMENT OF THE ANKLE

 POSTURAL TONE

• FLUCTUATION : HYPO – NORMAL

• INVOLUNTARY MOVEMENTS : MOBILE SPASM, LOCALIZED CONTRACTION, GRIMACING

• INVOLUNTARY MOVEMENTS LOCATED IN PROXIMAL FOR CHOEOATHETOSIS AND DISTAL

FOR PURE ATHETOSIS
 POSTURAL PATTERN

• POOR HEAD AND EYE CONTROL

• HYPOTONUS FOR PROXIMAL

• POOR GRADING MOVEMENT

• POOR SUSTAINED POSTURE BECAUSE OF POOR HEAD CONTROL

• MOVES A LOT

• DIFFICULT TO STAY STILL IN CERTAIN POSTURE

 ASSOCIATED PROBLEMS

• PROBLEM OF VISION, AUDITORY, VESTIBULAR SYSTEM

• FLUCTUATIONS OF EMOTION
• BREATHING, SPEECH, EATING

CONTRACTURE/ DEFORMITY

• LESS CONTRACTURES BUT MAY PRESENT WITH CONTRACTURE DUE TO REPETITION OF

SAME PATTERN OF MOVEMENT
• SUBLUXATION DUE TO HYPOTONIA
 CORTICAL LEVEL OF
POSTURAL TONE AXIS MOVEMENT

• RIGHT AXIS WITH CAPITAL • WATCHING WITH TWO EYES

• CONTROL OF HEAD & NECK FLEXION • OROMOTOR CONTROL AND
WITH VESTIBULAR SYSTEM • SYMMETRY AND MIDLINE PHONATION
• SUSTAINED POSTURAL TONE ORIENTATION WITH HEAD • VOLUNTARY MOVEMENT OF
OR POSTURE STABILITY HAND AND FOOT
• PROVIDE NECK SUPPORT LIKE • STABILIZING & CHANGING HAND
THE BRACE DIRECTION OF ARM AND HAND - SUPPORT ABILITY
- GRASPING & RELEASING
• WATCHING WITH HOLDING A BAR –NASAL
- FINE MOTOR SKILL
• OROMOTOR CONTROL AND SOUND PROMOTES FLEXOR
ANKLE / TOE & FOOT
PHONATION COMPONENT AND LONGER
- MOVES ITSELF
PHONATION - ACTING AS B.O.S

ASSOCIATED VISION, OROMOTOR CONTROL(EATING, DRINKING)

PROBLEMS BREATHING, SPEECH, COMMUNICATION, EMOTION
 HEAD STABILITY & MIDLINE ORIENTATION, CALM DOWN
HEAD CONTROL - SYMMETRIC POSTURE, SELF SAFETY

COTICAL LEVEL GRADING & DISSOCIATED MOVEMENTS, SUSTAINED MOVEMENT

: COGNITIVE LEVEL EYE-HAND COORDINATION
- NORMAL WATCHING WITH TWO EYES – OROMOTOR CONTROL AND PHONATION

HAND GRASPING INTER LINK TO TRUNK GRADING MOVEMENT

CONTROL MOVEMENT BY HIMSELF
VOLUNTARY MOVEMENT OF HAND AND FOOT(TOES)

SUBCORTICAL CONNECTIVE MOVEMENT OF THE HEAD,TRUNK AND LIMBS

FACILITATION HEAD CONTROL-GOOD ALIGNMENT, AGAINST
LEVEL
THE BODY

FACIAL MUSCLE ACTIVATION, DEEP BREATHING WITH MOUTH CLOSING, WATCHING

CAPITAL FLEXION
2018 KPIBA
ATAXIA RESULTS FROM DAMAGE TO THE CEREBELLUM
POOR COORDINATION AND UNSTEADINESS DUE TO THE BRAIN’S FAILURE(USUALLY
DISEASE IN THE CEREBELLUM) TO REGULATE THE BODY’S POSTURE AND REGULATE THE
STRENGTH AND DIRECTION OF LIMB MOVEMENT.

