This document discusses several primitive and tonic reflexes seen in infants, including their typical onset, integration period, grading scales, and clinical descriptions. The reflexes discussed include the asymmetric and symmetric tonic neck reflexes, positive support reflex, tonic labyrinthine reflex, and others. The document provides details on techniques for eliciting each reflex and what physical findings correspond to different grades of response.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
Controlled use of sensory stimulus.
Specific Motor response
Normalization of muscle tone
Use of Developmental sequences.
Sensorimotor development = from lower to higher level.
Use of activity to demand a purposeful response.
Practice of sensory motor response is necessary for motor learning.
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
Hierachical theory- says that higher centers control on lower center; but when higher center damage then this inhibitory control from the higher center is loss which leads to exageration of the movt.
In normal individual, these occur a smooth, rhythmic movt. Because there is a presence of control from higher center on lower center.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
Controlled use of sensory stimulus.
Specific Motor response
Normalization of muscle tone
Use of Developmental sequences.
Sensorimotor development = from lower to higher level.
Use of activity to demand a purposeful response.
Practice of sensory motor response is necessary for motor learning.
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
Hierachical theory- says that higher centers control on lower center; but when higher center damage then this inhibitory control from the higher center is loss which leads to exageration of the movt.
In normal individual, these occur a smooth, rhythmic movt. Because there is a presence of control from higher center on lower center.
Spina bifida/ dysraphism - assessment and physiotherapy management Susan Jose
refrences kessler tecklin darcy.
a all round description of assesment in physiotherapeutic methods and management techniques.
participationn increasing measures and limitation reduction stratergies
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
Spina Bifida: Physiotherapy in the management of meningomyeloceleAyobami Ayodele
Spina bifida is a treatable spinal cord malformation that occurs in varying degrees of severity. Meningomyelocele is associated with abnormal development of the cranial neural tube, which results in several characteristic CNS anomalies. About 90% of babies born with Spina Bifida now live to be adults, about 80% have normal intelligence and about 75% play sports and do other fun activities. Most do well in school, and many play in sports.
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
Spina bifida/ dysraphism - assessment and physiotherapy management Susan Jose
refrences kessler tecklin darcy.
a all round description of assesment in physiotherapeutic methods and management techniques.
participationn increasing measures and limitation reduction stratergies
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
Spina Bifida: Physiotherapy in the management of meningomyeloceleAyobami Ayodele
Spina bifida is a treatable spinal cord malformation that occurs in varying degrees of severity. Meningomyelocele is associated with abnormal development of the cranial neural tube, which results in several characteristic CNS anomalies. About 90% of babies born with Spina Bifida now live to be adults, about 80% have normal intelligence and about 75% play sports and do other fun activities. Most do well in school, and many play in sports.
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
2. Normal infants are born with numerous primitive reflexes
because of the unrestrained influence of the “old brain”
(deep gray matter), which contains the centers for such
reflexes. These centers include the brainstem,
cerebellum, mid brain and basal ganglia.
The “new brain” (cerebral cortical mantle) can be
viewed as an inhibitory organ: during development,
primitive reflexes are inhibited and integrated into more
functional, postural and voluntary motor responses.
With cerebral insults, this cortical suppression
/integration is released, and various deep gray matter
responses (primitive reflexes) reappear.
3. Reflexes important to examine in the patient
suspected of abnormal reflex activity include:
Flexor withdrawal
Traction
Grasp
Tonic neck
Tonic labyrinthine
Positive support and
Associated reactions.
4. Flexor withdrawal reaction is generally the
simplest to observe and is judged by an overt
movement response.
Tonic neck reflexes, on the other hand, bias
the musculature and may not be visible
through overt movement responses.
In these reflexes movement is rarely produced
but rather posture is typically influenced
through tonal adjustments.
5. Capute et al in 1976 described a quantitative reflex
scale for the grading reflexes:
0 : absent
1+ : transient; elicited involuntarily by passive action of
the infant, or noted only by change in tone.
2+ : visible movement of extremities.
