1 DNSA Intro PDF

www.rehabps.com 06.12.
16
Dynamic
Neuromuscular STRUCTURE
Stabilization
®
1. What is that DNS 4. Assessment

1. Children
according to Kolář 2. Founder 2. Adults
3. The main principles 5. Therapy
1. Developmental 6. Sport
DNS INTRODUCTION
kinesiology
2. Functional joint
centration
3. Three levels of
motor control
www.rehabps.com www.rehabps.com
DYNAMIC NEUROMUSCULAR PROF. PAVEL KOLÁŘ, PHD.

STABILIZATION (DNS)
Head of the Clinic of
§ DNS is a new and unique rehabilitation
strategy based on the principles of Rehabilitation and Sport
developmental kinesiology and the Medicine
neurophysiological aspects of maturing
postural – locomotor system
2nd Medical Faculty
Charles University
Prague, Czech Republic

PROF. PAVEL KOLÁŘ, PHD. PRAGUE SCHOOL OF REHABILITATION

§ Also serves as a medical Influenced by:
prof. Karel Lewit Prof. Václav Vojta
specialists for Czech
Olympic team, Davis cup
team, Ice hockey team
and many others
Dynamic Neuromuscular Stabilization 1

www.rehabps.com 06.12.16
PRAGUE SCHOOL OF REHABILITATION DYNAMIC NEUROMUSCULAR

STABILIZATION
Influenced by: prof.
Vladimir Janda Ludmila Mojžišova
§ Kolar´s approach to dynamic neuromuscular
stabilization (DNS) is a complex approach
§ Encompasses principles of developmental

kinesiology during the first year of life
§ Define the posture, breathing pattern and functional
joint centration from a neurodevelopmental
perspective
§ Derives ideal quality of these functional stereotypes
from central (neurological) programs maturing
during early postural ontogenesis
…and many others
DYNAMIC NEUROMUSCULAR STABILIZATION DYNAMIC NEUROMUSCULAR

STABILIZATION
Healthy newborn Poor pattern in adulthood
§ DNS assessment is based on the comparison
of the patient´s stabilizing pattern to that of a
healthy infant.
§ DNS treatment is based on the ontogenetic
postural locomotor patterns
§ Primary goal of the treatment to optimize the
distribution of internal forces of muscles that act on
each segment of the spine and/or any other joints
or segments. (Efficiency of movement)
Diastasis in the rectus abdominis
IDEAL POSTURE
DEVELOPMENTAL KINESIOLOGY
DEFINITION OF IDEAL FUNCTIONAL PATTERNS
Juli v sedě

DEVELOPMENTAL KINESIOLOGY DYNAMIC NEUROMUSCULAR

DIAGNOSTICS STABILIZATION
§ When assessing a patient and searching for
the primary cause of a problem in locomotor
system, the following consequences must be
considered:
§ The morphological aspects and external
biomechanical impacts affecting the spine and the
joints as well as the internal forces
§ The magnitude of the repeating internal forces
developed by the patient´s own musculature.
(They are massive.)
DEVELOPMENTAL KINESIOLOGY DEVELOPMENTAL KINESIOLOGY

DIFFERENT PATHOLOGY - SAME PATTERN USE IN THERAPY
DEVELOPMENTAL KINESIOLOGY
USE IN THERAPY
DNS
§ Understanding of developmental kinesiology

provides a framework to appreciate the regional
interdependence and the interlinking of the
skeleton, joins, and musculature during movement.
§ Muscles must be trained in both their stabilization
and dynamic (movement producing) functions.

IDEAL POSTURAL ACTIVITY OCCURS AS A

DYNAMIC NEUROMUSCULAR RESULT OF CNS MATURATION
STABILIZATION
IDEAL CNS
§ Research* addresses the importance of the DEVELOPMENT
deep spinal stabilizing system (maturation)
§ More than just the “deep muscles” provide
spinal and extremity joint stabilization
§ Through postural- locomotion kinematic chains,
nearly every muscle is involved in stabilizing
function.
CNS Program → Function (muscle synergy) → Structural maturation

