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