Righting Reactions
Automatic reactions produced and controlled by midbrain and play an important role in control of head and torso in space and facilitation and initiation of movement from one position to another
Types of Righting Reactions (Vertical)
- Labyrinth RR that acts upon the head
- Optical RR
- Body RR that acts upon the head
- Distinguished by primary receptor responsible
- Stability and alignment in midline
- Responsible for vertical righting
Types of RR (Rotational RR)
- Neck (acts upon body)
- Body (acts upon body)
- Called after that which initiates the movement (head or body)
- For mobility from and to central axis of body
Labyrinth RR that acts upon the head
- From 2 months- throughout life
- Dependent on an intact vestibular system
- Responsible for head righting
Position:
- Blindfold patient
- Baby: hold in space (prone, supine or upright)
- Children: over lap move to R/L/forward/backward
- Adults: supine/prone
- stimulus (the different positions)
- Reaction- correct head/maintain neutral, upright position in space against gravity
Optic RR
- From 1/2 months-throughout life
- Responsible for head righting
- Important mechanism for postural control
Position:
- to evaluate labyrinth, influence must be cancelled (not possible unless damaged)
- Stimulus (movement of body)
- Reaction (head maintains/correct neutral/upright position in space against gravity)
Body RR that acts upon the head
Position:
- Any position
- Stimulus (when any part of body surface experiences pressure)
- Reaction (normal position of head and torso must be redressed)
Neck RR that acts upon the body
- From birth-throughout life
- With protective reaction (head rotation in prone)
- Dissociation between head and trunk (log rolling)
Position:
- Adults, children & babies: supine (arms and legs in extension)
- Stimulus (rotates head passively to one side and keeps it there)
- Reaction (body rotates as a whole in direction in which head is turned)
Body RR that acts upon the body
- From 6/7 months- throughout life
- Segmental rotation
- Neck RR integrates (Body on body RR develops)
Position:
Adults, children & babies: supine (arms and legs in extension)
- Stimulus (rotate head to one side and keep it there, opposite leg or arm can be pulled over body)
- Reaction (segmental rotation around body axis in direction the head was turned, rest of the body follows once arm or leg is pulled over)
Principles in respect of RR assessment
Developmental sequence
- 1-4 weeks
- Neck RR observed
- Labyrinthine RR not developed = poor head control
- 2 months
- Labyrinthine & optic RR present
- 7-12 months
- Body on body RR
- Abnormal muscle tone and reflexes and reflexes assessed first
- sufficient stimuli
- sufficient time
- quality of active movement (not just if but how)
RR in patients with CNS injury
- Depending on postural tone and tonic reflex activity (RR will occur/not occur)
- If tone is normalised, RR return automatically
- Slight plasticity (RR present) but movement quality is poor and slow due to inhibitory influence of increased tone
- Voluntary compensatory movements can occur but are ineffective for fast movements, cognitive compensation occurs and causes careful and safe movements
- RR occurs in patients with increased muscle tone and involuntary movements, but RR are interrupted by tonic and ataxia activity
- RR present in hypotonic patients with ataxia or athetosis and sometimes they overcompensate.
Initiation is delayed because responsiveness of hypotonic muscles is lowered.
As a result of low tone and ungraded contraction and relaxation of muscles, patients appear insecure and movements are jerky and uncoordinated
RR in patients with CNS injury (cont.)
Labyrinth RR
- Present in most patients with moderate or light spasticity
- Athetoid patients: present but abnormal (rigid neck extension alternating with total flexion)
- Ataxic patients: weak movements with insufficient range and the position couldn’t be maintained
Neck RR:
Were absent in most patients with extensor spasticity of neck and torso
Body on body RR:
Present in patients with (moderate spasticity, athetosis, ataxia)
