- To provide excellence in comprehensive care by using my acquired skills as both a competent professional and also as a compassionate human being.
- To cultivate leadership role both in the community of researchers and in the nation to formulate and maintain health care principles and advancements.
- To employ the latest knowledge and techniques in prevention of disease and its complications, and the restoration of health by complete rehabilitation.
- To develop and employ methods to take care of an aging population.
- To show reverence for human beings by giving excellent care to all.
- To forever expand knowledge through experience, continuing education courses, and research.
Jumat, 27 Juni 2008
Physiotherapist Goal
Selasa, 06 Mei 2008
STATIC POSTURE ANALYSIS & ANATOMICAL LANDMARKS
STATIC POSTURE:
Evaluate from the Front
a) Weight Distribution
b) Head Carriage
c) Shoulder Level
d) Foot Placement
Evaluate from the Back
a) Head Carriage
b) Shoulder Height
c) Level of Pelvis
d) Weight Distribution on Feet
Observe from the Side
a) Posture against Plumb Line
(which drops from external auditory meatus to the tip of the acromion through the femoral trochanter to just in front of the medial
malleolus)
Observe from the Opposite Side
a) Assess Plumb Line
(compare with opposite side)
b) Head Carriage
c) Anteroposterior Spinal Curves
d) Extent of Knee Extension
ANATOMICAL PALPATION:
Palpate levels of Acromion Levels
Illiac Crest (By pushing soft tissue out of the way from below and placing proximal phalanges of the index fingers on similar portions of the right & left innominate)
Palpate & Observe top of the greater trochanter (at lateral to medial compression of the soft tissue of the lateral hip)
Unleveling of the Illiac Crest and Greater Trochanter in the standing position is the first index of suspicion for a short leg
Eyes should be at the same horizontal place as are palpating fingers for better hand eye coordination
Reference: Principles of Manual Medicine - Philip E. Greenman
Evaluate from the Front
a) Weight Distribution
b) Head Carriage
c) Shoulder Level
d) Foot Placement
Evaluate from the Back
a) Head Carriage
b) Shoulder Height
c) Level of Pelvis
d) Weight Distribution on Feet
Observe from the Side
a) Posture against Plumb Line
(which drops from external auditory meatus to the tip of the acromion through the femoral trochanter to just in front of the medial
malleolus)
Observe from the Opposite Side
a) Assess Plumb Line
(compare with opposite side)
b) Head Carriage
c) Anteroposterior Spinal Curves
d) Extent of Knee Extension
ANATOMICAL PALPATION:
Palpate levels of Acromion Levels
Illiac Crest (By pushing soft tissue out of the way from below and placing proximal phalanges of the index fingers on similar portions of the right & left innominate)
Palpate & Observe top of the greater trochanter (at lateral to medial compression of the soft tissue of the lateral hip)
Unleveling of the Illiac Crest and Greater Trochanter in the standing position is the first index of suspicion for a short leg
Eyes should be at the same horizontal place as are palpating fingers for better hand eye coordination
Reference: Principles of Manual Medicine - Philip E. Greenman
SCREENING MUSCULOSKELETAL EXAMINATION
Today's Topic: SCREENING MUSCULOSKELETAL EXAMINATION
12-step procedure for comprehensive musculoskeletal screening examination:
STEP 1: Gait analysis in multiple directions
STEP 2: Observation of static posture & palpable assessment of paired anatomical landmarks.
STEP 3: Dynamic trunk sidebending
STEP 4: Standing flexion test
STEP 5: Stork test
STEP 6: Seated flexion test
STEP 7: Screening test of upper extremities
STEP 8: Trunk rotation
STEP 9: Trunk sidebending
STEP 10: HEad & neck mobility
STEP 11: Respiration of thoracic cage
STEP 12: Lower extremity screening
Today we will cover STEP 1: Gait Analysis
Observe gait with patient walking a) towards you, b) away from you & c) from the side
Observe following different measures:
a) Stride Length
b) Arm Swing
c) Heel Strike
d) Toe Off
e) Pelvic Tilt
f) Shoulder Adaption
Look for functional capacity of the gait rather than usual pathological conditions (i.e., cross-patterning of the gait & symmetry of stride)
Reference: Principles of Manual Medicine - Philip E. Greenman
12-step procedure for comprehensive musculoskeletal screening examination:
STEP 1: Gait analysis in multiple directions
STEP 2: Observation of static posture & palpable assessment of paired anatomical landmarks.
STEP 3: Dynamic trunk sidebending
STEP 4: Standing flexion test
STEP 5: Stork test
STEP 6: Seated flexion test
STEP 7: Screening test of upper extremities
STEP 8: Trunk rotation
STEP 9: Trunk sidebending
STEP 10: HEad & neck mobility
STEP 11: Respiration of thoracic cage
STEP 12: Lower extremity screening
Today we will cover STEP 1: Gait Analysis
Observe gait with patient walking a) towards you, b) away from you & c) from the side
Observe following different measures:
a) Stride Length
b) Arm Swing
c) Heel Strike
d) Toe Off
e) Pelvic Tilt
f) Shoulder Adaption
Look for functional capacity of the gait rather than usual pathological conditions (i.e., cross-patterning of the gait & symmetry of stride)
Reference: Principles of Manual Medicine - Philip E. Greenman
Kamis, 03 April 2008
the withdrawal refleks
The Withdrawal Reflex, which first appears at 5-7 weeks after conception and is inhibited or suppressed at about 9 weeks in utero (when the first primitive reflexes begin to develop), is initially a rapid amoebic like withdrawal movement of the whole organism as a response to touch in the oral region. A few days later the head will turn away from the stimulus, and by the end of the 12th week the eyes will close tightly shut as an additional response. If the embryo is threatened, it withdraws as much as it can and then flattens (freezes) and becomes stationary. Early "avoidance reflexes (and Gilfoyle, Grady & Moore state that there are many of them in the first few weeks of uterine life) form the basis of the developing reflex structure.
It has been suggested (Goddard, 1989) that these early Withdrawal Reflexes may be the earliest manifestation of a Fear Paralysis Reflex, described in detail by Kaada (1986) as a major factor in SIDS.
If retained, fear withdrawal can be elicited by minor stress, and is often present in autistic children. The response can also be triggered by major stress, such as an explosion.
The Moro Reflex
The first of the primitive reflexes, the Moro emerges around 8-9 weeks in utero and is inhibited at about 16 weeks of neonate life. It is transformed into the adult startle or Strauss reflex, and should not be present in children beyond one year at the very, very latest.