• ATAXIA : MAINLY DAMAGE OF THE CBLL AND ITS AFFERENT & EFFERENT CONNECTIONS.
• A DISTURBANCE OF CO-ORDINATION OF VOLUNTARY MOVEMENTS DUE TO DYSSYNERGIA
OF THE MUSCLES AS A RESULT OF A LESION TO THE CBLL.

• VESTIBULAR SYSTEM, SENSORY SYSTEM(PROPRIOCEPTION OF LEGS)

• ATAXIA IS NOT A SPECIFIC DISEASE, BUT RATHER A SYMPTOM OF MANY DIVERSE
CONDITIONS THAT AFFECT THE NERVOUS SYSTEM.

• ATAXIA CAN BE A COMMON SYMPTOM FOR DIFFERENT PATHOLOGY.

VESTIBULOCEREBELLUM
• EQUILIBRIUM (FASTIGIAL N.- VESTIBULOSPINAL TR.) - LATERAL
• INFLUENCE EYE MOVEMENT & POSTURAL MUSCLES – MEDIAL

SPINOCEREBELLUM
• GROSS LIMB MOVEMENT (INTERPOSED N.) - RETICULOSPINAL TR.
• CONTROL ONGOING MOVEMENT

CEREBROCEREBELLUM
• DISTAL LIMB VOLUNTARY MOVEMENT (DENTATE N.) - RUBROSPINAL TR.
• PLANNING OF MOVEMENT (DENTATE N.)
• ABILITY TO JUDGE TIME INTERVAL AND PRODUCE ACCURATE RHYTHMS
• EQUILIBRIUM (FASTIGIAL N.)
- LAT. VESTIBULOSPINAL TR.
• INFLUENCE EYE MOVEMENT & POSTURAL
MUSCLES
- MED. VESTIBULOSPINAL TR.
• REGULATES BODY & LIMB
MOVEMENT(INTERPOSED N.)

- RETICULOSPINAL TR.

• CONTROL ONGOING MOVEMENT

• DISTAL LIMB VOLUNTARY MOVEMENT(DENTATE N.)

- RUBROSPINAL TR.

• PLANNING OF MOVEMENT(DENTATE N.)

• ABILITY TO JUDGE TIME INTERVAL AND PRODUCE

ACCURATE RHYTHMS
COMPARING ACTUAL MOTOR OUTPUT TO INTENDED MOVEMENT
• INFORMATION ABOUT THE ACTUAL MOVEMENTS
- FROM MUSCLE SPINDLE, GTO, AND CUTANEOUS MECHANORECEPTOR
- BY POSTERIOR SPINOCEREBELLAR AND CUNEOCEREBELLAR TR.
• INFORMATION REGARDING INTENDED MOVEMENTS
- FROM CEREBRUM BY CORTICOPONTINE FIBERS
- IN SPINAL INTERNEURONS VIA THE INTERNAL FEEDBACK TR.
- BY ANTERIOR SPINOCEREBELLAR AND POSTROSPINOCEREBELLAR TR.
THEN ADJUSTING THE MOVEMENT AS NECESSARY
• INTEGRATE INFORMATION FROM THESE SOURCES
• PRODUCE APPROPRIATE ADJUSTMENTS
• THE CEREBELLUM RECEIVES SOMATOSENSORY INPUT FROM THE SPINAL CORD, MOTOR
INFORMATION FROM THE CEREBRAL CORTEX , AND INPUT ABOUT BALANCE FROM THE

VESTIBULAR ORGANS OF THE INNER EAR.

• IT IS IMPORTANT FOR MAINTAINING POSTURE AND FOR COORDINATING HEAD AND

EYE MOVEMENTS AND IS ALSO INVOLVED IN FINE TUNING THE MOVEMENTS OF

MUSCLE AND IN LEARNING MOTOR SKILLS.

