DOCSLIB.ORG

Session 401: Primitive Reflex Integration Through Neuroplasticity Treatment Techniques

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Session 401: Primitive Reflex Integration Through Neuroplasticity Treatment Techniques Session 401: Primitive Reflex Integration Through Neuroplasticity Treatment Techniques Karen Pryor, PhD, PT, DPT To comply with professional boards/associations standards: • I declare that I (or my family) do not have a financial relationship in any amount, occurring in the last 12 months with a commercial interest whose products or services are discussed in my presentation. Additionally, all planners involved do not have any financial relationship. •Requirements for successful completion are attendance for the full session along with a completed session evaluation. •PESI and all current accreditation statuses does not imply endorsement of any commercial products displayed in conjunction with this activity. Session 401: Primitive Reflex Integration Through Neuroplasticity Treatment Techniques Karen Pryor, PhD, PT, DPT Financial: Karen Pryor is owner of Health Sphere Wellness Center. She receives a speaking honorarium from PESI, Inc. Non-financial: Karen Pryor serves on the Leadership Interagency Council for Early Intervention board. Primitive Reflex Integration Through Neuroplasticity Treatment Techniques Karen Pryor PhD, PT, DPT Copyright 2019 [email protected] 1 Overview Brain development Cranial Nerves Possible reasons for retained reflex and re-emerging reflex Developmental delays affecting reading, writing, math, ADHD, Autism © Mica Foster D.C. [email protected] PRIMITIVE REFLEXES Most appear at birth Tested shortly after delivery One of the primary determinants of developmental delay early on Retained or obligatory reflexes interfere with voluntary movements and development Primitive Reflexes Where to find and elicit primitive reflexes Get to the root of the problems Methods to integrate primitive reflexes advance skills Cranial Nerve function and intervention Tools you can use To reach and treat primitive reflexes - go into the brainstem - by way of cranial nerves 2 Challenges of obligatory primitive reflexes Reduce progression of developmental motor milestone skills Primitive reflexes do not travel alone Interferes with reading, page turning and visual functions, learning Persistence can cause deformities, abnormal movements Medication “manages” abnormal patterns and tone First things first Cranial Nerves Neonatal reflexes Infant reflexes Reactions Primary Motor Patterns ©Mica Foster DC Detour around damaged areas Find out pathways that are working Areas that are not working That’s where we start 3 Neck • Rotation can be restricted by primitive reflexes - higher tone in musculature • Reflex demonstration follows where the eyes look • May be restricted with torticollis • cervical misalignment • tightness in soft tissues • primitive reflex influence Cervical Considerations • Increased tone on one side - restrictions for rotation and integration of primitive reflexes • Plagiocephaly - misshapen head • May have non-symmetrical posture in sitting, place feet under self, lay head on table • Top down development approach • Gentle mobilization of cranial plates • Myofascial release of cervical and cranial musculature Trunk Accommodations • May throw arms and legs over for rolling • Hold to furniture to pull to stand, cruise, balance • Wide base of support for gait, side to side walk • May not demonstrate heel toe gait • Poor trunk stability and balance • Easily fatigue in standing and sitting - lay head on table to desk to rest trunk 4 Treatments • Visual tracking with sound- superior, inferior, medial, lateral, near and far - 1st rotation ability • Vestibular stimulation - rock, roll and swing • Sensory recognition of body 3-D Numb and dumb • Myofascial release to bilateral sides • Unwind cervical and trunk with myofascial stretching VISION DEVELOPMENT RE-DEVELOPMENT - 80% connection Birth – limited orientation to target stimulus 3 months – cortical / vision control eye and head movements 6 months – visual / reach and grasp / integration of near vision and manual actions 12 months – visual / gait control / near – far vision 18 months – speech / integration – vision, recognition, action, speech 24 months – integration, subconscious actions of vision, reach/grasp, gait