The Moro is a clasp reflex - the arms go out, and as the Moro becomes stronger, the arms come back in again. It is the clasping or bringing back of the arms which is the Moro. So there is a rapid intake of breath, out arms, legs to a lesser degree, freeze for a second, then back come arms and legs and then the baby screams the place down! It is a panic alarm reflex which helps the baby to hang on and cry in alarm. At birth the cortex is not wired up - we are a brain stem functioning, reflexive, floppy mass. Built into the brain stem is the Moro reflex to protect the new born child. As the baby cannot use the cortex to interpret the threat, the result is a panic response.
The Moro should be very strong at birth and during the first two months of life and should then be slowly inhibited by the developing brain so that by four months, in it crude form, it should no longer be present upon testing. It should slowly be more and more inhibited, and as it is inhibited over the next few months so what should emerge is the adult startle reflex.
Once the adult startle reflex has been developed, the individual will use the senses (eyes and ears) to locate the source of any perceived threat and will make an intellectual, cortical decision - should I be frightened or not? If the source cannot be located, a child may become worried and cry, but should not scream. The startle reflex is a rapid intake of breath, blink, shoulders up and then locate the source.
Agorophobia panic victims still retain the Moro, and it can be elicited by minor stress.
In its true infant form the Moro reflex can be activated by at least three things - a sudden noise (auditory Moro), movement (vestibular Moro) or change of light (visual Moro). The standard test for this reflex is vestibular, and the usual Moro that we see, or the primary one, is vestibular. That may be for the poulation we see, which is learning difficulties or panic victims.
As it is only suppressed (the primitive reflexes are always present), the Moro can be elicited by great stress. It will also reemerge in the event of a stroke or other brain injury or in pathology.
If a person grows up with a Moro but manages to control it, it affects the entire personality. They may need to ask question after question and are not happy about change unless they have instigated it. If they are going somewhere they want to know who will be there, what will happen and what they will have to do. They may be uptight and egocentric, not because they want to be, but because they need to be in control as much as possible. They also find it difficult to make relationships as they need to control the other person.
Quite often the Moro driven child, in addition to being immature, very sensitive, over reactive, and who often loses cortical control, has pupils which tend to remain enlarged under minimum stress. Obviously, if you are very anxious or very frightened (angst would be a better word), your pupils will be more dilated than normal because of the fight/flight mechanism, but you will still have some pupillary reaction to strong light, whereas with many of the children with a strong Moro, their pupils remain dilated and they are hypersensitive to light.
They do not know when to stop and do not learn from experience. The Moro affects the personality tremendously, and so has a very catastrophic effect it it remains present.
It is important to find out whether the Moro is vestibular, auditory or visual. Some SIDS babies do not have a Moro reflex - if distressed, they do not cry out - they simply die.
It is thought that if the Moro is present, then all of the following reflexes will possibly be there also.
The Palmar Reflex
This emerges at around 11 weeks in utero and is inhibited or suppressed at about 2-4 months after birth.
This reflex can be seen in a baby if you place your finger into the palm of the baby's hand. The thumb will come over and lock your finger, then the baby's other fingers will lock in the thumb and your finger very tightly. If you do this in both hands at the same time, the baby cannot let go. It is therefore possible to hang a baby from a washing line, but please do not try to do this!!!
The Palmar reflex should not be present beyond the first year of life, but if it remains present in children of school age, writing problems will develop. As soon as a pen or pencil is put into the child's hand, the fingers automatically tighten, and get tighter and tighter. The pressure increases on the paper and they start to lose control of the hand. It is no use telling them not to grip it so tightly! Writer's cramp is a likely result, and difficulty will be experienced in catching a ball. They may also not find it easy to juxtapose the fingers and thumb for rapid alternate movement, and if they cannot do this (dysdiadochokinesia), it shows that there is an immaturity of the cerebellum, and poor speech/language is a likely consequence. The cerebellum does not cross over, and so if you cannot do the movement on the right side, it shows that there is a problem in the right side of the cerebellum.
The Plantar Reflex
This emerges at around 11 weeks in utero and is inhibited or suppressed between 7-9 months after birth.
This reflex can be seen in a baby if you place your finger or a stimulus into the metatarsal arch of the foot. The ball of the foot drops and the heel comes in and the baby actually locks your finger, grasping it with the feet.
If the Plantar reflex remains present you are bound to have gravitational insecurity - it will affect stabiity and posture. It has been shown that balance may not be just regulated by the semicircular canals, but can be affected from the feet up.
The Asymmetrical Tonic Neck Reflex
Also known as the Tonic Neck Reflex (TNR), this emerges at around 18 weeks in utero and is inhibited or suppressed between 6-8 months after birth, while awake. It persists up to three and a half years while asleep.
The ATNR fulfils many purposes. With a baby, lying on the back, gently rotate the head to one side. The jaw arm would slowly extend, the jaw hand and fingers would also slowly extend. The jaw leg would extend, but not as much as the arm. The occipital (the back of the head) arm and leg would bend. This is the "kick" the mother feels, and it should get stronger and stronger as birth approaches. It has been suggested that one of its primary functions is to assist in the birth process - the rotation of the head allows the shoulders to move, and therefore the baby moves in a spiral down the birth canal.
The ATNR may also help survival. When a baby is placed prone, it should not go into the "frog" position. The head should go to one side, with extension of the jaw arm and leg. This allows free passage of air.
The ATNR is the first training ground for eye-hand coordination. When a baby is born it can only focus its eyes at about eight inches. Outside of that the baby can see movement and shadow, but it cannot focus. Through the ATNR, the baby slowly extends the vision from near point fixation to distance, and therefore this is vital for eye-hand coordination training.
If the ATNR remains strongly present it might affect vision. The hand does not want to cross the midline, and as the eyes are locked in to the hands, they do not want to cross the midline either. In crawling, the child is unable to reach and then bend the elbow to drag itself along (it is physiologically impossible to creep, commando style). In creeping, the arms need to remain straight, but the ATNR causes a bending of the occipital arm. In grasping, when the baby looks at the object, the fingers will want to straighten out.
Judging distance will also be difficult. If present in the legs, walking will be affected, and the child will tend to walk with a stiff leg gait. When at school, catching a ball (bringing the hands together at the midline) will be affected. When the head turns right, the left knee will bend and therefore disturb balance. Writing and copying problems will also be seen. Gross and fine muscle coordination and eye tracking will also be affected. It is clear, therefore, that the ATNR can have a very severe effect.
If the cortex is damaged for any reason, the ATNR is released.
The Spinal Galant Reflex
This emerges around 20 weeks in utero and should be inhibited or suppressed between 3 - 9 months after birth.
