1. PATHOLOGIC REFLEXES

5. HOFFMANN’S SIGN
STIMULUS : flicking down on the nail of the 3rd or 4th finger
RESPONSE: involuntary flexion of the distal phalanx of the
thumb or index finger

6. ASSOCIATED REACTIONS

7. • Involuntary limb movements in the affected limb as
reaction to voluntary, forceful movements in the
uninvolved side. - Brunnstrom
• These reactions come to a halt when muscle
tension or the stimulus ceases.

8. HUNTINGTON’S PHENOMENON
• YAWN
-is usually present in patients with spasticity.
Reaction: increase of flexor synergy ff’by the limb reaching
forward et the hand opens
- “Morning stretch”
• COUGHING ET SNEEZING
- evokes sudden muscular contraction of short duration.

9. HOMOLATERAL LIMB SYNKINESIS
• There is mutual dependency that exists between the synergies
of the AFFECTED upper and lower extremities.

10. RAIMISTE’S PHENOMENA
• Resisted abduction or adduction in the sound
side causes abduction or adduction of the
affected side
• Adduction is easier elicited.

11. HAND REACTIONS

12. TRUE GRASP REFLEX
STIMULUS: distally moving deep
pressure over certain areas of the
palmar surface
RESPONSE: flexion or grasping of the
fingers over the direction of the
stimulus
REFLEXOGENIC ZONE- most of palmar
surface excluding the ulnar side.
It is weakest over the thumb.

13. SOUQUE’S FINGER PHENOMENON
STIMULUS: elevation of the affected
limb at 90°
RESPONSE: extension of the fingers

14. PROPER LIMB POSITIONING

15. UE
• SCAPULAR PROTRACTION
• SHOULDER IN NEUTRAL OR
FLEXION @ 90°, PLACING ARM
ANTERIORLY
• ELBOW EXT. OR SLIGHTLY FLEXED
(10-15°)
• WRIST ET FINGERS EXTENDED OR
SLIGHTLY FLEXED
• HIP IN NEUTRAL OR SLIGHTLY
ABDUCTED
• KNEE EXTENDED
• ANKLE NEUTRAL
• TOES EXTENDED
LE
POSITIONS TO FACILITATE:

16. UE
• SCAPULAR RETRACTION ET ELEVATION
• SHOULDER ABDUCTION, EXTERNAL
ROTATION
• > 90°
• FA SUPINATION
• WRIST ET FINGER FLEXION
• PELVIC TILT
• HIP EXT., ADDUCTION ET
INTERNAL ROTATION
• KNEE EXTENSION
• ANKLE PF ET INVERSION
• TOE PLANTAR FLEXION
LE
POSITIONS TO AVOID

17. SUPINE POSITION
• PILLOW UNDER PT’S HEAD,
BED ELEVATED (25-30°)
• SUPPORT UNDER THE
AFFECTED ARM
• PILLOW UNDER BOTH
KNEES

18. SIDE-LYING ON
AFFECTED SIDE
• UE
SHOULDER IN NEUTRAL
POSITION
SCAPULAR PROTACTED
ELBOW SLIGHTLY BENT ET
SUPPORTED ON A PILLOW
WRIST ET FINGERS EXTENDED
• LE
AFFECTED HIP NEUTRAL ET KNEE
EXTENDED
ANKLE NEUTRAL OR SLIGHTLY
DORSIFLEXED

19. SIDE LYING ON
UNAFFECTED SIDE
• PILLOW UNDER PT’S HEAD, BED
ELEVATED (25-30°)
• SHOULDER ET SCAPULA PROTRACTED ET
SUPPOTED WITH A PILLOW
• ELBOW, WRIST ET FINGERS OF AFFECTED
SDE IN EXTENSION
• UNAFFECTED EXTREMITY ON A PILLOW
WITH SHOULDER AROUND 90°
ABDUCTED
• ELBOW SLIGHTLY FLEXED
!! AFFECTED UE IS PLACED
INFRONT OF THE BODY TO
IMPROVE AWARENESS

20. SITTING POSITION
• IN BED
SAME AS SUPINE POSITION BUT
THE HEAD OF THE BED IS
ELEVATED UPTO 80-90°
• IN CHAIR
SUPPORT THE AFFECTED ARM
WITH AN ARM TRSY OR BEDSIDE
TABLE.
OR ADD EXTRA CUSHION USING
PILLOWS TO POSITION
SHOULDER IN NEUTRAL
POSITION.