actions. Able to perform walk and talk VISION DEVELOPMENT WITH DIRECTION DETECTION Orientation - crude at birth, improved temporal resolution 5-10 mo temporal and spatial response improved 6-12 mo. Directional Motion – behavioral discrimination 7 wk initially. Velocity range expands 10-15 mo. Binocular Correlation – behavior discriminations initially 11-13 wk, range expands 15 mo on. 5 TORTICOLLIS AFFECTS MOVEMENT AND INTEGRATION OF PRIMITIVE REFLEXES Rotation is essential for function Required to progress and connect pathways to higher centers From brainstem to midbrain and cortex PRIMITIVE REFLEXES DO NOT TRAVEL ALONE Travel in gangs – usually not solitary May see mixed patterns – depends on where the eyes are looking Eyes are also affected by spastic patterns Catch as soon as possible CENTRAL NERVOUS SYSTEM LEVEL OF REFLEXES Spinal reflexes 1. Flexor withdrawl 2. Extensor thrust 3. Crossed extension 4. Moro 5. Startle ©Mica Foster DC 6 BRAIN STEM LEVEL REFLEX - REPTILIAN BRAIN 1. Asymmetrical Tonic Reflex 2. Symmetrical Tonic Reflex 3. Static Labyrinthine 4. Positive Supporting 5. Negative Supporting 6. Equilibrium reflexes – “yes, no, I don’t know” movements ©Mica Foster DC 17 YEAR OLD - ANOXIC GLOBAL BRAIN DAMAGE Began therapy in ICU with range of motion / specialty hospitals Continued with ataxic movements – cerebellum and basal brain structures, chopped thoughts Poor start and stop motion in eyes, neck, trunk, UE and LE’s Tremors in bilateral hand movements – drawing - Like treats like Plantar grasp + and extension synergies, high tone – gait Integration, “Neutralize the Eyes” and “Numb and Dumb” = heel toe gait MIDBRAIN REFLEXES - MAMMAL BRAIN 1. Kinetic Labyrinthine 2. Body righting acting on head 3. Body righting acting on body 4. Optical righting reflex 5. Protective extension 6. Parachute reflex ©Mica Foster DC 7 ASTNR - MAMMAL BRAIN DEMONSTRATION Children can demonstrate Primitive reflexes under stress, when fatigued or when lifting objects EYES AND VISION Eyes team? Low or high tone in striated muscles of eyes Give sense of 3 dimensional space References to self – 3-D being Spastic or low tone affecting eye musculature? Striated muscles like arms and legs Primitive reflexes are a motor response to a sensory stimulus Change the stimulus Change the response 8 SUCK AND SWALLOW Can affect and enhance head and neck control Assists in linking cranial nerves and bilateral hemispheres Exercise to multiple muscles of tongue Eye stabilization, focus ASYMMETRICAL TONIC NECK REFLEX Anatomy and function - head and neck turn toward object, push away from danger, facilitates body awareness and hand-eye coordination Window - 6-7 months Test - stimulate vision, head and neck will turn toward toy/light Persistence challenges – Difficulty feeding self, handwriting and reading challenges. Resolution – Integration method – fatigue reflex with repeated stimulation right and left with gentle holding of shoulders, arms or lower extremities. ”Numb and dumb” tone in affected side/s. 9 ASYMMETRICAL TONIC NECK May relate to torticollis – birth trauma C1,2,3 locking If present on one side and not the other, indicates increased damage on one side of brain. Torticollis can reduce integration of vision and asymmetrical tonic neck Stress, running can reappear Football player running with ball DISARMING PRIMITIVE REFLEX POWER The eyes control head turning Asymmetrical Tonic Neck Reflex position – work with partner to see how the power changes with eye direction change Change eye direction – Left to right to left Give advanced challenges COMPASS method SYMMETRICAL TONIC NECK REFLEX Anatomy and function – neck and upper extremity flexion and extension in lower extremities. Neck and upper extremity extension and flexion in lower extremities. This is a total body pattern demonstration, move through environment to escape danger. Window - After birth - 3 months Test – have patient look up, down at a light or toy. Persistence challenges – difficulty with looking at school black/white boards and transfer information to paper. Difficulty with walking looking up and down at pathway. Resolution – Integration method – Fatigue reflex by repeated elicitation. Isolate eyes only for stimulation while sitting supported or supine, without allowing body responses. 