It has been suggested that this reflex also facilitates the birth process. As the baby is working down the birth canal, and as the vaginal wall touches part of the back, on the side that is stimulated you will get hip rotation. It may also play a large part in helping the hip ball and socket to grind in. At birth the ball and socket are not properly formed.
It may play a large part in sound or vibration conduction in utero. It is believed that the Galant is very primitive, like a fish out of water going from side to side. However, we don't know sufficient about this reflex. After two half hour sessions of Auditory Integrative Training (AIT) for ten days, the Galant is gone.
The Galant is involved in movement and in micturation. If it remains present, either unilaterally or bilaterally, it may cause fidgeting, make sitting up difficult (even with a nappy touching the back), lead to problems when walking and bed wetting, in addition to affecting posture. There may also be a psychological effect. If present strongly on one side only, posture may be affected resulting in curvature of the spine.
A child with the Galant who is told to sit still may start to make a noise. They have to be doing something - the internal excitement is too great.
The Rooting and Suck Reflexes
These emerge around 24 - 28 weeks in utero and are inhibited or suppressed between 3 -4 months after birth.
In the new born, gentle stimulation down the facial fold in the area of the cheek will result in the baby's mouth moving and its head turning towards the stimulation.
The rooting relex and suck reflex work together, and are vital for locating and then being able to take the mother's breast.
In the new born, because the baby has no voluntary control at this point, built into the brain stem is an infant sucking reflex so that if anything touches the nasal fold, automatically the lips come out.
Premature babies, and some full term babies have not developed the suck reflex. Something may have happened in utero to prevent its emergence.
By around 4 months, the baby should have developed sufficient control in the oral region to be able to control the lips and go into voluntary as opposed to reflexive suck.
Many children who have verbal dyspraxia, articulation problems or who are dribblers, still have a retained rooting reflex on one side or a sucking reflex.
The rooting and suck reflexes do not contribute to learning difficulties, but if retained, they do indicate an immaturity in the central nervous system.
The Tonic Labyrinthine Reflex
This emerges around 3 - 4 months in utero (in flexion, or forwards - top picture) and at birth (in extension, or backwards - bottom picture) and is inhibited or suppressed between 3 -4 months after birth (in flexion) and 3 - 4 months to 3 and a half years (in extension).
TLR in flexion - if we had a new born baby lying on its back, and its head was gently lifted up above the level of the back, as you lifted the head up the knees would come up and the baby would go into a foetal form (flexus habitus - seen in utero).
TLR in extension - if we have a baby lying on its back and you slowly lowered the baby's head below the level of the back, you get the exact opposite from flexion. As the head goes back, so the legs and the feet stretch out, and the arms and hands stretch out into a near crucifixion position.
The TLR in extension is present at birth, and gets stronger over the next ten days. When the baby breaks out of flexus habitus, the head has to go back to get into the birth canal. With an elective caesarean section, the head has not gone into TLR in extension position. If there is an emergency caesarean, and the head has engaged, the TLR in extension has been activated.
If you have the TLR in extension you will be a "flopper". There can be a devastating effect on many functions if the TLR remains present - eyes, balance, proprioception.
The ability to track smoothly and evenly with eyes only comes as the TLR in extension is inhibited.
The Babinski Reflex
This emerges during the first week of life and is inhibited or suppressed by 12 months after birth (24 at the very, very latest).
If you lift up a baby's foot and with a blunt probe go up the outside of the foot, then across to under the big toe, what you will find is that the toes fan and the big toe elevates.
This should be transformed into an adult Plantar reflex, and the test should result in a slight flicking of the toes.
It is associated with the upper motor neurons, the pyramidic tract.
The Abdominal Reflex
This emerges during the first week of life and should be inhibited or suppressed by 12 months after birth (24 months at the very latest).
If you stroke very lightly above the umbilicus (about 1 inch), it should go up towards the stimulation and then back down again.
It is linked with the upper motor neurons, the pyramidic tract.
It is difficult to elicit in older children who are overweight or very thin, in adults, and where abdominal surgery has been performed.
The Landau Reflex
This emerges at 4 - 6 weeks after birth and is inhibited or suppressed between 3 - 3.5 years.
Its purpose is to inhibit the TLR in extension. If it is still present, it indicates the presence of the TLR in extension - the Landau has not done its job.
Lie on the floor, lift up your head, arms, hands and the upper part of the trunk, but keep your toes touching the floor. If the toes come up when the upper part of the torso is raised then this indicates the presence of the TLR in extension.
The ability to track comes as the Landau is inhibited.
The Head Righting Reflexes
The oculo head righting reflex and the labyrinthine head righting reflex.
These start to emerge around 2 - 3 months after birth and remain throughout life.
When the baby is born it cannot hold its head up. If the trunk and head is not supported, the head goes to one side, flops and then the trunk follows it. The baby has no trunkal rotation. Between the second and third month the baby slowly starts to develop the ability to control the neck and the head. By six months this should be quite well established. This allows the baby to sit up on the floor. If the baby starts to fall over, sitting on the floor, the head should automatically come to the midline so that there is control over the trunk. If you go too far, the head should still help to control the trunk, but the arm still comes out in what is called the parachute defence reflex. The important thing here is not the defence reflexes but the fact that we should slowly develop a head righting reflex, because that gives us good control over the upper part of the body.
So no matter where the trunk is or the hips are, the head should automatically come to the midline. Because you have your eyes open you can see where you are in space, so the eyes feed the information back to the three semicircular canals, the labyrinth, so we call that the oculo head righting reflex. The child can use the eyes to reinforce the labyrinth.
If the eyes are closed, the labyrinth should correct the head anyway. One shouldn't have to think about it at all - it is an automatic reflex reaction. Because that is being done by the three semicircular canals it is called the labyrinthine head righting reflex.
If the TLR is still present, the Head Righting Reflexes (HRR) never emerge fully. It is the emergence of the HRR which helps the eyes to have initial stability. You can actually say, TLR: absence of the HRR = oculo motor dysfunction.
When testing the HRR backwards, you may see the TLR in extension, and when testing forwards, the TLR in flexion.
The Symmetrical Tonic Neck Reflex
This emerges around 9 - 11 months after birth and is inhibited or suppressed at about one year.
It has a very short, significant life. This is virtually the cat reflex. After the baby, ideally in development, has crawled on its stomach, around 9 - 11 months the developing brain releases the reflex to allow the baby to begin to defy gravity. Every time the baby looks up the bottom goes back onto the ankles, and every time the baby looks down the elbows bend and the head virtually hits the floor.
The sole task of the STNR is to get the child to begin to defy gravity.