• DEFICITS IN LEARNING COMPLEX MOTOR TASKS AFTER CEREBELLAR LESIONS

• FMRI STUDIES – CEREBELLUM ACTIVE DURING LEARNING OF NOVEL

MOVEMENTS

• POSTULATED THAT CEREBELLAR NUCLEI STORE CERTAIN MOTOR MEMORIES

• CLUMSINESS, IMPRECISION, INSTABILITY

• NOT SMOOTH, DISORGANISED OR JERKY

• UNSTEADY, SHAKY MOVEMENTS OR TREMOR

- THEIR SENSE OF BALANCE AND DEPTH PERCEPTION IS AFFECTED

• DIFFICULTIES MAINTAINING BALANCE

• SIMPLE CONGENITAL ATAXIA

• ATAXIC DIPLEGIA

• DYSEQUILIBRIUM SYNDROME
PURE ATAXIA IN C.P IS RARE
NON-PROGRESSIVE & GENETIC
ATAXIC MOVEMENT IN THE UPPER LIMB & TRUNK
SPASTIC MOVEMENT IN THE LOWER LIMBS
ALL PROGRESSIVE & NON-PROGRESSIVE CHILD
GENETIC & HEREDITARY (POOR COGNITIVE)
NO EQ.R & FALL LIKE A TIMBER
NO SAVING REACTION
WIDE BASE & HIGH GUARD WALKING
• BASICALLY LOW TONE ON PROXIMAL
- POOR HEAD MOVEMENT DUE TO NYSTAGMUS OF THE EYE,
LOW COGNITION
- HEAD TITUBATION, ALL OF THESE THINGS LEAD TO LOW TONE
ON PROXIMAL
- POOR COACTIVATION OF PROXIMAL MUSCLE GROUP
• LOW BUT NOT EXCESSIVELY LOW
• LACK OF CO-ACTIVATION PROXIMALLY

- INABILITY TO HOLD STEADY POSTURE

- INABILITY TO GIVE STABILITY TO A MOVING PARTS

CAN APPEAR TO BE NORMAL BUT IMMATURE PATTERNS
• MASS PATTERN
- NOT INTEGRATED FOR SEQUENCING MOVEMENT
- LACK OF SELECTIVITY (INABILITY TO GIVE STABILITY TO A MOVING PARTS)
• POOR COORDINATION
- LACK OF NORMAL SENSORY FEEDBACK
- LACK OF MOVEMENTS INVOLVING MULTIPLE JOINTS
- ALTERNATING MOVEMENT
• COMPENSATORY STRATEGIES
- FLEXION AT SHOULDERS / THORACIC SPINE
- WIDE BASE OF SUPPORT
- HYPER EXTENSION OF KNEE
DISTURBED RECIPROCAL INNERVATION
• DIFFICULT IN REGULATING AGONIST & ANTAGONIST SEEN IN
- TRUNCAL & HEAD SWAY
- TITUBATION OF HEAD
- DYSMETRIA & OVERSHOOTING
- NYSTAGMUS
- JERKINESS OF MOVEMENTS
- INTENSION TREMOR
• LOW COGNITIVE LEVEL THAN AGE
• THE POOR ADEQUATE TIMING OF THE EYE AND NECK RESULTS TO THE HEAD
GOING TO LOW TONE, CONSEQUENTLY, THE POSTURAL TONE OF PROXIMAL IS
LOW
• PROBLEMS OF STABILITY
- NYSTAGMUS OF THE EYE, HEAD TITUBATION
- POOR PROXIMAL CO-ACTIVATION ON SAME TIME OF MUSCLE GROUP
- WEAK OR WIDE BASE OF SUPPORT
• PROBLEMS OF MOBILITY
- DYSMETRIA(HYPOMETRIA , HYPERMETRIA)
- INTENTION TREMOR
- POOR GRADING
- MOVEMENT OF PROXIMAL
• ATAXIC DIPLEGIA
- ATAXIA + SPASTIC DIPLEGIA
BALANCE REACTION :
USUALLY PRESENT BUT NOT ADEQUATE OFTEN DELAYED, BADLY
COORDINATED
• HAND FUNCTION IS INTERFERED BECAUSE OF HEAD TITUBATION, INTENTION TREMOR,
DYSMETRIA.

• VISUAL PERCEPTION PROBLEM : VISION IS DISSOCIATED POORLY FROM HEAD WITH

NYSTAGMUS.