* Bouche 2011, Kim 2010, Watanabe 2010 www.rehabps.com www.rehabps.com
DYNAMIC NEUROMUSCULAR
STABILIZATION
§ Muscle coordination is directly Central paresis
controlled by the CNS
§ Muscle function has a formative
influence to the structure
Development of the neck-shaft angle : a at birth, b at the age

of 1 year, c 3 years, d 5 years, e 9 years, f 15 years, g in
adulthood.
Healthy newborn
Hefti F.,Brunner, Freuler F., R.,Hasler C.,C.,Jundt G.: Pediatric Ortopedics in Practice. 2007 www.rehabps.com www.rehabps.com
Femoral
configuration:
3-6 months STABILIZATION
6-12 months
§ The QUALITY of postural stabilization depends
on the QUALITY of sensorimotor control
ANY PURPOSFUL MOVEMENT IS PRECEDED

Strong
Synchronization
BY THE AUTOMATIC ACTIVATION OF THE
between POSTURAL STABILIZERS.
morphological
development and
maturation of
nervous system
www.rehabps.com Borghuis 2008, Hodges 2004, McGill 2009 www.rehabps.com

DYNAMIC NEUROMUSCULAR STABILIZATION DYNAMIC NEUROMUSCULAR

§ Postural stabilization is an automatic, STABILIZATION
subconscious function that is frequently
compromised in patients with musculoskeletal § „Postural function is interdependent with
pain and with various neurological diagnoses respiratory function.“ Karel Lewit
§ Incorrect posture results in abnormal breathing
pattern and vice versa
§ The postural-respiratory function is not
completely under voluntary control → may be
difficult to resolve with traditional rehabilitation
approaches.
Patient after a stroke Patient with myopathy
THE GOAL OF DNS DEVELOPMENT

OF POSTURE
§ To improve or normalize the
quality of…
§ postural stabilization patterns
§ Posture is based on
§ respiratory patterns
motor ontogeny
§ locomotion patterns § The goal of the
ontogeny is
§ Integrate the proper postural- independent social
locomotion and respiratory bipedal locomotion
function within ADL and sport
performance
DEVELOPMENT OF POSTURE FUNCTIONAL JOINT CENTRATION

Maintaining the spine in a lordo- kyfotic curvature § Assumes that core stability and
basic extremity locomotor
Setting the pelvic and chest alignment for optimal function are mainly under the
stabilization in the sagittal plane control of the subcortex.
§ If CNS control is adequate, and
muscles are activated in
FIRST PART OF THE DEVELOPMENT balance, then each posture and
each spontaneous movement
automatically brings all the joints
Followed by the development of phasic movement into a FUNCTIONALLY
(grasp, task oriendted movement) and locomotion CENTRATED POSITION.
(step forward or support during locomotion)

FUNCTIONAL JOINT CENTRATION FUNCTIONAL JOINT CENTRATION

§ A functionally centrated (neutral or functionally optimal) joint
is not a static position but a dynamic neuromuscular § This ensures maximum
strategy of movement and stabilization. force-loading, minimum
§ The joint is in the most optimal position tension in passive
§ The centrated joint has the greatest interosseous structures (i.e. joint
contact, which allows for optimal load transfer across the capsule and the
joint and throughout the kinetic chain ligaments) and the
protection of all joint
structures during
loading and movement
Čihák, 2011 www.rehabps.com www.rehabps.com
Diagram by DNS instructor Diagram by DNS instructor

Richard Ulm, DC. Richard Ulm, DC.
Rintala M, Ulm R, Jezkova Rintala M, Ulm R, Jezkova
M, Kobesova A. Czech M, Kobesova A. Czech
Get-up. NSCA Get-up. NSCA
Coach. 2016;3(2):30-8. Coach. 2016;3(2):30-8.
ISSN 2376- ISSN 2376-
0982 Online. https://www.n 0982 Online. https://www.n
sca.com/publications/report sca.com/publications/report
s-and-journals/nsca-coach/ s-and-journals/nsca-coach/
BIOMECHANICS OF MUSCLE CONTRACTION BIOMECHANICS OF MUSCLE CONTRACTION

PF § Open kinetic chain
If the proximal muscle E.g. limb movement in space,
attachment is stabilized swing phase in gait, throwing
[punctum fixum (PF)], then arm in baseball.
the distal end of the muscle
moves toward the proximal PM
part [punctum mobile (PM)]
Proximal muscle pull =

stepping forward movement.
(Neumann, 2002) www.rehabps.com www.rehabps.com

BIOMECHANICS OF MUSCLE CONTRACTION BIOMECHANICS OF MUSCLE CONTRACTION

PM
§ If distal muscle attachment § Closed kinetic chain
is fixed [punctum fixum E.g. stance phase in gait, push-
(PF)], then the proximal up from a fixed elbow or hand.
end of the muscle moves PF
toward the distal part
[punctum mobile (PM)]
Distal muscle pull =

supporting function.
(Neumann, 2002) www.rehabps.com www.rehabps.com
THREE LEVELS OF SENSORIMOTOR 3 LEVELS OF MOTOR CONTROL