10 MORO REFLEX Anatomy and function – look up, neck extension and arms throw back to escape Window Prenatal- 4-6 months Test –If infant is stimulated with a 30 degree change in neck extension, it may elicit the reflex. If testing an older child have them look up at a toy and watch for upper extremities coming away from midline and hands beside ears. Persistence challenges – interferes with sitting, standing, jumping, one leg balance, difficulty with 2 handed activities, crossing midline, poor control when looking at objects on wall, blackboard, screens, then to paper on desk. Elicit Resolution – Integration method – work on lower eye level activities in sitting or standing. There will be more cortical connections formed so lower centers are no longer needed. STARTLE REFLEX Anatomy and function – reaction to loud noise, throw into extension to lay low and protect head Window - 4-6 months, may reappear with ACES, Adverse Childhood Event Persistence challenges – Distractible, fidgety, poor concentration, poor performance in chaotic room, may stay in fight or flight Elicit – reaction to loud noise, neck into extension, arms
Load more

Recommended publications
  • Focusing on the Re-Emergence of Primitive Reflexes Following Acquired Brain Injuries
    33 Focusing on The Re-Emergence of Primitive Reflexes Following Acquired Brain Injuries Resiliency Through Reconnections - Reflex Integration Following Brain Injury Alex Andrich, OD, FCOVD Scottsdale, Arizona Patti Andrich, MA, OTR/L, COVT, CINPP September 19, 2019 Alex Andrich, OD, FCOVD Patti Andrich, MA, OTR/L, COVT, CINPP © 2019 Sensory Focus No Pictures or Videos of Patients The contents of this presentation are the property of Sensory Focus / The VISION Development Team and may not be reproduced or shared in any format without express written permission. Disclosure: BINOVI The patients shown today have given us permission to use their pictures and videos for educational purposes only. They would not want their images/videos distributed or shared. We are not receiving any financial compensation for mentioning any other device, equipment, or services that are mentioned during this presentation. Objectives – Advanced Course Objectives Detail what primitive reflexes (PR) are Learn how to effectively screen for the presence of PRs Why they re-emerge following a brain injury Learn how to reintegrate these reflexes to improve patient How they affect sensory-motor integration outcomes How integration techniques can be used in the treatment Current research regarding PR integration and brain of brain injuries injuries will be highlighted Cases will be presented Pioneers to Present Day Leaders Getting Back to Life After Brain Injury (BI) Descartes (1596-1650) What is Vision? Neuro-Optometric Testing Vision writes spatial equations
    [Show full text]
  • Improvement and Neuroplasticity After Combined Rehabilitation to Forced Grasping
    Hindawi Case Reports in Neurological Medicine Volume 2017, Article ID 1028390, 7 pages https://doi.org/10.1155/2017/1028390 Case Report Improvement and Neuroplasticity after Combined Rehabilitation to Forced Grasping Michiko Arima, Atsuko Ogata, Kazumi Kawahira, and Megumi Shimodozono Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan Correspondence should be addressed to Michiko Arima; [email protected] Received 20 September 2016; Revised 31 December 2016; Accepted 9 January 2017; Published 6 February 2017 Academic Editor: Pablo Mir Copyright © 2017 Michiko Arima et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The grasp reflex is a distressing symptom but the need to treat or suppress it has rarely been discussed in the literature. We report the case of a 17-year-old man who had suffered cerebral infarction of the right putamen and temporal lobe 10 years previously. Forced grasping of the hemiparetic left upper limb was improved after a unique combined treatment. Botulinum toxin typeA (BTX-A) was first injected into the left biceps, wrist flexor muscles, and finger flexor muscles. Forced grasping was reduced along with spasticity of the upper limb. In addition, repetitive facilitative exercise and object-related training were performed under low-amplitude continuous neuromuscular electrical stimulation. Since this 2-week treatment improved upper limb function, we compared brain activities, as measured by near-infrared spectroscopy during finger pinching, before and after the combined treatment.