• UNCOORDINATED BREATHING AND LOW TONE ON PROXIMAL PART OF THE BODY

CONTRIBUTE DIFFICULTIES OF SWALLOWING AND PHONATION

• SPATIAL-TEMPORAL RELATIONSHIP IN THE SPACE LIKE BODY SCHEME

• EMOTIONAL PROBLEMS

• LESS CONTRACTURE AROUND ANKLE BECAUSE OF REPEATED MOVEMENT

• POOR COORDINATION OF ORAL MOTOR • POOR EYE-HEAD MOVEMENT
NYSTAGMUS • LACK OF CO-ACTIVATION PROXIMAL PART
STRUCTURES (JAW & TONGUE) & -

- FIXATION OF EYE UNSUSTAINED & UNSTEADY POSTURE

BREATHING AND SWALLOWING
TITUBATION OF HEAD INABILITY TO GIVE STABILITY TO A MOVING
- DYSARTHRIA -
PART
- ARTICULARATION PROBLEMS
• DISTURBED RECIPROCAL INNERVATION

• POOR HANDS FUNCTION POOR AXIS • POOR COORDINATION OF MOVEMENT

NOT MODULATE FORCE, TIMING, SPEED,
- DYSMETRIA OF THE EYE -

- INTENTIONAL TREMOR DIRECTION

AND HEAD - LACK OF SELECTIVITY
- DIFFICULTY OF FINELY GRADING MOVEMENT
- ERKY MOVEMENT

• POOR SOMATO-SENSORY FEEDBACK

• POOR PERCEPTUAL PROBLEMS • INADEQUATE BALANCE REACTION
- PERCEPTUAL-MOTOR EXPERIENCE - POOR P.R & E.R
- SPATIAL RELATIONSHIPS(BODY SCHEME) - POOR REGULATE BALANCE AND EYE MOVEMENT
• POOR ADJUSTMENT OF MOTOR LEARNING - MANY CHILDREN ARE FEARFUL AS A RESULT
 • SUSTAINED POSTURAL CONTROL
• HEAD AND EYE CONTROL FOR INCREASE • ADL ADAPTATION
POSTURAL TONE • TEACH AND GUIDE QUALITY OF
• IMPROVE PROXIMAL PART CO-ACTIVATION MOVEMENT

• MODULATION OF TIMING , SPEED,

AND DIRECTION
• TRUNK CONTROL
- GRADING MOVEMENT AND AXIAL
ROTATION
DECREASE MASS PATTERN
SPINE MOVEMENT
-
(HEAD/TRUNKAL SWAY)
• SEQUENCE OF MOVEMENT
- SELECTIVE MOVEMENT

• BALANCE REACTION &

EQUILIBRIUM REACTION
CONSIDERTION OF TWO ELEMENTS OF
HUMAN MOVEMENT

STABILITY MOBILITY
 CORTICAL LEVEL
POSTURAL TONE AXIS OF MOVEMENT
• VISUAL CONTROL
• INCREASE AND STEADY • NECK AXIS WITH CAPITAL - WATCHING TWO EEYS MOVEMENT
POSTURAL TONE FLEXION - DISSOCIATION FROM HEAD
• MAINTAIN OF HEAD & NECK • GRADING MOVEMENT OF - REDUCTION OF NYSTAGMUS
WITHOUT TITUBATION AND PROXIMAL(DIRECTION, FORCE, • MOVE THE HAND & ARM
NYSTAGMUS TIMING) WITHOUT INTENTION TREMOR &
• CO-ACTIVATION OF TRUNK • SPINE MOVEMENT(ROTATION DYSMETRIA
WITHOUT SWAY WITH AXIS) • SELECTIVE ARM MOVEMENT
• VISION • SEQUENCIAL MOVEMENT OF FROM TRUNK
• FACIAL MUSCLE WHOLE BODY WITHIN AXIS • STEP CONTROL (ANKLE & TOE
MOVEMENT)

VISUAL PROBLEM(DISSOCIATION, NYSTAGMUS)