CONTROL IN ASSESSMENT AND
TREATMENT
1. Spinal & brain stem level
§ Three different levels of sensorimotor control
Inborn Motor Functions
within the CNS can be distinguished during
examination and assessment. 2. Subcortical level
§ During the neonatal stage, general movements
and primitive reflexes are controlled MAINLY at
the SPINAL AND BRAIN STEM LEVELS 3. Cortical level Learned Motor Functions
1. SPINAL & BRAIN STEM LEVEL (0-6W) 2. SUBCORTICAL LEVEL

§ Functional & structural immaturity § Primitive reflexes become inhibited and
§ No balance, no postural function integrated into higher levels of motor control.
§ Primitive reflexes present
§ Crucial for early diagnosis § Maturation of postural-locomotion patterns
§ Stabilization
§ Equilibrium
§ Muscle co-contraction
§ Stepping forward & supporting function

DEVELOPMENT IN 1ST TRIMENON

2. SUBCORTICAL LEVEL
§ This level of the CNS motor control emerges

and matures mainly during the first year of life.
§ This allows for basic trunk stabilization, a
prerequisite for any phasic movement and for the
locomotor function of the extremities. Development from the newborn stage (holokinetic
§ At the subcortical level, orofacial muscles and mvt, no purposeful mvt, asymmetry) to a posture
afferent information are automatically which allows the child to stop a movement in the
integrated into postural-locomotor patterns. middle, stabilize the trunk and pelvis in the sagittal
plane, and start to develop voluntary grasp.
DEVELOPMENT 1ST TRIMENON LIMB FUNCTION DIFFERENTIATION WITHIN

THE GLOBAL PATTERN = 4.5 MONTHS
Contralateral Pattern Ipsilateral Pattern
§ Development from the global (holokinetic) mvt to

more localized control
§ From untargetted mvt to precise movements
TWO PATTERNS DISPLAYED IN ONTOGENY CONTRALATERAL PATTERN

Contralateral Pattern
§ Developed from a
prone position
§ Diagonal extremities
are in supporting
function, the other
two in phasic function
§ Presents after the
ipsilateral pattern
develops.

TWO PATTERNS DISPLAYED IN ONTOGENY IPSILATERAL PATTERN
Ipsilateral pattern
§ Developed from a
supine position
§ Initially see in the child
rolling over
§ Underlying extremities
are in supporting
function, upper lying in
phasic function
KEY MILESTONES POSITION TRANSFER DURING

0-28day Newborn, Holokinetic mvt, asymmetry
LOCOMOTOR FUNCTION
6w Fencer, beginning of ERO activity, more
abdominal activity
3m Sagittal stabilization, symmetry, One hand support
isolated mvt of the head and eyes Crawling
4,5m Differentiation of the limbs, spine, Differentiated on 4
abdominal muscles Oblique sit
6m Turning over High Standing
Tripod
7,5m Oblique sit, the trunk is uprighted in kneeling
frontal plane Bear Squat
8-10m Sit, crawling, first attempt to reach Regular sit
vertical plane 3rd Trimenon 4th Trimenon
14-16m Gait development
ERO external rotators www.rehabps.com www.rehabps.com
3. CORTICAL LEVEL
§ MOTOR LEARNING
§ Individual qualities and characteristics of
movement
§ Allows for isolated segmental movement and
relaxation
§ It incorporates
§ Gnostic function (multisensory integration)
§ Motor function
§ Ideal-motor function

3. CORTICAL LEVEL DNS

§ Should not be ignored § Human ontogenetic
models (i.e.,
§ A child with impaired cortical developmental motor
motor control may be patterns) can be used in
diagnosed with both DIAGNOSIS and
developmental coordination TREATMENT of locomotor
disorder (DCD) system dysfunction.
1. Just maintaining the
position
2. Initial muscle activity
3. Transitional movements
Dynamic
Neuromuscular ASSESSMENT (CHILDREN)
§ 70% of children develop normally (Costi in Vojta
Stabilization
®
69,7%, Prechtl 72%)

according to Kolář § 30% have abnormal development (doesn´t mean
CP)
§ We should identify these children and start
HOW TO ASSESS THE CHILD treatment as early as possible
AND THE ADULT.
ASSESSMENT (CHILDREN) ASSESSMENT (CHILDREN)

