THE EFFECT OF STNR (SYMMETRICAL TONIC NECK REFLEX)

THE EFFECT OF STNR (SYMMETRICAL TONIC NECK REFLEX):

STNR

Patient Story:

Recently we had a patient in our clinic named Umar, a 4 year old boy. His parents were stressed that the boy was walking and even running but he always keeps his both hands flexed, especially when he was walking. Such postural attitude was not severe when he was sitting. Other than just this complaint he was active and also with good communication. In fact he was a good learner. He was also walking with in-toeing.

We examined him and found that his STNR was not properly integrated and hence his more complex pattern of postural response was not achieved. We explained the patient about pediatric reflexes and their impact made on child’s growth. Reassured them as this was not late and it can be channeled and integrated for his proper functional improvement.

Now lets us know about STNR. What is it?

How does an infant develop the ability to get from his tummy up onto hands and knees? Its thanks to Symmetrical Tonic Neck Reflex (STNR). This reflex emerges at about six to nine months after birth. During this time, when the infant is on his tummy and lifts his head, his arms automatically straighten and his legs automatically bend, leaving him sitting back on his heels. But conversely, when he tilts his head down, the opposite actions reflexively manifest: his arms bend and his legs straighten, elevating his rear end. Over time, these movements are refined into a fluid motion that brings him up from his tummy into a stable all-fours posture, in preparation for crawling.

By the time the infant is about nine to eleven months of age, these reflexive movements will have done their work, and his head movement no longer triggers automatic bending or straightening of his arms and legs. He’s ready now for independent crawling, which learning specialists agree is the foundation for cross-lateral integration: the ability to coordinate the use of both brain hemispheres for easy learning.

Now let us look in to the patient story. Points noted on examination were:

1.       Difficult cross lateral integration.

2.       Preferred ‘W’ sitting which was the reason for in-toeing due to internal femoral rotation and flat feet.

3.       He did not perform crawling on his normal development before he started walking. This was the main reason for him not developing a good cross lateral integration.

4.       Poor eye-hand coordination.

W-Sitting

Note: These children if not treated on right time they will be very poor performers in their schooling and other life activities. By time they isolate themselves and will have problems added up.

Our patient was treated with reflex integration therapy and gait training weekly twice and with proper advices for his parents on handling him and home exercises.

Results: Significant results were achieved after a period of 2 months, where he started to extend his hands on walking and attitude of in-toeing started decreasing. Also he showed interests in these activities. Later hand function home therapies were added. He is following with us in the same 2 weeks per session. He is making himself ready for his schooling in another 4 months.

Now let us see some more on retained STNR that we may have encountered with children in their normal day to day life.

1.     Agitated and unable to focus when sitting for any length of time.

2.     More comfortable when standing.

3.     When sitting, prefers postures that allow legs to be straight.

4.     On the floor, prefers “w” sitting, with feet tucked back on either side.

5.     Poor eye-hand coordination.

6.     Poor at sports, especially swimming (raising head to breathe causes arms to automatically stiffen).

7.     Difficulty copying from the board (rapid adjustment of near to far focus).

8.     Muscle tension in neck and shoulder.

9.     Legs on the move, or twisted around chair legs.

10.   Skipping the infant crawling stage.

Sitting at desk with STNR

Wandering with pain inside hospital

Welcome to my dear readers! In this very first article of mine I wish to share a true clinic experience of mine and some explanations regarding that.

Now at present I am practicing in Oman. This happened five years back when I was practicing in India. I got one patient with back pain and neck pain (suffering for 13 years). The pain for her was so much and she was living with that pain, or to be more specific, she was forced to live with that pain. It was not that she didn’t opt for medical services in all these days. She had a long medical history. She took treatment by the advice of a physician (orthopedic). Initially she was treated with analgesics (pain medication). As she had no improvement she was continuing the medication whenever she gets pain, but only for a temporary relief. Later on she had pain in her shoulders hip and knee joint. The doctor had tested her for TB (Tuberculosis) of the spine. It was negative and still on doubt he started her with ATT (Anti-Tuberculosis therapy) for 6 months. Even after 6 months she had pain and he added an another 6 months course in vain. This was her history when she came to us. On physical therapy postural and muscular assessment we found that she had lower crossed syndrome and forward head posture(a disorder of the muscles due to chronic faulty posture). This was the reason for her chronic and never ending neck and back pain. Once the position of your spine shifts from normal then it will affect your other joints from shoulder, hip and so on. The physician should have referred her to Physical therapy. But on all these years she did not have even one session of physical therapy. Now the treatment for her will be to correct the faulty posture of her body by muscular exercises (strengthening and stretching as per individual need) and specific physical modalities to reduce her pain. More than therapy assessment of the condition by a person with sound knowledge in the science of biomechanics in important, by which he can land with an appropriate plan of action.Though will be a little long term process she can be rehabilitated at least from her debilitating pain. This will be done by a physical Therapist. This is the story.

Now I wish to share my views. First of all I am not against any  physicians or other medical professionals. Everybody is good on their job i.e. if done without taking unnecessary extra responsibility or by underestimating others responsibility. The physician’s job is well ahead of Physical therapists and I personally love them. But in this case I think I don’t have to explain further as the story is very clear. My point is that Physical therapists are specialists in biomechanics of the human body and also with sound knowledge of all the diseases affecting the human body and are with high potency to serve the community on their limits independently. Now why I have to specify independence is that if done under others supervision or advice the patient would have been deprived of her right to be treated due to some unwanted ego. With good cooperation we can serve the community better. Will meet you in another interesting article. Until then stay healthy! stay aware!