ASSOCIATED OROMOTOR CONTROL(EATING, SWALLOWING, DRINKING)
PROBLEMS
BREATHING, SPEECH, PHONATION
 ATHETOSIS ATAXIA

MIDLINE ORIENTATION POOR FIX OR KEEP

INVOLUNTARY MOVEMENT ROTATORY SWAY ANT. & POST. SWAY

USING FOR STABILITY

HAND FUNCTION POOR GRASP & REALEASE
BUT NOT SELECTIVE

SPEED OF MOVEMENT RAPID SLOW

MOBILITY

STABILITY
2018 KPIBA
 “HYPOTONIA”
HAVING REDUCED MUSCLE TONE(FLOPPINESS),

MAKING ANY MOVEMENTS AGAINST GRAVITY DIFFICULT,

AND SUSTAINING UPRIGHT POSTURES

SUCH AS SITTING AND STANDING DIFFICULT.

• THE WORD ‘FLOPPY’ CAN BE USED TO MEAN :

- DECREASE IN MUSCLE TONE (HYPOTONIA)

- DECREASE IN MUSCLE POWER (WEAKNESS)

- LIGAMENTOUS LAXITY AND INCREASED RANGE OF JOINT MOBILITY.

• STRICTLY SPEAKING, THE TERM ‘FLOPPY’ SHOULD BE USED TO DESCRIBE HYPOTONIA.

(GOWDA, 2007)
AT BIRTH
1. BRAIN AND SPINAL CORD INJURY OR TRAUMA

- HYPOXIC-ISCHEMIC ENCEPHALOPATHY AND INTRACRANIAL HEMORRHAGE

2. GENETIC AND CHROMOSOMAL

- DOWN SYNDROME AND PRADER-WILLI SYNDROME

3. CEREBRAL DYSGENESIS AND OTHER STRUCTURAL CEREBRAL ABNORMALITIES

4. PEROXISOMAL DISORDERS

- CEREBROHEPATORENAL SYNDROME (ZELLWEGER SYNDROME) AND NEONATAL

ADRENOLEUKODYSTROPHY

5. OTHER RARE METABOLIC OR GENETIC CONDITIONS

- GENERALIZED GM1, GANGLIOSIDOSIS, FAMILIAL DYSAUTONOMIA , COHEN SYNDROME, AND

OCULOCEREBRORENAL SYNDROME (LOWE SYNDROME)

6. BENIGN CONGENITAL HYPOTONIA

• LEVEL OF ANTERIOR HORN CELL - LOWER MOTOR NEURON

- SPINAL MUSCULAR ATROPHY TYPE I (WERDNIG-HOFFMAN DISEASE)

- GLYCOGEN STORAGE DISEASE TYPE II (POMPE’S DISEASE)

- MITOCHONDRIAL

• LEVEL OF NEUROMUSCULAR JUNCTION

- MYASTHENIA: NEONATAL TRANSIENT OR CONGENITAL MYASTHENIC SYNDROME

• LEVEL OF THE MUSCLE

- MUSCULAR DYSTROPHY: CONGENITAL MYOTONIC AND CONGENITAL MUSCULAR

DYSTROPHY
• SEVERE

- LITTLE OR NO POSTURAL CONTROL AGAINST GRAVITY

• MILD

- ALMOST NORMAL REPERTOIRE OF POSTURES AGAINST GRAVITY

• HYPOTONIA CAN BE A TRANSIENT STAGE

- SPASTICITY, ATHETOSIS, ATAXIA OR A COMBINATION OF ANY OF THESE

(A) pull to sit, (B) scarf sign, (C) shoulder suspension, and (D) ventral suspension.
 VERY LOW TONE

Showing “U” posture with horizontal suspension. (Dawn E, 2009)

• AN INFANT

- POOR HEAD CONTROL AND RESIST PROPPING ON THEIR TUMMIES WHEN AWAKE.

• BABIES

- OFTEN SEEM TO “SLIP OUT OF YOUR HANDS”

- HAVE TROUBLE “STIFFENING” THEIR BODIES WHEN YOU CARRY THEM.

