In the last section on General Movement in his manual, Dr. Wachs elaborates on activities targeted to specific reflexes. He begins with the Asymmetric Tonic Neck Reflex (ATNR) and the first activity is Bear Walk. The patient stands upright and bends forward at the waist, touching the floor with his hands. The head should remain upright with the soles and heels of the feet flat on the floor. He moves forward, backward, right, left, and then pivots. The feet may be spread to help maintain the center of gravity in the torso, but balance should be maintained by “steering” with the hands rather than relying on the feet. As the body is propelled forward by the hands, the patient should be able to move arms and legs simultaneously. This should be done both “same”, in which the right arm and right leg are moving simultaneously, alternating with left arm and left leg in sequence, as well as “not same”, in which left arms moves synchronously with right leg, as one does in cross country skiing.
Crab Walk. Here’s a nice brief video off the net of an adult doing crab walk. In his manual Harry notes that with palms flat on the floor, fingers should be pointed forward toward the feet. This is basically the bear walk flipped upside down, with all body parts parallel to the floor. move forward, backward, right, left, and pivot. This should be done both “same”, in which the right arm and right leg are moving simultaneously, alternating with left arm and left leg in sequence, as well as “not same”, in which left arms moves synchronously with right leg
Inchworm. The video below is a perfect demonstration of the inchworm. Note that when the hands are moving the feet are still and vice-versa. Harry emphasizes that hands and feet should not move simultaneously as in the Bear Walk. Specify how many steps are to be taken, and whether with hands or feet – such as in this video it would be take six hand steps forward; now take six feet steps forward. Note that these are tiny movements of the feet and hands rather than strides.
Wall Walk. Make a vertical line on a wall with masking tape and have the patient stand with feet flat on the floor and far enough from the wall so that his arms and hands bear the body weight. Place hands on the wall on either side of the tape. Instruct patient to walk his hands up the wall alternately until fully extended, then back down again. Soles of the feet should remain flat on the floor. Repeat this with feet turned out and hands turned in, then with feet turned in and hands turned out. Mark some index cards as “R” and “L”, and place them on the wall with random spacing. Have the patient do the wall walk touching the “R” card with the right hand and the “L” card with the left hand.
Ankle Grab. While standing, patient bends forward and grasps right ankle with right hand and left ankle with left hand. Walk around in that position first. The different directions to try are forward, backward, sideways, right, left, and pivot. Then repeat the procedure with right hand grasping left ankle and left hand grasping right ankle.
Wheelbarrow. Patient has hands flat on the floor with fingers pointing forward. Grasp his ankles and lift them up, allowing him to support himself with arms and upper body only. Many of you will remember this position from having “wheelbarrow races” as kids in camp! Direct the patient to walk in different directions – follow a straight line, criss-cross, walk on R & L cards (see Wall Walk above) or solve a maze. When he’s good at this, place some obstacles in his path to get around. Then have some manipulatives to pick up, such as cubes or balls, and place in a container while he has to maintain balance with the other arm. Have some fun!
The next section of activities is oriented toward the Tonic Labyrinthine Reflex (TLR). The first activity is Log Roll. The child begins lying on his back, legs sretched straight out, with arms at his side. He rolls around like a log, following a designated path about 10 feet long. Once he can do this, have him roll around a corner. First keep the head on the line as the pivot point, then try feet as the pivot point.
Tasmanian Devil. This sounds like fun, doesn’t it? I mean, just the name alone has to get kids excited!
Okay, boys and girls, it’s time for some post-rotary nystagmus! The child is seated in something that spins, such as a swivel chair. His legs should cross at his thighs, with arms crossed over his chest – right arm on top of left arm and right leg on top of left leg). Bow the head slightly forward and keep eyes closed. Spin the chair to the right for 30-60 seconds, intermittently tapping his shoulder gently. Tell him before you begin that you’ll be asking him to count the number of times you tapped when the spinning stops. You should stop with him facing the same direction as when he started. When that is completed, cross left arm on top of right arm and left leg on top of right leg, and repeat the procedure.
Some patients with poorly integrated vestibular systems will experience persistence of post-rotary nystagmus resulting in dizziness. You should note that fixating on a target – particularly converging to a near target, stops the post-rotary nystagmus if the VOR is intact and there is good visual-vestibular interaction. I don’t see that Harry addresses this directly, but I suspect he would agree, that in some cases – particularly adults with ABI having reflex integration problems, work with a vestibular rehabilitation specialist may be required if there is abnormal persistence of post-rotary nystagmus and dizziness even though ocular convergence is normal.
Roly Poly. Child lies on floor on his back, knees held against his chest. He grasps his legs with his arms under his knees, locking his hands around his wrists. He then shifts his body weight by rocking slowly side to side until he develops enough momentum to completely roll over sideways. Once in motion he continues this, rolling around the room.
Dr. Wachs finishes General Movement with activities for the Symmetric Tonic Reflex, Spinal Gallant Reflex, and Hand-Feet Postural Reflex. Time for me to head off for some morning Starbucks Coffee!