3+ : pronounced or sustained; more exaggerated than
normally seen at chronological age; not readily
habituated.
4+ : obligatory; infant unable to break out of reflex for a
minimum of 60 sec (pathologic).
6. ASYMMETRICAL TONIC NECK
REFLEX
The asymmetric tonic neck reflex is mediated
ipsilaterally through the first three cervical nerve roots.
Mc Couch et al. (1951) localised the receptive field for
the tonic neck reflexes to the upper neck joints,
especially to the atlantoaxial and atlanto- occipital
joints.
Pacella and Barera (1940) documented an influence
of the ATNR on the grasp reflex with a reinforcement
of the grasp reflex on the occiput side and the
weakening of the grasp reflex on the face side of an
ATNR.
This interaction between the two reflexes explains the
occasional inclusion of finger extension/flexion in the
ATNR pattern.
7. ASYMMETRICAL TONIC NECK REFLEX
Onset: birth Integration: 4-6
months
DESCRIPTION : When the child is
supine he may be seen to lie with
head turned to one side with
extension of extremities on that
side, and contralateral flexion of
extremities. This may also be
noted in sitting position. It is often
described as “fencer” position.
TECHNIQUE: The child is placed
in supine. He is first observed for
active head turning and
subsequent extremity movement. If
the reflex is not noted, the head is
turned for 5 sec. This is repeated
for five times to each side. If no
movement is noted, the head
turning is repeated and changes in
tone are observed. This is then
repeated with the child in a seated
position.
GRADING:
0 : Absent
1+: tone changes in extremities with head rotation. On
the chin side there is increased tone on flexion. On the
occiput side there is increased tone on extension. Active
head rotation on the child’s part may yield slight
movement of the extremities Passive movement of the
head does not yield movement of the extremities.
2+: Visible extension of the extremities on the chin side
and the flexion of the extremities on the occiput side.
Movement is noted on both passive and active rotation
of the head. (this is seen in normal development of reflex
between 1 and 3 months of age.)
3+: Exaggerated quality with full extension of extremities
on the chin side (180 degrees) or full flexion of
extremities on occiput side (greater than or equal to 90
degrees at the elbow)
4+: Pathologic. Obligatory extension/flexion for more
than 60 sec.
9. SYMMETRICAL TONIC NECK REFLEX
Onset: 4-6 months Integration: 8-12
months
The symmetrical tonic reflex is analogous to
the asymmetrical tonic neck reflex, but the
head-on- body manipulation of the flexion
extension in the midline changes the axis of
differentiation from sagittal to horizontal ( i.e.,
there is an upper- lower rather than a right left
extremity difference).
10. SYMMETRICAL TONIC NECK REFLEX
DESCRIPTION : On raising the
head of a prone child, extensor tone
increases in the arms and flexor tone
increases in the legs; flexing the neck
has the opposite effect with
increased flexor tone in the arms and
increased extensor tone in the legs.
TECHNIQUE: The child is prone ,
suspended, sitting or kneeling. Active
neck extension/flexion is sought
through visual stimulus or command.
Movement or tone changes in
extremities is assessed. If there is no
active movement, the neck is
passively extended/flexed five times
and tone/movement is assessed.
GRADING:
0 : Absent
1+: Mild, intermittent arm extension and
leg flexion with neck extension; the
reverse with neck flexion. Frequently only
tone changes in the extremities with neck
flexion/extension.
2+: Visible and consistent arm extension,
or leg flexion with neck extension; the
reverse is noted with flexion.
3+: Marked arm extension or leg flexion
with neck extension, reverse with flexion.
Not easily overcome by the child. Not
readily habituated and present after five
trials.
4+: Pathologic. Obligatory. Position
remains after 60 sec.
12. TONIC LABYRINTHINE REFLEX
Magnus (1926) described the essential
components of the tonic labyrinthine reflex:
There is only one position in which the
extension becomes maximal: the supine
position with snout about 45degrees above the
horizontal plane. The extensor tone diminishes
to a relative minimum if the baby is brought into
the prone position with snout about 45degrees
below the horizontal plane.
