CHAPTER 25: Evatuation of Performance Skitts and Ctient Factors 3g7

htex/Reaction AgeRange Test Position Stimulus Response

-'=, sfpnninn- ---TT J Birth-3 months

: r'eflex Birth-3 to 4 months

-q reaction Birth-z months

Supported in uprightposition with some

weight bearing on feet

Any-usuatly supine

Sitting or supine

Lean client forward; pressure

of feet on supportingsu rfa ce

Pressure in palm of hand orutnar side

Brush dorsum of one ofctient's hands againstunder edge of a table oredge of a stiff cardboaro

Stimulation to tips. gums, orfront of tongue

Touch or stroke outward oncorner of [ips or on cheek

Rhythmic, atternatingsteppi ng

Flexing of fingers; graspingof ctimrlrrc nhieet

Flexion of arm withptacement of the hand ontabtetop

Sucking, swallowing motions

Lower Lip, tongue, and

head move towardstim utus

..'rg reflex

.:'rg reflex

Birth-2 months

Birth-4 months

Any

Any

:a from Mathiowetz and Bass Haugen (1995); Barnes, CrutchfieLd, Heriza (19g2).

-:-E 25-1.3. AUTOMATIC MOVEMENT REFI-EXESO

leflex Age Range Test Position Stimutus Response

reflex

.:-:au reflex

:,:ective..itensor thrust

Birth-5 months SemirecLining or supine

4-12 to 24 months Prone. suspended in space

with support underchest

6 months-death Sitting or prone

Dropping head backwardfrom semisittjng positionor [oud noise near the head

Passive or active neck extension

Disptace body forward. sidewaysand backward (separateLy)

Extension or flexion and

abduction of arms--t -^-^^l:-^ ^fdru 5Prtrouril9 ul

fi ngers

Back and Legs extend

Protective extension oflimb to protecthead

lata from Mathiowetz and Bass Haugen (1995); Barnes, Crutchfield, Heriza (1982).

:3IE 25_14. SPINAL-LEVEL REFLEXES

leflex Age Range Test Position Stimutus Response

-.:x0r

,,r'ithdrawaI

1':ensor:h rust

. -ossed

extension

Birth-2 months

Birth-2 months

Birth-2 months

Stimutation to so[e

of foot

Pressure to batl of footof flexed leg

Passively flexextended Leg

Uncontrolled fLexion

of stimutated leg

Uncontrolled extensionof stimutated [eg

Extension of oppositeLeg, with hip internaIrotation and

adduction

Supine or sitting w'ith head jn

midposition, legs extended

Supine or sitting with head jn

midposition; one leg is in extensionand other is futly flexed

Supine with head in midposition; one

leg is in extension and other isfutly flexed

Data from Mathiowetz and Bass Haugen (1995); Barnes, Crutchfietd. Heriza (1982).

388 UNIT SEVEN: OccupationaL Therapy Eva[uation

TABLE 25_1"5. BRAINSTEM.LEVEL REFLEXESO

Reftex Age Range Test Position Stimulus Response

Asymmetricat tonic Bjrth-4 to 6 months

neck reftex(ATNR)

SymmetricaI tonicneck reflex(sTNR)

Tonic Labyrinthine

reflex (TLR)

TLR supine

Posjtive supportingreaction

Birth-4 to 6 months

Supine or sitting,with arms and Legs

extended; clientswith minimalreflexes responses

can be tested inquadruped

Sitting or quadruped

Prone with head

in midposition

Supine with head inmidposition

Standing, supine, or

sitti n g

Passivety or activeLy

turn the head 90o

to one side

i/ 1\ Fiov e liant'< hord\'/ ' '""and bring chjn toward

chest; (2) extend

client's head

Test position is

sti m u lus

Test position is

sti m u Ius

Firmty contact batl offoot to ftoor; or

footboard of bed and

dorsiflex foot

Resist any motion orhave clientqflroeTc:n nhicrt

with unaffectednan0

Increase of extensor tone of

limbs on face side and

ftexor tone of limbs on

skut[ side

(1) Ftexion of upper extremitie:and extension of lowerextremity; (2) extension of

upper extremitjes and flexic-of lower extremities

FLexion of extremities or

increase in f[exor tone

Extension of extremities or

increase in extensor tone

Rigid extension of lower

extremity owing toco-contraction of ftexors an:

extensors of knee and hiP

joints

Motion used as a stimuluswitt be mimicked by

other hand

Birth-4 to 6 months

Birth-4 to 6 months

Birth-4 to 6 months

Associated

reactions

Assocjated movements Any position

are normal throughoutlife when attemptingstrenuous actjvities;associated reactions

are stereotyped tonicreactions by which one

extremity inftuencesnncfrrra nf rnnfhprHvJrer v

extremity

oData from lvlathiowetz and Bass Haugen (1995); Barnes, Crutchfie[d, Heriza (1982).