If it remains it impedes, in some way, creeping on hands and knees. It is impossible to crawl if the STNR persists, and the child will be a "bottom hopper". If you test just for the STNR alone, it may be a good indication of neurological dysfunction. In around 75% of LD children there is a retained STNR.
When writing, the elbows bend and the head goes nearer and nearer to the writing surface. It also makes them messy eaters. When they are using a spoon and they put their head down, they do not have control over the hand and head movement, and therefore spill as much food as they put in their mouth. These people tend to compensate by lifting the spoon up and putting their head down.
The STNR has been associated with reading, writing and concentration problems. It will also affect copying and spelling and has a definite, noticeable effect on posture and movement. It is very closely tied in with the TLR.
The Amphibian Reflex
If you have a baby lying on its back and you lift up one arm to about 45 degrees, the knee on the side that you elevate bends. It is a preparation for rolling over, but the baby cannot roll over yet. It is the precursor for crawling on the tummy, to use the legs. If they do not have an amphibian reflex, they cannot bend the knee on that side to propel themselves along on the commando crawl.
The Segmental Rolling Reflexes
This starts to emerge around 6 - 10 months after birth and remains present throughout life.
If you bend the knee up and you push the knee slowly across the midline, the arm/body should follow through. This allows you to roll over.
Many children with coordination problems and dyspraxia do not have this. It is the ability to use one part of the body without other parts of the body on the same side locking in. So the SRR gives us that smooth, good, erect coordination of the body.
It has been suggested (Goddard, 1989) that these early Withdrawal Reflexes may be the earliest manifestation of a Fear Paralysis Reflex, described in detail by Kaada (1986) as a major factor in SIDS.
If retained, fear withdrawal can be elicited by minor stress, and is often present in autistic children. The response can also be triggered by major stress, such as an explosion.
The Moro Reflex
The first of the primitive reflexes, the Moro emerges around 8-9 weeks in utero and is inhibited at about 16 weeks of neonate life. It is transformed into the adult startle or Strauss reflex, and should not be present in children beyond one year at the very, very latest.
The Moro is a clasp reflex - the arms go out, and as the Moro becomes stronger, the arms come back in again. It is the clasping or bringing back of the arms which is the Moro. So there is a rapid intake of breath, out arms, legs to a lesser degree, freeze for a second, then back come arms and legs and then the baby screams the place down! It is a panic alarm reflex which helps the baby to hang on and cry in alarm. At birth the cortex is not wired up - we are a brain stem functioning, reflexive, floppy mass. Built into the brain stem is the Moro reflex to protect the new born child. As the baby cannot use the cortex to interpret the threat, the result is a panic response.
The Moro should be very strong at birth and during the first two months of life and should then be slowly inhibited by the developing brain so that by four months, in it crude form, it should no longer be present upon testing. It should slowly be more and more inhibited, and as it is inhibited over the next few months so what should emerge is the adult startle reflex.
Once the adult startle reflex has been developed, the individual will use the senses (eyes and ears) to locate the source of any perceived threat and will make an intellectual, cortical decision - should I be frightened or not? If the source cannot be located, a child may become worried and cry, but should not scream. The startle reflex is a rapid intake of breath, blink, shoulders up and then locate the source.
Agorophobia panic victims still retain the Moro, and it can be elicited by minor stress.
In its true infant form the Moro reflex can be activated by at least three things - a sudden noise (auditory Moro), movement (vestibular Moro) or change of light (visual Moro). The standard test for this reflex is vestibular, and the usual Moro that we see, or the primary one, is vestibular. That may be for the poulation we see, which is learning difficulties or panic victims.
As it is only suppressed (the primitive reflexes are always present), the Moro can be elicited by great stress. It will also reemerge in the event of a stroke or other brain injury or in pathology.
If a person grows up with a Moro but manages to control it, it affects the entire personality. They may need to ask question after question and are not happy about change unless they have instigated it. If they are going somewhere they want to know who will be there, what will happen and what they will have to do. They may be uptight and egocentric, not because they want to be, but because they need to be in control as much as possible. They also find it difficult to make relationships as they need to control the other person.
Quite often the Moro driven child, in addition to being immature, very sensitive, over reactive, and who often loses cortical control, has pupils which tend to remain enlarged under minimum stress. Obviously, if you are very anxious or very frightened (angst would be a better word), your pupils will be more dilated than normal because of the fight/flight mechanism, but you will still have some pupillary reaction to strong light, whereas with many of the children with a strong Moro, their pupils remain dilated and they are hypersensitive to light.
They do not know when to stop and do not learn from experience. The Moro affects the personality tremendously, and so has a very catastrophic effect it it remains present.
It is important to find out whether the Moro is vestibular, auditory or visual. Some SIDS babies do not have a Moro reflex - if distressed, they do not cry out - they simply die.
It is thought that if the Moro is present, then all of the following reflexes will possibly be there also.
The Palmar Reflex
This emerges at around 11 weeks in utero and is inhibited or suppressed at about 2-4 months after birth.
This reflex can be seen in a baby if you place your finger into the palm of the baby's hand. The thumb will come over and lock your finger, then the baby's other fingers will lock in the thumb and your finger very tightly. If you do this in both hands at the same time, the baby cannot let go. It is therefore possible to hang a baby from a washing line, but please do not try to do this!!!
The Palmar reflex should not be present beyond the first year of life, but if it remains present in children of school age, writing problems will develop. As soon as a pen or pencil is put into the child's hand, the fingers automatically tighten, and get tighter and tighter. The pressure increases on the paper and they start to lose control of the hand. It is no use telling them not to grip it so tightly! Writer's cramp is a likely result, and difficulty will be experienced in catching a ball. They may also not find it easy to juxtapose the fingers and thumb for rapid alternate movement, and if they cannot do this (dysdiadochokinesia), it shows that there is an immaturity of the cerebellum, and poor speech/language is a likely consequence. The cerebellum does not cross over, and so if you cannot do the movement on the right side, it shows that there is a problem in the right side of the cerebellum.
The Plantar Reflex
This emerges at around 11 weeks in utero and is inhibited or suppressed between 7-9 months after birth.
This reflex can be seen in a baby if you place your finger or a stimulus into the metatarsal arch of the foot. The ball of the foot drops and the heel comes in and the baby actually locks your finger, grasping it with the feet.
If the Plantar reflex remains present you are bound to have gravitational insecurity - it will affect stabiity and posture. It has been shown that balance may not be just regulated by the semicircular canals, but can be affected from the feet up.
