help! anoxic brain injury with high tendency of extension

[caramel2d]

dear all, i'm now working on an adult case with anoxic brain damage who has mental retardation. he seemingly presents some primitive reflexes after the injury e.g. grasp reflex, TLR, ATNR. he can't stand at all and when i tried to get him sit, he just kept leaning back and sliding out. then i tried out some mat exercise e.g. bridging, curl-up however the performance wasn't consistent.

can anybody give some light on what else i should try? how about his prognosis?? he is a suicidal case with old parents, i want very much to help him, please help.

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[Rajul vasa]

what is the age of the patient and how long is the problem?
Do u have some one to assist u?

Rajul Vasa
www.brainstrokes.com

[caramel2d]

the patient is young at his 20, the incident happened 2 or 3 yrs ago. i'm working on him and some assistants may help

[neurospast]

in order to make him sit you might have to make it more interesting to sit so let him try to grab something which is out of reach so he has to flex. Apparently the extension reflex is far to big so you have to stay away from extension. Any support= stimulation of the back will increase extension. in order to control that he should always sit in a position of more than 90 dgrs hip/ knee flexion (ideal but not practical).
Another possibility is working in kneeling position because you have to prevent stimulation of the back! (it will increase extension). Or for sure crawling position. I expect ataxia as well so the more support the better but avoid stimulation of extension. Prognosis is poor unfortunately but what you can mean for him extremely important. Wheelchair bound is likely his future and this should be your first goal, transfers always in flexion, use a turn safe which will break extension and help with independence.

[tnmuralidharan]

hi,
try to inhibit his extensor tone by making him lie prone as this would increase the floxor tone according to the TLR, when you flex a patients head the body would flex and vice versa. you can use the head as the key control and try to reduce the amount of extension. dont encourage pelvic bridging as the patient himself is extending a lot!! Find out if the problem is because of the tone in teh extensors or becanse of an undiagnosed hip conditionwhich could be a HO. Try to teach him flexion of trunk in lying!! you can also use the area around t12 vertebra as a key point to get trunk flexion!! Try to do coming up to standing emphasising on the flexion part of the trunk!!