TABLE 25_1.6. MIDBRAIN.LEVEL REACTIONS'

Reaction Age Range Test Position Stimulus Response

Neck righting Birth-6 months

Labyrinthine 2 months-deathrighting actingon head

Body righting 6 months-5 Years

acting on head

Supine with arms and

legs extended

Prone, supine, or

vertical positionsin cnero. rlipni'c

vision is occtuded

Ctient is btindfoldedprone and supine

Supine with arms and

legs extended

Passively turn head toone side and hotd itthere

Prone or supine positions

are test stimuli, or invertjcaI position body is

tilted lateral.ty

Asymmetric stimutation ofpressure sense organS 0n

anterior of body surface

Passively or actively turnhead to one side

Body rotates as a

whole in d'irection towhich head was turned

Head seeks verticalposition in space

Head js brought into a face-vertjcalposition that orients it tosurface with which cuent is inc0ntacr

Segmental rotatjon around bodY

axis toward direction of headBody righting

0n Dooy

6-18 months

oData from Mathiowetz and Bass Haugen (1995); Barnes, Crutchfietd, Heriza (1982)

CHAPTER 25: EvaLuation of Performance SkiLl.s and Client Factors

25-1.7 . CORTICAL REACTTONS'

Age Range Test Position Stimulus Response

:*. -;hting 2 months-death

.. :^um Depends on

. ' -:'on test position;throughout Life

Prone or supine on a rajsed mat

sitting with head LateraLLy flexed;

eyes open

Supine (7-B months); prone (5 months);quadruped (9-12 months); sittjng(O months); kneet-standing(15 months); standing (15 months)

Position of head inrelation to Landmarks

in space

Rocking client or

supporting surface

sufficientty todisturb ba[ance

Head is raised uprightin space

Automatic movements

to maintain baLance,

right head and body;nrnfortivo roaefinnc

. from Mathiowetz and Bass Haugen (1995); Barnes, CrutchfieLd, Heriza (1982).

-l

r :'-.rln.srem-leuel reflexes: Static, postural re{lexes that

-.rlrse a change in muscle tone throughout the body in:.:ponse to a change of tl-re head's position in space or

.:'r relation to the bocly, which activates the vestibular:', Steirri the changed tone is maintained as long as the:irmlrlus is present (Table 25-15).

t '1.[itlbrain-Leue| reactictns: Permit the develttpmeut ,-,i

:'.lzrtlrrationally acquirecl motor milestones; righting re-

i.tions are integrated at this level and interact with.r-Le another to effect tl-re normal head-to-body relir-

ir,)n in space and to each other (Table 75'16).

. --orrlcal reactic,ns: The result of the ef{icient interac-iLtrfl of the cerebral cortex, basal ganglia, and cere-

l-,elLum (equilibrium reactions occur when muscle

.one is norrnalizecl; enable the adaptatittn to changes

:n the body's center of gravity; and involve the inte-:ration of vestibular, visual, ancl tactile inpr-rts)

rTable 25-17).

i:cording Results-,. :ositicrn(s) should be noted. Results ale usual recor.led

*'hether the client's response is positive or negative.

::1sity (i.e., the speecl of response and degree of change).ell as quality (i.e., which components .rf the response

-. :resent uncler u,hich conditions) of responses should be

- - rmented.

-.terpreting Results

- -rlatory reflexive reslonses, such irs domination of a pos-' .,rl reflex, indicates severe central nervous system abnor-' -.-rt1'. Disturbance of higher-integrating centers manifests- evidence of a reflex, bltt not complete domination--r.rstonucci, 1997; Mathiowetz & Bass Har-rgen, 2002).

: : cxampie, a lr'eak reflex response ''vould be tonal changes

:' rhe extremities as opposed to actuai movement. This' r,-iLcl not be confused with tonal changes in a stimulus-

.-rtral condition. Problems with reflex lntegration result

:- lecreased trunk segmentation, ability to perform isolated

.. rvenent, adaptation of rnuscles tct postural change, and

function of antigravity mr-rsclcs antl incleaseLl s\-tl.:rgi.tlcmovement. Forrnal ertal.uertior-t should aiu'ays be accotttf.,'t-

nied by observ:rtion of hor'v reflexes affect motor ancl frinc-

tional performance. For erample, a positive .ls)'tlltnctrtctonic neck reflex (ATNR) can interfere '"vith rolling fron-r

supine to prren., duc to scapular retractioll on thc skull'sideextremity (which prevents bringing that arm across) and an

extended arm on the face side.

=

= ENDURANCE

Endurance can be dehnecl as the abllity to srtstain a gii-en

activit)' over time. lt is reiirted to cardiopr,rlmonarl', biome-

chanical, and neuromuscular function (Asmussen, 1979;

Farber, 1991a, i991b; Lunsford, 1978;Trombiy & Podolski,

2002). Endurance is a measure of stanrina and litness and

can hc conrpromr.e.l hv irractrr'i11, ilnptrhilizdli"n' crr-diorespiratory cleconclitioning, muscular deconclitioning,and diminished flexibility. ErLclurance is relirted to intcnsitr',

duration, and frequency of activity. It can be reported as a

percentage of maximai heart rate, as a number of repef itions

over time, or as the amounl of time a contr:rction c:rn be

hel.1 (Tiombly & Podolski, 2002).

Cardiorespiratory Endurance

Carcliorespiratory endurance is dehned by tl-rc AnlericartColiege of Sports Medicine (199i) as "the abrLity' to per-

form large-muscle, dynamic, morlerate-to-1-righ intcnsityexercises for prolongecl periods" (p. 39). Cardit'reslirator)'endurance depends on the functiorral states of the respira-

tory, cardic',vascular, and n-iusculoskele t'.rl systems. Maximaloxygen uptake (VO2max) is a standald ineasure of c:rr-

ciiorespiratory endurance. It is a measure of the maxin-ral

amount of oxygen that a person can take in and .lispense

during exercise and is relatecl to a person's maximal meta-

bolic equivalent (MET) capacity. "One MET is equivalent

to an ox)rsen r-rptake oi 3.5 [millilitets per kllogram bodv

weight per minute]. It is conventional in exercise testinq tt'