The Asymmetrical Tonic Neck Reflex
Also known as the Tonic Neck Reflex (TNR), this emerges at around 18 weeks in utero and is inhibited or suppressed between 6-8 months after birth, while awake. It persists up to three and a half years while asleep.
The ATNR fulfils many purposes. With a baby, lying on the back, gently rotate the head to one side. The jaw arm would slowly extend, the jaw hand and fingers would also slowly extend. The jaw leg would extend, but not as much as the arm. The occipital (the back of the head) arm and leg would bend. This is the "kick" the mother feels, and it should get stronger and stronger as birth approaches. It has been suggested that one of its primary functions is to assist in the birth process - the rotation of the head allows the shoulders to move, and therefore the baby moves in a spiral down the birth canal.
The ATNR may also help survival. When a baby is placed prone, it should not go into the "frog" position. The head should go to one side, with extension of the jaw arm and leg. This allows free passage of air.
The ATNR is the first training ground for eye-hand coordination. When a baby is born it can only focus its eyes at about eight inches. Outside of that the baby can see movement and shadow, but it cannot focus. Through the ATNR, the baby slowly extends the vision from near point fixation to distance, and therefore this is vital for eye-hand coordination training.
If the ATNR remains strongly present it might affect vision. The hand does not want to cross the midline, and as the eyes are locked in to the hands, they do not want to cross the midline either. In crawling, the child is unable to reach and then bend the elbow to drag itself along (it is physiologically impossible to creep, commando style). In creeping, the arms need to remain straight, but the ATNR causes a bending of the occipital arm. In grasping, when the baby looks at the object, the fingers will want to straighten out.
Judging distance will also be difficult. If present in the legs, walking will be affected, and the child will tend to walk with a stiff leg gait. When at school, catching a ball (bringing the hands together at the midline) will be affected. When the head turns right, the left knee will bend and therefore disturb balance. Writing and copying problems will also be seen. Gross and fine muscle coordination and eye tracking will also be affected. It is clear, therefore, that the ATNR can have a very severe effect.
If the cortex is damaged for any reason, the ATNR is released.
The Spinal Galant Reflex
This emerges around 20 weeks in utero and should be inhibited or suppressed between 3 - 9 months after birth.
It has been suggested that this reflex also facilitates the birth process. As the baby is working down the birth canal, and as the vaginal wall touches part of the back, on the side that is stimulated you will get hip rotation. It may also play a large part in helping the hip ball and socket to grind in. At birth the ball and socket are not properly formed.
It may play a large part in sound or vibration conduction in utero. It is believed that the Galant is very primitive, like a fish out of water going from side to side. However, we don't know sufficient about this reflex. After two half hour sessions of Auditory Integrative Training (AIT) for ten days, the Galant is gone.
The Galant is involved in movement and in micturation. If it remains present, either unilaterally or bilaterally, it may cause fidgeting, make sitting up difficult (even with a nappy touching the back), lead to problems when walking and bed wetting, in addition to affecting posture. There may also be a psychological effect. If present strongly on one side only, posture may be affected resulting in curvature of the spine.
A child with the Galant who is told to sit still may start to make a noise. They have to be doing something - the internal excitement is too great.
The Rooting and Suck Reflexes
These emerge around 24 - 28 weeks in utero and are inhibited or suppressed between 3 -4 months after birth.
In the new born, gentle stimulation down the facial fold in the area of the cheek will result in the baby's mouth moving and its head turning towards the stimulation.
The rooting relex and suck reflex work together, and are vital for locating and then being able to take the mother's breast.
In the new born, because the baby has no voluntary control at this point, built into the brain stem is an infant sucking reflex so that if anything touches the nasal fold, automatically the lips come out.
Premature babies, and some full term babies have not developed the suck reflex. Something may have happened in utero to prevent its emergence.
By around 4 months, the baby should have developed sufficient control in the oral region to be able to control the lips and go into voluntary as opposed to reflexive suck.
Many children who have verbal dyspraxia, articulation problems or who are dribblers, still have a retained rooting reflex on one side or a sucking reflex.
The rooting and suck reflexes do not contribute to learning difficulties, but if retained, they do indicate an immaturity in the central nervous system.
The Tonic Labyrinthine Reflex
This emerges around 3 - 4 months in utero (in flexion, or forwards - top picture) and at birth (in extension, or backwards - bottom picture) and is inhibited or suppressed between 3 -4 months after birth (in flexion) and 3 - 4 months to 3 and a half years (in extension).
TLR in flexion - if we had a new born baby lying on its back, and its head was gently lifted up above the level of the back, as you lifted the head up the knees would come up and the baby would go into a foetal form (flexus habitus - seen in utero).
TLR in extension - if we have a baby lying on its back and you slowly lowered the baby's head below the level of the back, you get the exact opposite from flexion. As the head goes back, so the legs and the feet stretch out, and the arms and hands stretch out into a near crucifixion position.
The TLR in extension is present at birth, and gets stronger over the next ten days. When the baby breaks out of flexus habitus, the head has to go back to get into the birth canal. With an elective caesarean section, the head has not gone into TLR in extension position. If there is an emergency caesarean, and the head has engaged, the TLR in extension has been activated.
If you have the TLR in extension you will be a "flopper". There can be a devastating effect on many functions if the TLR remains present - eyes, balance, proprioception.
The ability to track smoothly and evenly with eyes only comes as the TLR in extension is inhibited.
The Babinski Reflex
This emerges during the first week of life and is inhibited or suppressed by 12 months after birth (24 at the very, very latest).
If you lift up a baby's foot and with a blunt probe go up the outside of the foot, then across to under the big toe, what you will find is that the toes fan and the big toe elevates.
This should be transformed into an adult Plantar reflex, and the test should result in a slight flicking of the toes.
It is associated with the upper motor neurons, the pyramidic tract.
The Abdominal Reflex
This emerges during the first week of life and should be inhibited or suppressed by 12 months after birth (24 months at the very latest).
If you stroke very lightly above the umbilicus (about 1 inch), it should go up towards the stimulation and then back down again.
It is linked with the upper motor neurons, the pyramidic tract.
It is difficult to elicit in older children who are overweight or very thin, in adults, and where abdominal surgery has been performed.
The Landau Reflex
This emerges at 4 - 6 weeks after birth and is inhibited or suppressed between 3 - 3.5 years.
Its purpose is to inhibit the TLR in extension. If it is still present, it indicates the presence of the TLR in extension - the Landau has not done its job.
Lie on the floor, lift up your head, arms, hands and the upper part of the trunk, but keep your toes touching the floor. If the toes come up when the upper part of the torso is raised then this indicates the presence of the TLR in extension.
The ability to track comes as the Landau is inhibited.