    [Show full text]
  • The Grasp Reflex and Moro Reflex in Infants: Hierarchy of Primitive
    Hindawi Publishing Corporation International Journal of Pediatrics Volume 2012, Article ID 191562, 10 pages doi:10.1155/2012/191562 Review Article The Grasp Reflex and Moro Reflex in Infants: Hierarchy of Primitive Reflex Responses Yasuyuki Futagi, Yasuhisa Toribe, and Yasuhiro Suzuki Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan Correspondence should be addressed to Yasuyuki Futagi, [email protected] Received 27 October 2011; Accepted 30 March 2012 Academic Editor: Sheffali Gulati Copyright © 2012 Yasuyuki Futagi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The plantar grasp reflex is of great clinical significance, especially in terms of the detection of spasticity. The palmar grasp reflex also has diagnostic significance. This grasp reflex of the hands and feet is mediated by a spinal reflex mechanism, which appears to be under the regulatory control of nonprimary motor areas through the spinal interneurons. This reflex in human infants can be regarded as a rudiment of phylogenetic function. The absence of the Moro reflex during the neonatal period and early infancy is highly diagnostic, indicating a variety of compromised conditions. The center of the reflex is probably in the lower region of the pons to the medulla. The phylogenetic meaning of the reflex remains unclear. However, the hierarchical interrelation among these primitive reflexes seems to be essential for the arboreal life of monkey newborns, and the possible role of the Moro reflex in these newborns was discussed in relation to the interrelationship.
    [Show full text]
  • The Concept of the Reflex in the Description of Behavior 321
    THE CONCEPT OF THE REFLEX IN THE DESCRIPTION OF BEHAVIOR 321 The present paper was published in the Journal of General Psychology, I I 2 * s here the editor. ( 93 > 5' 4 7~45$) an^ reprinted by permission of INTRODUCTORY NOTE THE EXTENSION of the concept of the reflex to the description of the behavior of intact organisms is a common practice in modern theorizing. Nevertheless, we owe most of our knowledge of the reflex to investigators who have dealt only with "preparations," and who have never held themselves to be con- cerned with anything but a subsidiary function of the central nervous system. Doubtless, there is ample justification for the use of relatively simple systems in an early investigation. But it is true, nevertheless, that the concept of the reflex has not emerged unmarked by such a circumstance of its development. In its extension to the behavior of intact organisms, that is to say, the his- torical definition finds itself encumbered with what now appear to be super- fluous interpretations. The present paper examines the concept of the reflex and attempts to evaluate the historical definition. It undertakes eventually to frame an alterna- tive definition, which is not wholly in despite of the historical usage. The reader will recognize a method of criticism first formulated with respect to scientific Ernst Mach in The Science and concepts by [ of Mechanics} per- haps better stated by Henri Poincare. To the works of these men and to Bridgman's excellent application of the method [in The Logic of Modern Physics] the reader is referred for any discussion of the method qua method.
    [Show full text]
  • Classic Signs Revisited Postgrad Med J: First Published As 10.1136/Pgmj.71.841.645 on 1 November 1995
    Postgrad MedJ3 1995; 71: 645-648 C The Fellowship of Postgraduate Medicine, 1995 Classic signs revisited Postgrad Med J: first published as 10.1136/pgmj.71.841.645 on 1 November 1995. Downloaded from The Babinski reflex J van Gijn Summary The information that may be deduced from scratching a patient's sole, is as The plantar response is a reflex important as a diagnostic sign as it is simple to elicit. When the great toe moves that involves not only the toes, but upward (sign of Babinski), this signifies, as everybody knows, a disturbance of all muscles that shorten the leg. In the pyramidal tract. This explains why few patients with neurological symptoms the newborn the synergy is brisk, can avoid having their plantar reflexes examined - often to their great surprise, or involving all flexor muscles of the even alarm if the trouble is in the head. Unfortunately the reality is less simple leg; these include the toe 'exten- than the theory. Often it is difficult to decide whether the great toe actually does sors', which also shorten the leg go up: the toe movements may be slight, vacillate between up and down, seem on contraction and therefore are down one day but up the next, or be interrupted by voluntary withdrawal flexors in a physiological sense. As movements. It is therefore no great surprise that such difficult plantar responses the nervous system matures and give rise to wide variations between doctors, or even between different occasions the pyramidal tract gains more with the same observer. Under these circumstances the interpretation may be control over spinal motoneurones influenced by the physician's previous expectations.' Since it is obviously the flexion synergy becomes less important for the diagnosis in individual patients whether or not a lesion of the brisk, and the toe 'extensors' are pyramidal system exists, there is a need for criteria that are both reliable and no longer part of it.