- WHEN LYING ON THEIR BACKS WILL OFTEN REST WITH THEIR ARMS AND LEGS
EXTENDED OUTWARD

- SOMETIMES RESIST BEARING WEIGHT ON THEIR FEET WHEN HELD UPRIGHT ON

YOUR LEGS.
• YOUNGER CHILDREN

- TEND TO LEAN EXCESSIVELY FORWARD WHEN THEY ARE SITTING UP.

• OLDER TODDLERS AND CHILDREN

- TEND TO “W-SIT” TO REDUCE THE CHALLENGE TO THEIR POSTURAL MUSCLES.

 • LACK OF HEAD AND TRUNK CONTROL

- POOR ANTI-GRAVITY (UPRIGHT) MOVEMENT

Significant head lag with traction.

(Dawn E, 2009)
 • LACK OF ANTIGRAVITY ACTIVITY

- NECESSARY FULL SUPPORT

The “shoulder slip through” response with

vertical suspension.
(Dawn E, 2009)
• LACK OF ALIGNMENT

- INSUFFICIENT PROXIMAL STABILITY

• DISLOCATION & SUBLUXATION

- HIP JOINT CAN DISLOCATE ANTERIORLY (FROG

POSITION)

- CAUTION WITH HANDLING TO PREVENT

DISLOCATION: MANDIBLE, SHOULDERS

 JOINT HYPERLAXITY

” sitting, a physical finding indicative Hyperlaxity of hand/wrist/finger joints. Heel to ear test
of joint hyperlaxity. (Dawn E, 2009) (Dawn E, 2009) (Archna B, 2000)
 SEMI – AROUSAL NONE – AROUSAL
WATCHING WITH TWO EYES
SENSORY CHANNEL
MOTIVATION
VESTIBULAR SYSTEM(VOR)

BREATHING AROUSAL PUPIL – MIDLINE

MUSCULATURE SYSTEM
SUCK-SWALLOWING
(DEEP TENDON REFLEX)
VOLUNTARY MOVEMENT
BODY TEMPERATURE
HEAD CONTROL
BREATHING
CO-ACTIVATION
• IMPROVE AROUSAL LEVEL

- STIMULATE FACIAL MUSCLES (START OF

FLEXOR ACTIVITY, ALERT)

- DEEP BREATHING WITH FLEXED

POSTURE FOR IMPROVE AROUSAL LEVEL

• STIMULATION OF VESTIBULAR SYSTEM

- INCREASE OF POSTURAL TONE

- VOR
• FLEXED POSTURE & MOVEMENT

- STABILITY OF NECK & TRUNK

- PERCEPTUAL PROCESS(BODY SCHEME

– HAND TO MOUTH)

- PROVIDE STABLE & MOBILE BOS

• ADVISE PATTERNS ON HANDLING
- POSITIONING, FEEDING

• BE CAREFUL NOT TO STIMULATE HYPERTONUS

- NECESSARY TO ASSESS THEIR THRESHOLD TO STIMULATION
(APPROPRIATE STIMULATION)
- STIMULATED WITHIN TIPS
 POSTURAL POSTURE
CORTICAL MOVEMENT
TONE PATTEN : AXIS

• IMPROVE AROUSAL LEVEL

• STIMULATION OF SENSORY • WATCHING WITH TWO EYES
• FLEXED POSTURE &
CHANNEL FOR INCREASE POSTURAL • OROMOTOR CONTROL(FEEDING)
MOVEMENT
TONE (TACTILE, AUDITORY, VESTIBULAR, • MOTIVATION TO MOVE
• ACTIVITIES OF NECK AND
VISION) • VOLUNTARY CONTROL OF HAND
TRUNK AGAINST GRAVITY
• STIMULATION FACIAL MUSCLE AND FOOT
(CONNECTED MOVEMENT OF HEAD
WITH FLEXOR POSTURE • PERCEPTUAL PROCESS FOR BODY
TO TRUNK)
• DEEP BREATHING SCHEME(HAND TO MOUTH)

OROMOTOR CONTROL(EATING, DRINKING)

ASSOCIATED PROBLEMS
BREATHING