The Head Righting Reflexes
The oculo head righting reflex and the labyrinthine head righting reflex.
These start to emerge around 2 - 3 months after birth and remain throughout life.
When the baby is born it cannot hold its head up. If the trunk and head is not supported, the head goes to one side, flops and then the trunk follows it. The baby has no trunkal rotation. Between the second and third month the baby slowly starts to develop the ability to control the neck and the head. By six months this should be quite well established. This allows the baby to sit up on the floor. If the baby starts to fall over, sitting on the floor, the head should automatically come to the midline so that there is control over the trunk. If you go too far, the head should still help to control the trunk, but the arm still comes out in what is called the parachute defence reflex. The important thing here is not the defence reflexes but the fact that we should slowly develop a head righting reflex, because that gives us good control over the upper part of the body.
So no matter where the trunk is or the hips are, the head should automatically come to the midline. Because you have your eyes open you can see where you are in space, so the eyes feed the information back to the three semicircular canals, the labyrinth, so we call that the oculo head righting reflex. The child can use the eyes to reinforce the labyrinth.
If the eyes are closed, the labyrinth should correct the head anyway. One shouldn't have to think about it at all - it is an automatic reflex reaction. Because that is being done by the three semicircular canals it is called the labyrinthine head righting reflex.
If the TLR is still present, the Head Righting Reflexes (HRR) never emerge fully. It is the emergence of the HRR which helps the eyes to have initial stability. You can actually say, TLR: absence of the HRR = oculo motor dysfunction.
When testing the HRR backwards, you may see the TLR in extension, and when testing forwards, the TLR in flexion.
The Symmetrical Tonic Neck Reflex
This emerges around 9 - 11 months after birth and is inhibited or suppressed at about one year.
It has a very short, significant life. This is virtually the cat reflex. After the baby, ideally in development, has crawled on its stomach, around 9 - 11 months the developing brain releases the reflex to allow the baby to begin to defy gravity. Every time the baby looks up the bottom goes back onto the ankles, and every time the baby looks down the elbows bend and the head virtually hits the floor.
The sole task of the STNR is to get the child to begin to defy gravity.
If it remains it impedes, in some way, creeping on hands and knees. It is impossible to crawl if the STNR persists, and the child will be a "bottom hopper". If you test just for the STNR alone, it may be a good indication of neurological dysfunction. In around 75% of LD children there is a retained STNR.
When writing, the elbows bend and the head goes nearer and nearer to the writing surface. It also makes them messy eaters. When they are using a spoon and they put their head down, they do not have control over the hand and head movement, and therefore spill as much food as they put in their mouth. These people tend to compensate by lifting the spoon up and putting their head down.
The STNR has been associated with reading, writing and concentration problems. It will also affect copying and spelling and has a definite, noticeable effect on posture and movement. It is very closely tied in with the TLR.
The Amphibian Reflex
If you have a baby lying on its back and you lift up one arm to about 45 degrees, the knee on the side that you elevate bends. It is a preparation for rolling over, but the baby cannot roll over yet. It is the precursor for crawling on the tummy, to use the legs. If they do not have an amphibian reflex, they cannot bend the knee on that side to propel themselves along on the commando crawl.
The Segmental Rolling Reflexes
This starts to emerge around 6 - 10 months after birth and remains present throughout life.
If you bend the knee up and you push the knee slowly across the midline, the arm/body should follow through. This allows you to roll over.
Many children with coordination problems and dyspraxia do not have this. It is the ability to use one part of the body without other parts of the body on the same side locking in. So the SRR gives us that smooth, good, erect coordination of the body.
Plantar Facitis
Plantar Fasciitis
What Is Plantar Fasciitis? Plantar fasciitis is pain on the bottom of the heel that usually is felt on the first step out of bed in the morning or when walking again after resting from a walking or running activity. However, plantar fasciitis pain can, if it persists, soon be felt any time you are walking, running or jumping. Although the pain is mostly felt at the bottom of the heel, it can radiate down the entire bottom of the foot towards the toes. The Anatomy Of The Plantar Fascia The plantar fascia consists of dense bands of tissue deep below the skin that extend out in a fan like fashion from the heel bone to the toes. If you pull your toes and foot up towards your head, you will feel this tissue tighten. What Causes Plantar Fasciitis? Plantar fasciitis is thought to be caused by repetitive stretching of the tight bands of the plantar fascia which result in microtears in these bands as they arise from the heel. Because these tears don’t occur from a single traumatic event, they do not result in an immediate healing reaction, but instead result in chronic irritation or inflammation which increases with activity. A sudden weight gain may also increase stress to an otherwise normal plantar fascia. Pulling of the tight plantar fascia on the heel bone during activity can result in the formation of a bone spur off the tip of the heel bone at the origin of the plantar fascia tissue. This bone spur itself is not the cause of pain, but rather the result of chronic irritation to the bone caused by the stretching of the tight tissue. Treatment Tips Surgery is rarely necessary to treat plantar fasciitis. To decrease your pain and symptoms, you may want to:
Taping the heel and arch may also help. Custom shoe inserts may be needed to support the arch and the heel.
Increase the flexibility of the plantar fascia and calf muscles by doing stretching exercises. Tight calf muscles increase the stress on the plantar fascia and predispose you to plantar fasciitis.
Stretch the calf muscle as well as the plantar fascia by standing on a step with only the front of the foot supported on the step and the heel free. Hold onto the rail for support and then slowly lower your heels toward the lower step. You should feel this in the calf muscle and in the plantar fascia. Hold the stretch for a count of 10, then slowly return the heel to the level of the rest of the foot. Repeat slowly 10 times.
Massage the plantar fascia by rolling your foot over a round tube-like object with a diameter of 3 to 4 inches. A rolling pin works nicely for this stretch.
Strengthen the muscles of the foot and ankle that support the arch. One way to do this is to scrunch up a hand towel with your toes or use your toes to pull a towel weighted with a food can across the floor.
Warm up well before stretching. Cold tissues cannot stretch as effectively. After stretching, ice your heel for 20 to 30 minutes at the point of maximum tenderness to decrease any inflammation that may result from too vigorous a workout.
Take oral anti-inflammatory medications such as aspirin or ibuprofen to decrease the inflammation caused by the irritation of the plantar fascia and decrease your symptoms so that you can stretch and increase your flexibility. In some cases, your physician may recommend a prescription anti-inflammatory for you.
Try a night splint. These devices, prescribed by your physician, keep the foot flexed at 90 degrees instead of the typical relaxed foot position of toes pointed down that occurs during sleep. Wearing a splint may lessen the pain of the first step in the morning.