    [Show full text]
  • The Brain That Changes Itself
    The Brain That Changes Itself Stories of Personal Triumph from the Frontiers of Brain Science NORMAN DOIDGE, M.D. For Eugene L. Goldberg, M.D., because you said you might like to read it Contents 1 A Woman Perpetually Falling . Rescued by the Man Who Discovered the Plasticity of Our Senses 2 Building Herself a Better Brain A Woman Labeled "Retarded" Discovers How to Heal Herself 3 Redesigning the Brain A Scientist Changes Brains to Sharpen Perception and Memory, Increase Speed of Thought, and Heal Learning Problems 4 Acquiring Tastes and Loves What Neuroplasticity Teaches Us About Sexual Attraction and Love 5 Midnight Resurrections Stroke Victims Learn to Move and Speak Again 6 Brain Lock Unlocked Using Plasticity to Stop Worries, OPsessions, Compulsions, and Bad Habits 7 Pain The Dark Side of Plasticity 8 Imagination How Thinking Makes It So 9 Turning Our Ghosts into Ancestors Psychoanalysis as a Neuroplastic Therapy 10 Rejuvenation The Discovery of the Neuronal Stem Cell and Lessons for Preserving Our Brains 11 More than the Sum of Her Parts A Woman Shows Us How Radically Plastic the Brain Can Be Appendix 1 The Culturally Modified Brain Appendix 2 Plasticity and the Idea of Progress Note to the Reader All the names of people who have undergone neuroplastic transformations are real, except in the few places indicated, and in the cases of children and their families. The Notes and References section at the end of the book includes comments on both the chapters and the appendices. Preface This book is about the revolutionary discovery that the human brain can change itself, as told through the stories of the scientists, doctors, and patients who have together brought about these astonishing transformations.
    [Show full text]
  • The Leg Cross Flexion-Extension Reflex: Biomechanics, Neurophysiology, MNRI® Assessment, and Repatterning
    Po R t a l t o n e u R o d e ve l o P m e n t a n d le a R n i n g t h e o R y a n d h i s t o R y o f m n R i ® R e f l e x i n t e g R a t i o n The Leg Cross Flexion-Extension Reflex: Biomechanics, Neurophysiology, MNRI® Assessment, and Repatterning Elvin Akhmatov, MA, Ph.D. Student, Orlando, FL, USA; Jakub Buraczewski, PT, MNRI® Core Specialist; Denis Masgutov, Director of SMEI , Poland Introduction wo separate reflexes, Phillipson’s Withdrawal and Leg Cross Flexion-Extension, are eas- ily confused because they have similar motor Tpatterns and are elicited by stimuli that can appear to be alike and usually manifest at the same time. The authors’ purpose is to distinguish clearly between these two reflexes and to present detailed information on the one they refer to as the Leg Cross Flexion-Extension Reflex. The other reflex, often con- Elvin Akhmatov Jakub Buraczewski Denis Masgutov fused with Leg Cross Flexion-Extension, goes by sev- eral names: Phillipson’s Withdrawal, Phillipson’s Leg Flexion, Crossed Extensor, and Leg Withdrawal Reflex, among others. For clarity in this paper, the other reflex will be referred to as Phillipson’s Withdrawal. On the neurophysiological level, these two reflex patterns present the work of two different nerve tracts – tactile and proprioceptive, activated and processed by different receptors. The Leg Cross Flexion-Extension Reflex is extremely important for overall sensory-motor integration, mo- tor programing and control.