§ To judge the quality of the development of the We utilize observation of three reactions/movements:
child (ideal vs. pathological) we use the 1. Spontaneous movement
assessments protocols according to Vojta
2. Primitive reflexes
§ All healthy children display (acquire) the same
skills at approximately the same age 3. Postural reactions
§ Lack of presentation at the appropriate
age may indicate improper
development of the child

1. ASSESSMENT OF SPONTANEOUS MOVEMENT 1. ASSESSMENT OF SPONTANEOUS MOVEMENT

§ Observe the child in § Spontaneous movement should be observed in prone
prone and supine and supine positions
positions § Always watch all the body segments, their position
§ Observe the locomotor and their reaction to gravity
movements § Quality of support
§ Not only quantity is § Grasping functions
important; quality must § Locomotion
also be judged § Communication
SCREENING
2. ASSESSMENT OF PRIMITIVE REFLEXES
§ Also allows for early administration of appropriate therapy –
§ Primitive reflexes (PR) – are reflex patterns that
the earlier, the better
develop as a motor reaction to a specific stimulus
§ Prevents fixation of atypical movement patterns
§ PR are usually typical for early childhood and are
§ Decreases the risk for abnormal motor as well as structural mostly represented in the first 4-6 weeks after birth
development
Automatic gait
Sucking reflex
2. ASSESSMENT OF PRIMITIVE REFLEXES 2. ASSESSMENT OF PRIMITIVE REFLEXES

§ Primitive reflexes are present from birth, some are
positive during the intrauterine development
§ Some reflexes vanish depending on how the CNS § In the first month of development, the assessment of
matures; some of them are positive only under primitive reflexes is considered more valuable then
pathological conditions the assessment of tendon reflexes
§ Very few of them remain present for the entire life of the § Zafeiriou (1995) recommended the following eight
child reflexes as most reliable during the first month: the
palmar grasp reflex, plantar reflex, Galant response,
ATNR, suprapubic extensor reflex, crossed extensor
reflex, Rossolimo reflex, heel reflex
Moro Reaction Grasp reflex of the toes


3. POSTURAL 3. POSTURAL REACTION

REACTION
§ All maneuvers are very well defined and described so they
§ Postural tests represent can be repeated with consistency. The therapist observes
an infant´s automatic the changes in the child’s reaction to the stimulus.
response to a passive § The responses or reactions to the tests change as the
change in body position CNS matures.
§ All seven postural tests § The order in which the tests are performed are important
are performed routinely because they are each more posturally challenging than
the previous.
§ If one segment reaction is not OK, the whole reaction is
noted as NOT IDEAL
3. POSTURAL REACTION
3. POSTURAL
REACTION
1. Traction test
2. Landau reaction
3. Auxillary suspension
4. Vojta´s side tilt reaction
5. Collis horizontal
suspension
6. Peiper Isbert vertical 0 – 6 weeks 7 wks – 3 months 3 – end of 6 months
suspension
7. Collis vertical
suspension Different age = Different response
Vojta.com www.rehabps.com www.rehabps.com
ASSESSING
SPONTANEOUS
MOTOR SKILLS,
Age 7 Mo
POSTURAL
NOT CORRESPONDING TO
REACTIONS AND
THE CALENDAR OR PRIMITIVE
DEVELOPMENTAL AGE REFLEXES ARE
Age 7 Mo SIMPLY DIFFERENT
WAYS TO
newborn
EVALUATE CNS
FUNCTION

CCD 1.st Grade 2.nd Grade 3.rd Grade 4.th Grade

Very mild Mild Moderate Severe
30% 18,8% 7,2% 3,9% 0,4%
ASSESSMENT -CONCLUSION Postural
reactions
1-3 abnormal 4-5 abnormal 6-7 abnormal,
ideal segmental
7 abnormal,
ideal segmental
reactions reactions NOT
§ These three parts of assessment (SPONTANEOUS presented presented
MOVEMENT, PRIMITIVE REFLEXES AND POSTURAL Primitive completely OK 25% disturbed 60% disturbed 100%
TEST) enable us to distinguish the severity of the child’s reflexes
disturbance (or the quality of their maturation) Improvement 93,9% 71,3% 40- 50% less 20%
without therapy (12,5%)
§ CCD – central coordination disturbance is not a diagnoses; Risk of un ideal 6,7% 28,7% 60% 80%
just indicates un-ideal development to help us to start the development
treatment ASAP (without RL
treatment)
§ Because of the neuroplasticity of the child’s brain, the earlier
we start the treatment, the better results we can achieve Improvement 100% 98% 95,2% 45,7%
with RL
§ As the child ages, the poor stereotypes become fixed and treatment
integrated to the spontaneous movement, making Indication for NO, just check NO, just check YES YES
improvement in the child’s condition less likely. treatment up up
development development
www.rehabps.com RL- reflex locomotion www.rehabps.com
ASSESSMENT OF ADULTS ASSESSMENT OF ADULTS