Massage the heel with a sports cream which may lessen symptoms. A variety of therapeutic treatments can also be administered by a physical therapist.
How To Prevent Plantar Fasciitis
Don't try running to lose weight after a rapid weight gain. Walk first, and stretch the muscles of the foot and calf to help condition your body before running.
Wear good, supportive shoes for your athletic activities.
Always warm up well and stretch before participating in sports.
Keep the muscles of your feet and ankles strong to support your arch.
Rest from activities that cause pain to the heel, ice and support the heel. Begin the appropriate exercises as soon as possible.
See your physician if pain persists despite these measures.
This Sports Tip is a joint endeavor of the American Orthopaedic Society for Sports Medicine and the National Athletic Trainers Association to promote the health and safety of athletes. Copyright 1997 American Orthopaedic Society for Sports Medicine
What Is Plantar Fasciitis? Plantar fasciitis is pain on the bottom of the heel that usually is felt on the first step out of bed in the morning or when walking again after resting from a walking or running activity. However, plantar fasciitis pain can, if it persists, soon be felt any time you are walking, running or jumping. Although the pain is mostly felt at the bottom of the heel, it can radiate down the entire bottom of the foot towards the toes. The Anatomy Of The Plantar Fascia The plantar fascia consists of dense bands of tissue deep below the skin that extend out in a fan like fashion from the heel bone to the toes. If you pull your toes and foot up towards your head, you will feel this tissue tighten. What Causes Plantar Fasciitis? Plantar fasciitis is thought to be caused by repetitive stretching of the tight bands of the plantar fascia which result in microtears in these bands as they arise from the heel. Because these tears don’t occur from a single traumatic event, they do not result in an immediate healing reaction, but instead result in chronic irritation or inflammation which increases with activity. A sudden weight gain may also increase stress to an otherwise normal plantar fascia. Pulling of the tight plantar fascia on the heel bone during activity can result in the formation of a bone spur off the tip of the heel bone at the origin of the plantar fascia tissue. This bone spur itself is not the cause of pain, but rather the result of chronic irritation to the bone caused by the stretching of the tight tissue. Treatment Tips Surgery is rarely necessary to treat plantar fasciitis. To decrease your pain and symptoms, you may want to:
Taping the heel and arch may also help. Custom shoe inserts may be needed to support the arch and the heel.
Increase the flexibility of the plantar fascia and calf muscles by doing stretching exercises. Tight calf muscles increase the stress on the plantar fascia and predispose you to plantar fasciitis.
Stretch the calf muscle as well as the plantar fascia by standing on a step with only the front of the foot supported on the step and the heel free. Hold onto the rail for support and then slowly lower your heels toward the lower step. You should feel this in the calf muscle and in the plantar fascia. Hold the stretch for a count of 10, then slowly return the heel to the level of the rest of the foot. Repeat slowly 10 times.
Massage the plantar fascia by rolling your foot over a round tube-like object with a diameter of 3 to 4 inches. A rolling pin works nicely for this stretch.
Strengthen the muscles of the foot and ankle that support the arch. One way to do this is to scrunch up a hand towel with your toes or use your toes to pull a towel weighted with a food can across the floor.
Warm up well before stretching. Cold tissues cannot stretch as effectively. After stretching, ice your heel for 20 to 30 minutes at the point of maximum tenderness to decrease any inflammation that may result from too vigorous a workout.
Take oral anti-inflammatory medications such as aspirin or ibuprofen to decrease the inflammation caused by the irritation of the plantar fascia and decrease your symptoms so that you can stretch and increase your flexibility. In some cases, your physician may recommend a prescription anti-inflammatory for you.
Try a night splint. These devices, prescribed by your physician, keep the foot flexed at 90 degrees instead of the typical relaxed foot position of toes pointed down that occurs during sleep. Wearing a splint may lessen the pain of the first step in the morning.
Massage the heel with a sports cream which may lessen symptoms. A variety of therapeutic treatments can also be administered by a physical therapist.
How To Prevent Plantar Fasciitis
Don't try running to lose weight after a rapid weight gain. Walk first, and stretch the muscles of the foot and calf to help condition your body before running.
Wear good, supportive shoes for your athletic activities.
Always warm up well and stretch before participating in sports.
Keep the muscles of your feet and ankles strong to support your arch.
Rest from activities that cause pain to the heel, ice and support the heel. Begin the appropriate exercises as soon as possible.
See your physician if pain persists despite these measures.
This Sports Tip is a joint endeavor of the American Orthopaedic Society for Sports Medicine and the National Athletic Trainers Association to promote the health and safety of athletes. Copyright 1997 American Orthopaedic Society for Sports Medicine
Daniel Sadana.Fisioterapis
Daniel Sadana
Fisioterapis