These reflexes are not evoked by movement but
depend upon position.
13. TONIC LABYRINTHINE REFLEX
Tonic labyrinthine reflex in a supine position (TLS)
demonstrates not only an increase in extensor tone, but
also shoulder adduction with retraction, thus mimicking a
“surrender” position.
In prone , the tonic labyrinthine reflex (TLP) consists of
hip-knee flexion with shoulder protraction and further
flexion.
A persistent non physiologic TLS will prevent an infant
from rolling over in normal fashion.; however the history
of “rolling over” before 3 months of age should make the
examiner highly suspicious of a strong TL with an
attendant high risk for significant motor impairment.
A marked TL may inhibit the “embrace” phase of MORO
reflex.
14. TONIC LABYRINTHINE REFLEX
DESCRIPTION : The
posture of the limbs
changes with respect to
the position of head in
space (orientation of the
labyrinths). Supine the
limb extends or extensor
tone increase. Prone, the
limbs flex or the flexor
tone increases.
TECHNIQUE: The child
is observed supine.
Support is then placed
between the shoulders so
that the head is extended
to 45 degrees. The tone
is assessed. The child’s
head is then flexed to 45
degrees with the back
supported and finally he
is asked to grasp the
midline. The child is then
placed prone and tone is
GRADING:
0 : Absent
1+: In the supine position, the shoulders are retracted and
arms are lying in “surrender” posture. There would be
momentary shoulder retraction and leg extension when
support is placed between the shoulders and head
extended. When the child is made to flex his head,
shoulder retraction is broken and hands immediately come
to midline. In prone there may be momentary flexion noted
at the hips.
2+: With his head in extension the child is not able to
overcome shoulder retraction. His hands do not come to
the midline when his head is flexed, but he can overcome
this on command. Prone, some degree of flexion with
increased flexor tone is noted.
3+: When the child’s head is extended there is a significant
shoulder retraction and leg extension. He is unable to bring
his hands together fully when asked to flex his head and
his shoulders do not protract. In prone there may be
considerable flexion.
16. POSITIVE SUPPORT REFLEX
Onset: birth Integration: 6 months
Magnus (1925) described positive supporting reaction
as a mechanism necessary for maintaining erect
posture.
Rademaker’s (1924) further refined its description as a
simultaneous contraction of opposing muscles so as to
fix the joints of the lower extremities; tactile, pressure,
and proprioceptive components were used to elicit it.
He proposed it as a preparatory position for motion.
Paine( 1964) reported that its presence to a strong
degree from a newborn period is common in spastic
tetraparesis.
Pressure on the soles of the feet yields an anti gravity
contraction of the extensor muscles producing an erect
17. POSITIVE SUPPORT REFLEX
DESCRIPTION : Upon
stimulation, co-
contraction of the
opposing muscle
groups occurs so as to
fix the joints of the lower
extremities in a position
capable of supporting
weight.
TECHNIQUE: The
child is suspended in a
vertical position and the
balls of the feet are
brought in contact with
the floor or a surface for
60 secs. The child is
then bounced five
times.
GRADING:
0 : Absent. No attempt at weight bearing.
1+: The child does not maintain his weight for 60 sec. he
may land flatfooted with no discernible movement from
heel to toe. The knees may be partially flexed without
evidence of extension.
2+: The child is able to support his weight for greater than
60 sec. there is quick movement from plantar flexion to
dorsiflexion. There is extremity extension with body
support. Slight hip and knee flexion may be noted.
3+: There is delayed movement from plantar flexion to
dorsiflexion. The child remains in equinus position. The
knees may be hyper extended in a genu recurvatum
position or there may be fixed and persistent knee flexion.
The child seems to be standing on his toes.
4+: The child remains in equinus position. He is not able
to move out of position without circumducting the legs and
stays in this position for greater than 60 sec.
19. ASSOCIATED REACTIONS
Onset: birth- 3months Integration: 8-9
years
STIMULUS: Resisted voluntary
movement on any part of the body.
RESPONSE: Involuntary movements
in a resting extremity.