§ We developed a set of the DNS tests
§ In principle, any kind of movement can be used as an § All tests require proper core bracing and stability
functional assessment
§ Each test has a different postural challenge
§ Because we believe that development shows us an ideal
§ Not always necessary to perform each of them
posture, follows can be assessed:
on every patient
§ Every position displayed in development
§ Every transitional phase
§ from one position to another
§ forward or backward (reverse) movement
§ During postural assessment we are interested in the
deviation from the ideal postural model and the
ethiopathogenic consequences
TREATMENT TREATMENT
§ Manual therapy
§ Soft tissue
§ Spine & rib mobilization
§ Sagittal stabilization training
combined with breathing
function § Exercise in open kinetic chain: Phasic movement with
low/adequate resistance (beginning)
§ Work in close kinetic chain: Improve support function
§ Exercise in developmental positions (just hold it)
§ Move from one developmental position to another.
§ Manage the difficulty by changing the resistance (TB, PT,
Kettlebell), or by assisting the movement

Dynamic
Neuromuscular
Stabilization
®
DNS
according to Kolář
§ DNS’s approach provides functional tools to
DNS IN SPORT
assess and activate the intrinsic spinal
stabilizers in order to optimize the movement
system for…
§ Pre-rehabilitation (prevention)
§ Rehabilitation of athletic injuries
§ Increased performance
STABILIZATION AND SPORT STABILIZATION AND SPORT
§ CORE stability is not achieved purely by strength of
abdominals, spinal extensors, gluts or any other
muscles, rather core stabilization is
§ Dynamic neuromuscular accomplished through precise coordination of
CORE stability is necessary these muscles to generate
for optimal athletic
performance as well intra-abdominal pressure.
This regulated by the CNS.
DYNAMIC NEUROMUSCULAR JUST BECAUSE WE CAN MOVE PROPERLY,

STABILIZATION AND SPORT DOESN’T MEAN WE WILL MOVE PROPERLY.
§ The best sport performance
requires maximal loading
Maintaining proper movement
§ FUNCTIONAL CAPACITY =
The point at which a strategies in sports requires
person/athlete is no longer having the functional capacity
able to maintain proper (ideal) to handle the
locomotor strategies due to challenges/strains of that
the magnitude of the ‘strain’ sport.
on the movement system.

When the challenge or strain is more than the CNS can
Strain (load, speed, endurance)

Absolute Fatigue
handle, the athlete will restore to a more primitive
stabilizing strategy, often representing newborn posture.
Functional Gap
Functional Capacity
LOAD STRAIN
SPEED STRAIN
When the necessary joint motion

speed (rotational velocity)
exceeds the athlete’s capacity to
maintain proper movement
strategies – or .to maintain
functional centration throughout
the movement.
When the force output exceeds the athlete’s capacity to

maintain proper movement strategies – or to maintain
functional centration throughout the movement.
FATIGUE STRAIN When an athlete is performing above functional

threshold, they are forced to use compensatory
When the duration of the movement strategies, which typically represent
movement exceeds the newborn posture.
athlete’s capacity to
maintain proper movement THE GREATER THE FUNCTIONAL GAP, THE
strategies – the athlete does MORE LIKELY THE ATHLETE WILL GET INJURED.
not have the “endurance” to
maintain proper movement
This is because they are executing high
strategies.
threshold movements with their joints
decentrated, which creates tissue overload.

THE NATURE OF SPORTS IS PUSH OUR

BODIES TO THEIR ABSOLUTE LIMITS.
Applying the principles of
DNS to sports requires
doing “Threshold Training”
to increase the athlete’s
capacity to maintain
proper movement
strategies within their
sport.
Before After
Threshold Training Threshold Training
STABILIZATION AND SPORT
FUNCTIONAL CAPACITY
training is essential if we are
going to be able to apply
DNS to sports.