INGIN bayi Anda sehat dan bugar? Coba ajak si kecil berolahraga. Konon senam bayi bisa menjadi pilihan buat sang buah hati Anda untuk tumbuh menjadi anak yang aktif dan lincah. Menggerakkan otot-otot tubuh dan persendian tubuh menjadi inti senam. Ya, prinsip ini pulalah yang dianut dalam senam bayi. Dr Amendi Nasution SpRM menjabarkan, senam bayi sebagai gerakan-gerakan yang dilakukan pada bayi, terutama persendirian tulang dan otot, agar bayi siap menghadapi tahap perkembangannya. "Bayi usia empat bulan sudah bisa tengkurap. Lalu masuk tahap duduk, sekitar tujuh sampai delapan bulan bulan. Mulai berdiri dan merambat pada usia 10 bulan. Baru pada usia 12 bulan, bayi bisa berjalan," gamblang Amendi, dokter spesialis rehabilitasi medik, RSUPN Cipto Mangunkusumo (RSCM).Sependapat dengan Amendi, ahli fisioterapi RS Azra, Bogor, Daniel Sadana mengatakan, senam bayi sebagai stimulasi dalam permainan gerakan yang merangsang kemampuan gerak bayi dan tumbuh kembangnya berdasarkan ilmu syaraf motorik. Mungkin Anda melihat si kecil sudah lincah bergerak. Meski begitu, Anda tidak boleh asal memberikan senam bayi pada buah hati. Mengapa? "Di bawah usia tiga bulan, kepala bayi masih lemah. Kalaupun ada gerakan-gerakan tertentu bisa disebut gerakan refleks. Sehingga idealnya senam bayi dilakukan saat bayi Anda usianya di atas tiga bulan," terang Daniel, selaku Koordinator Rehabilitasi Medik Anak itu. Amendi membagi senam bayi dalam tiga tahap. Tahap pertama, senam bayi tengkurap ke arah duduk. Tahap kedua, bayi usia enam sampai sembilan bulan, senam melatih bayi bisa duduk sendiri dan berdiri. Tahap ketiga, senam bayi mempersiapkan bayi bisa rambatan dan jalan mandiri.Tentu saja, bayi perlu distimulasi untuk melakukan gerak sesuai tahapan perkembangannya. "Belajar merangkak pada bayi usia enam sampai Sembilan bulan, bisa dirangsang dengan posisi berlutut sembari memberikan mainan di depannya yang agak tinggi. Kalau bayi 9-12 bulan yang belajar berdiri, bisa distimulasi dari posisi tengkurap untuk meraih obyek yang lebih tinggi. Lalu, meraih dan menekuk kakinya," beber Daniel. Lagi lanjutnya, bayi yang bisa berdiri, supaya tubuhnya mulai bergerak bisa dibiarkan memegang meja atau kursi yang digerakkan Anda. Manfaat Senam Bayi Tentu saja, tujuan senam bayi adalah merangsang tumbuh kembang anak dan kemampuan gerak bayi optimal. Masih ada lagi manfaat lainnya, sebut Amendi, melatih otot dan persendian, memperlancar peredaran darah, menjaga kinerja jantung, melatih kewaspadaan terhadap situasi dan posisi, artinya menjaga keseimbangan tubuh agar tidak gampang jatuh. Yang terpenting, lewat sentuhan senam bayi mempererat hubungan anak dan orangtua. "Bisa mengetahui perkembangan motorik kasar pada bayi, bahkan dapat mendeteksi keterlambatan motorik kasar," timpal Daniel. Umpamanya saja, anak usia sembilan bulan, saat melakukan senam bayi, anak belum bisa duduk. Berarti, ada yang salah pada tahap perkembangan yang seharusnya. Bisa dikatakan ada sesuatu yang bersifat patologis. Orangtua mesti curiga terhadap kelainan pada anaknya. Senam bayi tidak bisa dipaksakan kepada anak. Kuncinya senam bayi yang ideal bagi anak adalah kenyamanan. "Bayi diletakkan dalam alas yang empuk, bayi lapar, bayi habis makan, bayi sakit, kondisi tangan pun steril dan tidak memakai perhiasan," ujar Daniel mengenai hal-hal yang mesti diperhatikan orangtua saat melakukan senam bayi.
Fisioterapis
INGIN bayi Anda sehat dan bugar? Coba ajak si kecil berolahraga. Konon senam bayi bisa menjadi pilihan buat sang buah hati Anda untuk tumbuh menjadi anak yang aktif dan lincah. Menggerakkan otot-otot tubuh dan persendian tubuh menjadi inti senam. Ya, prinsip ini pulalah yang dianut dalam senam bayi. Dr Amendi Nasution SpRM menjabarkan, senam bayi sebagai gerakan-gerakan yang dilakukan pada bayi, terutama persendirian tulang dan otot, agar bayi siap menghadapi tahap perkembangannya. "Bayi usia empat bulan sudah bisa tengkurap. Lalu masuk tahap duduk, sekitar tujuh sampai delapan bulan bulan. Mulai berdiri dan merambat pada usia 10 bulan. Baru pada usia 12 bulan, bayi bisa berjalan," gamblang Amendi, dokter spesialis rehabilitasi medik, RSUPN Cipto Mangunkusumo (RSCM).Sependapat dengan Amendi, ahli fisioterapi RS Azra, Bogor, Daniel Sadana mengatakan, senam bayi sebagai stimulasi dalam permainan gerakan yang merangsang kemampuan gerak bayi dan tumbuh kembangnya berdasarkan ilmu syaraf motorik. Mungkin Anda melihat si kecil sudah lincah bergerak. Meski begitu, Anda tidak boleh asal memberikan senam bayi pada buah hati. Mengapa? "Di bawah usia tiga bulan, kepala bayi masih lemah. Kalaupun ada gerakan-gerakan tertentu bisa disebut gerakan refleks. Sehingga idealnya senam bayi dilakukan saat bayi Anda usianya di atas tiga bulan," terang Daniel, selaku Koordinator Rehabilitasi Medik Anak itu. Amendi membagi senam bayi dalam tiga tahap. Tahap pertama, senam bayi tengkurap ke arah duduk. Tahap kedua, bayi usia enam sampai sembilan bulan, senam melatih bayi bisa duduk sendiri dan berdiri. Tahap ketiga, senam bayi mempersiapkan bayi bisa rambatan dan jalan mandiri.Tentu saja, bayi perlu distimulasi untuk melakukan gerak sesuai tahapan perkembangannya. "Belajar merangkak pada bayi usia enam sampai Sembilan bulan, bisa dirangsang dengan posisi berlutut sembari memberikan mainan di depannya yang agak tinggi. Kalau bayi 9-12 bulan yang belajar berdiri, bisa distimulasi dari posisi tengkurap untuk meraih obyek yang lebih tinggi. Lalu, meraih dan menekuk kakinya," beber Daniel. Lagi lanjutnya, bayi yang bisa berdiri, supaya tubuhnya mulai bergerak bisa dibiarkan memegang meja atau kursi yang digerakkan Anda. Manfaat Senam Bayi Tentu saja, tujuan senam bayi adalah merangsang tumbuh kembang anak dan kemampuan gerak bayi optimal. Masih ada lagi manfaat lainnya, sebut Amendi, melatih otot dan persendian, memperlancar peredaran darah, menjaga kinerja jantung, melatih kewaspadaan terhadap situasi dan posisi, artinya menjaga keseimbangan tubuh agar tidak gampang jatuh. Yang terpenting, lewat sentuhan senam bayi mempererat hubungan anak dan orangtua. "Bisa mengetahui perkembangan motorik kasar pada bayi, bahkan dapat mendeteksi keterlambatan motorik kasar," timpal Daniel. Umpamanya saja, anak usia sembilan bulan, saat melakukan senam bayi, anak belum bisa duduk. Berarti, ada yang salah pada tahap perkembangan yang seharusnya. Bisa dikatakan ada sesuatu yang bersifat patologis. Orangtua mesti curiga terhadap kelainan pada anaknya. Senam bayi tidak bisa dipaksakan kepada anak. Kuncinya senam bayi yang ideal bagi anak adalah kenyamanan. "Bayi diletakkan dalam alas yang empuk, bayi lapar, bayi habis makan, bayi sakit, kondisi tangan pun steril dan tidak memakai perhiasan," ujar Daniel mengenai hal-hal yang mesti diperhatikan orangtua saat melakukan senam bayi.
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