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윤선 즙
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1 Normal development Mechanism of Human 1 Normal development Mechanism of Human 1. Prenatal :, Neonatal[Newborn] : 0 1mon Postnatal[infant] : 1mon Walking.,,,. level [reflex] [reaction] level [postrue]' [movement]'., CP[cerebral Palsy]. 1) level [ ]. spinal level Brain-stem level mid-brain level cerebral level cerebellum level level apedal quadripedal bipedal reflex. sitting. righting reaction upright. Equilibrium reaction upright. voluntary movement. skill movement. 2) Newborn [0 1mon] No. 6 No. 4 [amateur] Mid brain level Brain-stem level [amateur] cerebellum Ant. horn. brain area brodmann No.4,,.

2 Normal development Mechanism of Human 2... spinal level - pattern. reflex. ex) rooting reflex, sucking reflex, swallowing reflex. ex) flexor withdrawal reflex, extensor thrust reflex, moro reflex crossed extension reflex, grasping reflex, startle reaction spinal level primitive reflex. reflex.. 3) Postural[infant] [1mon walking].. tonic reflex, righting reaction, equilibrium reaction, apedal,,,,.. cephalocaudal direction proximodistal direction ulnoradial direction prone supine : prone. prone, supine. prone development head hold[1mon ] :. prone on elbow[1mon ] prone on the hands[5mon ] :,. AR.[ AR muscle cocontraction.] swimming position[7mon ] : crawling crawling[8mon ] kneeling[10mon1 ] standing & walking[12mon ] 7

3 Normal development Mechanism of Human 3. supine development body image: 5 kicking.. rolling[5mon ]: ATNR 6. sitting[6mon ]: + + parachute reaction +. 4), level. level tonic reflex cerebral palsy. CP. 2. [Normal development] 1) Neurodevelopmental theory Movement sensory-motor-sensory. brain release phenomenon hypertoni -city. Law of shunting - CNS.. automatic automatic. Mobility stability.. 2) reflex.. sucking reflex, rooting reflex reflex. 11 wks 3) cephalocaudal direction ulnoradial direction proximal direction reciprocal interweaving 4). [ex : prone > supine ] :

4 Normal development Mechanism of Human 4. CNS 5). reflex. prone. [ 11 wks ] rooting reflex & sucking TLR Traction reaction ATNR & STNR Flexor withdrawal reflex & extensor thrust reflex PSR[positive supporting reaction] autonomic stepping reaction moro reflex 6) development of head control 1 2mon :. head control prone. head control [3 4mon] [, ] prone on elbow prone on hands quadripedal level [co-contraction ] sitting equlibrium reaction righting reaction parachute reaction standing positive supporting reaction dorsiflexion reaction hopping reaction 7) level spinal level reflex group[apedal] 2mon [high level reflex ]. flexor withdrawal reflex extensor thrust reflex crossed extension reflex brain stem level reflex group[apedal] 4, 6mon[ ]

5 Normal development Mechanism of Human 5 tonic reflex. postural tone antigravity activity uprighting. a. [general static reflex] ATNR & STNR[ 4, 6mon] ATNR supine., prone. TLR[tonic labyrinthine reflex : 4mon] reflex. CNS TLR TNR CNS. AR[Associated Reaction; 4, 6mon],. AR. CNS AR cortex level [associated motion] coordination CNS AR. CNS AR spasticity. b. [local static reaction] : muscle tone. PSR[positive supporting reaction: 3 8mon] extensor pattern reaction. standing. extensor thrust reflex. NSR[negative supporting reaction; 4 8mon] muscle tone reaction. walking. mid brain level postural reflex quadripedal level. rolling, sitting, creeping, crawling mon. a. RR cortex level 6 7mon ER ER 5 ER. NRR[neck righting reaction; 6mon] : BRROTB[body righting reaction on the body]. BRROTB[6 18mon]

6 Normal development Mechanism of Human 6 rolling uprighting posture cf. NRR - not segmental rolling in truck[logo rolling]. BRROTB -segmental rolling in trunk BRROTH[body righting reaction on the head] : reflex sidelying. LRR[labyrinthine righting reaction: 1, 2mon ] head control reaction. ORR[optical righting reaction] head control. ORR[1,2mon ] head control reaction. LRR cerebral cortex occipital loberk. b. amphibian reaction[apr: 6mon 2.5yrs] : prone crawling c. Moro reflex[mr : 4mon] RR Parachute reaction, reflex head control. head control reflex. parachute reaction. d. Parachute reaction[6mon ] PSR[ Parachute reaction. : 3 8mon] Parachute reaction in lat. side[6mon ] Parachute reaction in forward[7mon ] Parachute reaction in backward[9mon ] sitting & standin R & ER body aligment. protective reaction. cf. iprighting posturebody balancemechnism 1st mechanism - R & ER 2nd mechanism - Parachute reaction e. RR : antigravity. cortical level postural reflex a. standing & walking b. ER. : bipedal level. c. page