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www.rehabps.com 06.12.

1. What is that DNS 4. Assessment

DYNAMIC NEUROMUSCULAR PROF. PAVEL KOLÁŘ, PHD.

Prague, Czech Republic

PROF. PAVEL KOLÁŘ, PHD. PRAGUE SCHOOL OF REHABILITATION

Dynamic Neuromuscular Stabilization 1

PRAGUE SCHOOL OF REHABILITATION DYNAMIC NEUROMUSCULAR

§ Encompasses principles of developmental

DYNAMIC NEUROMUSCULAR STABILIZATION DYNAMIC NEUROMUSCULAR

Dynamic Neuromuscular Stabilization 2

DEVELOPMENTAL KINESIOLOGY DYNAMIC NEUROMUSCULAR

DEVELOPMENTAL KINESIOLOGY DEVELOPMENTAL KINESIOLOGY

§ Understanding of developmental kinesiology

Dynamic Neuromuscular Stabilization 3

IDEAL POSTURAL ACTIVITY OCCURS AS A

CNS Program → Function (muscle synergy) → Structural maturation

Development of the neck-shaft angle : a at birth, b at the age

ANY PURPOSFUL MOVEMENT IS PRECEDED

Dynamic Neuromuscular Stabilization 4

DYNAMIC NEUROMUSCULAR STABILIZATION DYNAMIC NEUROMUSCULAR

THE GOAL OF DNS DEVELOPMENT

DEVELOPMENT OF POSTURE FUNCTIONAL JOINT CENTRATION

Dynamic Neuromuscular Stabilization 5

FUNCTIONAL JOINT CENTRATION FUNCTIONAL JOINT CENTRATION

Čihák, 2011 www.rehabps.com www.rehabps.com

Diagram by DNS instructor Diagram by DNS instructor

BIOMECHANICS OF MUSCLE CONTRACTION BIOMECHANICS OF MUSCLE CONTRACTION

Proximal muscle pull =

(Neumann, 2002) www.rehabps.com www.rehabps.com

Dynamic Neuromuscular Stabilization 6

BIOMECHANICS OF MUSCLE CONTRACTION BIOMECHANICS OF MUSCLE CONTRACTION

Distal muscle pull =

(Neumann, 2002) www.rehabps.com www.rehabps.com

THREE LEVELS OF SENSORIMOTOR 3 LEVELS OF MOTOR CONTROL

1. SPINAL & BRAIN STEM LEVEL (0-6W) 2. SUBCORTICAL LEVEL

Dynamic Neuromuscular Stabilization 7

DEVELOPMENT IN 1ST TRIMENON

§ This level of the CNS motor control emerges

DEVELOPMENT 1ST TRIMENON LIMB FUNCTION DIFFERENTIATION WITHIN

§ Development from the global (holokinetic) mvt to

TWO PATTERNS DISPLAYED IN ONTOGENY CONTRALATERAL PATTERN

Dynamic Neuromuscular Stabilization 8

TWO PATTERNS DISPLAYED IN ONTOGENY IPSILATERAL PATTERN

KEY MILESTONES POSITION TRANSFER DURING

14-16m Gait development

ERO external rotators www.rehabps.com www.rehabps.com

Dynamic Neuromuscular Stabilization 9

3. CORTICAL LEVEL DNS

69,7%, Prechtl 72%)

ASSESSMENT (CHILDREN) ASSESSMENT (CHILDREN)

Dynamic Neuromuscular Stabilization 10

1. ASSESSMENT OF SPONTANEOUS MOVEMENT 1. ASSESSMENT OF SPONTANEOUS MOVEMENT

2. ASSESSMENT OF PRIMITIVE REFLEXES 2. ASSESSMENT OF PRIMITIVE REFLEXES

Moro Reaction Grasp reflex of the toes

Dynamic Neuromuscular Stabilization 11

3. POSTURAL 3. POSTURAL REACTION

Dynamic Neuromuscular Stabilization 12

CCD 1.st Grade 2.nd Grade 3.rd Grade 4.th Grade

ASSESSMENT OF ADULTS ASSESSMENT OF ADULTS

Dynamic Neuromuscular Stabilization 13

§ DNS’s approach provides functional tools to

This regulated by the CNS.

DYNAMIC NEUROMUSCULAR JUST BECAUSE WE CAN MOVE PROPERLY,