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 upright
position with some
weight bearing on feet
Any-usuatly supine
Sitting or supine
Lean client forward; pressure
of feet on supporting
su rfa ce
Pressure in palm of hand or
utnar side
Brush dorsum of one of
ctient's hands against
under edge of a table or
edge of a stiff cardboaro
Stimulation to tips. gums, or
front of tongue
Touch or stroke outward on
corner of [ips or on cheek
Rhythmic, atternating
steppi ng
Flexing of fingers; grasping
of ctimrlrrc nhieet
Flexion of arm with
ptacement of the hand on
tabtetop
Sucking, swallowing motions
Lower Lip, tongue, and
head move toward
stim 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 under
chest
6 months-death Sitting or prone
Dropping head backward
from semisittjng position
or [oud noise near the head
Passive or active neck extension
Disptace body forward. sideways
and backward (separateLy)
Extension or flexion and
abduction of arms
--t -^-^^l:-^
^f dru 5Prtrouril9 ul
fi ngers
Back and Legs extend
Protective extension of
limb to protect
head
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 foot
of flexed leg
Passively flex
extended Leg
Uncontrolled fLexion
of stimutated leg
Uncontrolled extension
of stimutated [eg
Extension of opposite
Leg, with hip internaI
rotation and
adduction
Supine or sitting w'ith head
jn
midposition, legs extended
Supine or sitting with head
jn
midposition; one leg is in extension
and other is futly flexed
Supine with head in midposition; one
leg is in extension and other is
futly 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 tonic
neck reflex
(sTNR)
Tonic Labyrinthine
reflex (TLR)
TLR supine
Posjtive supporting
reaction
Birth-4 to 6 months
Supine or sitting,
with arms and Legs
extended; clients
with minimal
reflexes responses
can be tested in
quadruped
Sitting or quadruped
Prone with head
in midposition
Supine with head in
midposition
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 of
foot to ftoor; or
footboard of bed and
dorsiflex foot
Resist any motion or
have client
qflroeTc:n
nhicrt
with unaffected
nan0
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 lower
extremity; (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 to
co-contraction of ftexors an:
extensors of knee and hiP
joints
Motion used as a stimulus
witt 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 throughout
life when attempting
strenuous actjvities;
associated reactions
are stereotyped tonic
reactions by which one
extremity inftuences
nncfrrra nf rnnfhpr
HvJrer
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-death
righting acting
on head
Body righting 6 months-5
Years
acting on head
Supine with arms and
legs extended
Prone, supine, or
vertical positions
in cnero. rlipni'c
vision is occtuded
Ctient is btindfolded
prone and supine
Supine with arms and
legs extended
Passively turn head to
one side and hotd it
there
Prone or supine positions
are test stimuli, or in
vertjcaI position body is
tilted lateral.ty
Asymmetric stimutation of
pressure sense organS 0n
anterior of body surface
Passively or actively turn
head to one side
Body rotates as a
whole in d'irection to
which head was turned
Head seeks vertical
position in space
Head
js
brought into a face-vertjcal
position that orients it to
surface with which cuent is in
c0ntacr
Segmental rotatjon around bodY
axis toward direction of head
Body 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 in
relation to Landmarks
in space
Rocking client or
supporting surface
sufficientty to
disturb ba[ance
Head is raised upright
in 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.tlc
movement. 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)'tlltnctrtc
tonic neck reflex (ATNR) can interfere '"vith
rolling fron-r
supine to prren., duc to scapular retractioll on thc skull'side
extremity
(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 Anlericart
Coliege of Sports Medicine
(199i) as "the abrLity' to per-
form large-muscle, dynamic, morlerate-to-1-righ intcnsity
exercises 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. Maximal
oxygen 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'