7 Normal development Mechanism of Human 7 3. CP[Cerebral Palsy] 1) CP CP,. level tonic reflex. 2) CP spastic type: cerebral cortex. athetoid type: basal ganglia. ataxia type: cerebellum. quadriplegia:. diplegia:. hemiplegia: side. : ataxic type type CP level tonic reflex. tonic reflex? 3) CP CNS postural reflex mechanism abnormal muscle tone.,,. 4) CP CP. CP,. 5) CP lying abnormal reflex TLR TNR rolling, 2 deformity. moro reflex : head control [3 4mon] reflex, reflex sitting position. body righthing reaction on the body : sidelying, reaction rolling

8 Normal development Mechanism of Human 8. sitting & standing righting & equlibrium reaction parachute reaction positive supporting reaction sitting RR ER. TNR & TLR walking positive supporting reaction TNR & TLR 6) CP program. abnormal pattern movement compensation habit contracture & defo -rmity muscle tone hypertonus hypotonus type tonic reflex normal pattern movement deformity ] righting & equlibrium reaction head mid-line head control sitting trunk rolling pattern standing oral motor problem hand movement. [ brain area ]. rib cage. rib cage.. rib cage CP.[boby breathing] 4 CP reverse pattern[, ].. CP type muscle unbalance deformity.

9 Normal development Mechanism of Human 9 contracture.. postural pattern & motor pattern :,, level. movement pattern muscle & CNS, CP type. visual field. [visual field normal midline.]. CP. 4. [Tonic reflex] 1) Tonic reflex - a tonic reflex reflex. TLR (tonic labyrinthine reflex) ATNR (asymmetrical tonic neck reflex) STNR (symmetrical tonic neck reflex) AR (associated reaction) PSR (positive supporting reaction) NSR (negative supporting reaction) ATNR[abnormal tonic neck reflex] 1 pattern com -pensation 2 pattern contracture deformity. normal tonic reflex lying sitting. ex) ATNR - rolling. STNR, SR - bipedal. AR - CNS. [muscle coordination cocontraction.] tonic reflex. 2) Tonic reflex - TLR[tonic labyrinthine reflex] Bobath TLR primitive reflexabnormal reflex.. reflex. normal baby - TNR > TLR

10 Normal development Mechanism of Human 10 cerebral palsy - TNR < TLR spastic quadriplegia, athetoid type. TLR : head control antigravity activity. ATNR[asymmetrical tonic neck reflex] normal ATNR rolling., hand-eye coo -rdination. normal ATNR. abnormal ATNR scoriosis, torticollis, hip subluxation & dislocation. reflex spastic type athetoid type. abnormal ATNR sitting, standing. ATNR normal ATNR - rolling, head-eye coordination. abnormal ATNR -. STNR[symmetrical tonic neck reflex] normal STNR. AR[associated reaction] normal AR CNS,. abnormal AR spastic type hemiplegia diplegia. abnormal AR contr -acture deformity. PSR[positive supporting reaction] normal PSR bipedal. normal PSR. abnormal PSR bipedal. tonic reflex.

11 Normal development Mechanism of Human Spastic type. 1) Pathway : ant & post. spinocerebellar tract :,, : extrapyramidal tract, ' : pyramidal tract pathway : voluntary movement. : cortexlevel : cerebellum level : : pyramical tract[pt] voluntary movement extrapyramidal system. : cortex level. : feedback mechanism of cerebellum 2) Mechanism of spasticity extrapyramidal tract[ept] stretch[, -system ] -system spasticity. tract muscle tone., : -system muscle tone hypotonus.[flaccid stage], [MS] CNS -system. : CNS -systemdml. spasticity.[spastic stage]

12 Normal development Mechanism of Human 12 : muscle tone. flaccid paralysis. [.] 6. Ant. & Post. spinocerebellar tract 1) Post. spinocerebellar tract[psct] - MS [, ] Post. spinocerenellar tract[psct] PSCT Ia afferent PSCT MS[1 ] < < < cerebellum Ia fiber CC[2 ] 1:DRG-T 6 and below 2 : Clarke's column[ : sitting's nucleus] 3 : Inf. pontocerebellar peduncle[icp] PSCT[ : CNS ] ICP cortex of vermins[ ] [base]. [clarke`s column :CC : nucleus dorsalis]. [PSCT]. PSCT [Inf. cerebellar peduncle :ICP] [ ].. CC C 8 L 2 L 2 CC. PSCT MS tendon, trunk., tendon. Cerebellum Paleocerebellum : a. tension b. coordination between agonist and antagoinst : muscle tone. potural tone. : movement..