    [Show full text]
  • Brainstem Dysfunction in Critically Ill Patients
    Benghanem et al. Critical Care (2020) 24:5 https://doi.org/10.1186/s13054-019-2718-9 REVIEW Open Access Brainstem dysfunction in critically ill patients Sarah Benghanem1,2 , Aurélien Mazeraud3,4, Eric Azabou5, Vibol Chhor6, Cassia Righy Shinotsuka7,8, Jan Claassen9, Benjamin Rohaut1,9,10† and Tarek Sharshar3,4*† Abstract The brainstem conveys sensory and motor inputs between the spinal cord and the brain, and contains nuclei of the cranial nerves. It controls the sleep-wake cycle and vital functions via the ascending reticular activating system and the autonomic nuclei, respectively. Brainstem dysfunction may lead to sensory and motor deficits, cranial nerve palsies, impairment of consciousness, dysautonomia, and respiratory failure. The brainstem is prone to various primary and secondary insults, resulting in acute or chronic dysfunction. Of particular importance for characterizing brainstem dysfunction and identifying the underlying etiology are a detailed clinical examination, MRI, neurophysiologic tests such as brainstem auditory evoked potentials, and an analysis of the cerebrospinal fluid. Detection of brainstem dysfunction is challenging but of utmost importance in comatose and deeply sedated patients both to guide therapy and to support outcome prediction. In the present review, we summarize the neuroanatomy, clinical syndromes, and diagnostic techniques of critical illness-associated brainstem dysfunction for the critical care setting. Keywords: Brainstem dysfunction, Brain injured patients, Intensive care unit, Sedation, Brainstem
    [Show full text]
  • Neurologic AESI Glossary of Terms
    Neurologic AESI Glossary of Terms Includes terms for the following Brighton Collaboration Case Definitions: • Encephalitis, myelitis, acute disseminated encephalomyelitis • Guillain Barré and Miller Fisher Syndromes • Peripheral Facial Nerve Palsy (Bell’s palsy) • Aseptic meningitis • Generalized convulsion Acalculia: inability to perform simple mathematical tasks (addition, subtraction, multiplication) Agnosia: inability to recognize objects or persons Agraphesthesia: difficulty recognizing a written number or letter traced on the palm of the hand Agraphia: impairment in the ability to write AIDP: acute inflammatory demyelinating polyneuropathy (most common form of GBS) Alexia: impairment of ability to read AMAN: acute motor axonal neuropathy (a less common form of GBS) AMSAN: acute motor and sensory axonal neuropathy (a less common form of GBS) Aphasia / Dysphasia: impairment of spoken language abilities that affect production and/or comprehension of speech. Apraxia: inability to execute purposeful movements Aprosodia: decreased ability to generate or comprehend emotion as conveyed in spoken language Asterognosia: inability to identify an object by active touch of the hands without other sensory input (e.g. visual) Ataxia: loss of coordination in voluntary movements; can present in many ways including: lack of coordination, slurred speech, gait abnormalities, inability to balance, trouble eating and swallowing, loss of fine motor skills, tremors; Atonic motor manifestations: sudden loss in tone of postural muscles; may be preceded by
    [Show full text]
  • Spontaneous Motility Disorders and Postural Control in Infants (0-6
    Medical Rehabilitation (Med Rehabil) 2015, 19 (1), 25-33 eISSN 1896–3250 ISSN 1427–9622 © AWF Kraków Spontaneous motility disorders and postural control in infants (0-6 months of life) with a history of perinatal disorders Zaburzenia motoryki spontanicznej oraz kontroli posturalnej u niemowląt (0-6 miesiąc życia) z obciążonym wywiadem okołoporodowym Magdalena Czajkowska FinMed, Rehabilitation Center, Szczecin, Poland Key words early physiotherapy intervention, neonatal reflexes, Vojta method, standard pattern, segmental extension, locomotion Abstract Newborn infants with a history of perinatal neurological conditions require special monitoring. Their psychomotor development is determined by the potential damage to the structure of their immature nervous system, perinatal hypoxia or disharmony in motor development. However, muscle tension disorders and minor postural control issues, in the light of the high plasticity of the brain, can be independently adjusted. What is more, in most cases infants need help from the moment of birth, and the first signs of irreg- ularities occur within the first weeks of life. The first signs of disturbances in motor development are frequently found by an infant’s parents or guardians. They have the opportunity to observe the infant in natural settings, such as during care, play or feeding. Care- ful clinical examination performed by a pediatric neurologist takes into account an assessment of the child’s eye contact, spontane- ous motor activity and support and erectile mechanisms, and also evaluates the child’s neonatal reflexes and postural reactions (in the case of a diagnosis by Vaclav Vojta). Early physiotherapy intervention shall take action when the first signs of delayed motor de- velopment appear in the infant.
    [Show full text]
  • Brainstem Dysfunction in Critically Ill Patients
    Benghanem et al. Critical Care (2020) 24:5 https://doi.org/10.1186/s13054-019-2718-9 REVIEW Open Access Brainstem dysfunction in critically ill patients Sarah Benghanem1,2 , Aurélien Mazeraud3,4, Eric Azabou5, Vibol Chhor6, Cassia Righy Shinotsuka7,8, Jan Claassen9, Benjamin Rohaut1,9,10† and Tarek Sharshar3,4*† Abstract The brainstem conveys sensory and motor inputs between the spinal cord and the brain, and contains nuclei of the cranial nerves. It controls the sleep-wake cycle and vital functions via the ascending reticular activating system and the autonomic nuclei, respectively. Brainstem dysfunction may lead to sensory and motor deficits, cranial nerve palsies, impairment of consciousness, dysautonomia, and respiratory failure. The brainstem is prone to various primary and secondary insults, resulting in acute or chronic dysfunction. Of particular importance for characterizing brainstem dysfunction and identifying the underlying etiology are a detailed clinical examination, MRI, neurophysiologic tests such as brainstem auditory evoked potentials, and an analysis of the cerebrospinal fluid. Detection of brainstem dysfunction is challenging but of utmost importance in comatose and deeply sedated patients both to guide therapy and to support outcome prediction. In the present review, we summarize the neuroanatomy, clinical syndromes, and diagnostic techniques of critical illness-associated brainstem dysfunction for the critical care setting. Keywords: Brainstem dysfunction, Brain injured patients, Intensive care unit, Sedation, Brainstem
    [Show full text]
  • Understanding the Impact of Retained Reflexes on Relationships and Development a Guide for the Infant Mental Health Practitioner
    Understanding the Impact of Retained Reflexes on Relationships and Development A Guide for the Infant Mental Health Practitioner Pamela Crljenica, LMSW, IMH-E® (III) Ledges Wellness LLC [email protected] Michigan State University School of Social Work Faculty Workshop Description The field of Infant Mental Health has long understood the critical importance of the infant- parent relationship to all learning and development. But, what if something is interfering with that relationship that the field has yet to recognize? What does it mean for development if a child's or parent’s primitive reflexes, specifically Fear Paralysis and Moro, are still retained? And, how does this impact their ability to build a successful relationship? In this workshop, learn how to identify if these reflexes are retained and impacting attachment, and what you as an Infant Mental Health practitioner can do about it. Objectives Identify specific symptoms of inappropriately active (i.e., retained) Fear Paralysis and Moro reflexes. Learn and apply several relationship- based strategies that encourage integration of the Fear Paralysis and Moro reflexes. What are Primitive Reflexes? Can also be known as primary, infant, or newborn reflexes Innate movement patterns that emerge in- utero Originate in the brainstem or spinal cord Activated through the birthing process (cardinal movements) A predetermined patterned movement response triggered by a sensory stimulation Happens automatically without conscious effort or will What do Primitive Reflexes do? Start a developmental process in the brain and central nervous system Help babies during the birth process and orient them to their new environment after birth Prepares newborn to move against gravity and teaches muscles to move together Gradually lead to voluntary movement (i.e., transforms into adult postural and defensive reflexes) Simply put… Primitive reflexes are the blueprint for movement.
    [Show full text]