13 Normal development Mechanism of Human 13 2) Ant. spinocerebellar tract[asct] - GTO ANT. spinocerenellar tract[asct] ASCT Ib afferent ASCT[ : ] GTO < < < cerebellum Ib fiber 1:DRG-T 6 and below[1 ] Border cells 2 : Border cells - cooper sherrington [2 ] 3 : Sup. pontocerebellar peduncle[scp] ASCT SCP cortex of vermins[ ] [base]. [ASCT]. ASCT. ASCT [SCP] [ ].. ASCT MS tendon, trunk... 3) Cuneocerebellar tract[cct] - Cuneocerebellar tract[cct] Ib afferent CCT MS < < < cerebellum Ib fiber 1:DRG-aboveT 6[ascend in cuneate fascicle] 2 : Cuneate fascicle[lat. cuneate nucleus] 3 : Inf. pontocerebellar peduncle[icp] CCT Cuneate fascicle[ : CS] accessory cuneate nucleus[ ] cortex of vermins[ ] [CS] ICP. [post. ext. arcuate fiber]. 4) Spino-olivocerebellar Tract[SOCT] Spino-olivocerebellar Tract[SOCT] < < < :DRG 2 : Intermediate Gray in AWC 3 : Olive nucleus 4 : Red nucleus. Cerebellar cortex & Central gray 5 : Ia, II afferent fiber 6 : Spino-olivery tract 7 : Olive-cerebellar tract cerebellum

14 Normal development Mechanism of Human [SOT] [OCT] ICP.. OCT [Extra-pyramidal tract].

15 Normal development Mechanism of Human 15 Basis for Normal Development A. CNS B. 1. Brain Spinal cord. 2. Cerebellum frontal lobe:,, parietal lobe:,,, & temporal lobe:, occipital lobe: 3. Brain stem 1) cerebrum spinal cord 2) cerebrum cerebrum. 3) brain stem 4. 1) ( ),,.( ). 2) ( ),,.( ) 3). + = 1.. CNS. bipedal 2. motor control 1) [ 3mon]:. 2). prone development. cocontraction.. 3) trunk rotation., balance

16 Normal development Mechanism of Human 16 4) : : C. [Proprioception] 1. receptor muscle spindle GTO[golgi tendon organ] D. [motor system] 1. [ : corticospinal tract CST: pyramidal tract] 1) origin - Brodmann's number 4 area of cerebral cortex 2) pathway No. 4 internal capsule mid-brain pons medullar oblongata spinal cord ant. CST[15 20%] ant. horn[crossed] -fiber lat. corticospinal tract[80 85%, crossed] ant. horn -fiber 3) [extrapyramidal tract] 1) - medula oblongata. 2) pathway 3) cerebral tract internal capsule midbrain. pons cerebellum[crossed, ] spinal cord[pyramidal tract ] ant. horn cell -fiber cerebellum cerebrum feedback mechanism 3. 1). 2). spasticity. 3) Brodmann's number 4 area plasticity. 4) [corona radiata],.

17 Normal development Mechanism of Human 17 5) internal capsule spasticity. E. [vestibular equilibrium system] 1. receptor -. utriculus & sacculus static condition. semicircular canals dynamic condition. 2. pathway labyrinthine [ tract ] :, [ tract.] :,. F. cerebellum 1. -,, 2. -,.[head control ] - -,. G. cerebral cortex 1. primary somatosensory cortex. No. 3 - No. 1 - No primary visual cortex Brodmann's No primary auditory cortex Brodmann's No primary gustatory cortex Brodmann's No primary somatomotor cortex.

18 Normal development Mechanism of Human 18. No 4 flaccid paralysis No. 4 & 6 spastic paralysis. 6. premotor cortex Brodmann's No. 6, 6, 8.No.4. thalamus, cerebellum feedbakc mechanism.. Bodmann's No.6.. stretch reflex. spasticity. cerebellum, basal ganglia feedback mechanism.. No motor speech cortex Brodmann's No 44,. 8. prefrontal cortex Brodmann's No. 9, 10, 11, 12, 46, primary olfactory cortex Brodmann's No secondary receptive cortex associated area somatosensory associated area Brodmann's No. 5, 7 No. 1, 2, 3 visual associated area Brodmann's No. 18, 19. area 17. auditory associated area Brodmann's No. 42, 22. area 41. olfactory associated area - Brodmann's No. 34, 28.

19 Normal development Mechanism of Human Brodmann's No. 39,

2-1

2-1 Part Brain, Head & Neck PART Brain, Head & Neck Overview of brain Caudate nucleus Nucleus accumbens Globus pallidus Subthalamic nucleus Putamen Substantia nigra Cerebral corter Thalamus Nucleus subthalamicus