Neuromotor Immaturity in Children and Adults: The INPP Screening Test for Clinicians and Health Practitioners

Foreword x
Dr Arthur Paynter

Acknowledgements xiii

1 Identifying Signs of Neuromotor Immaturity in Children and Adults 1

1.1 Introduction 1

1.2 How to use this Manual 2

1.3 Overview 3

1.4 Relationship between Neuromotor Immaturity and Learning Outcomes 4

Literature review 4

1.5 Neuromotor Immaturity in Adolescents 6

1.6 Relevance of the INPP Screening Test to Health Practitioners 8

1.7 What is the INPP Method? 8

Why assess posture and balance? 9

Why carry out assessments for balance? 9

What is the significance of static balance and dynamic balance to learning? 10

What is the significance of postural control to learning? 10

What is the link between primitive reflexes, balance and postural control? 11

1.8 How Does the Vestibular System Work? 11

1.9 Primitive Reflexes 12

Why have these four reflexes been selected for evaluation? 12

1.10 What Evidence is there that Intervention in the Form of Movement Programmes Aimed at the Level of Primitive Reflexes Improves Reflex Status and Educational Outcomes? 18

1.11 What was known about Exercises to Inhibit Primitive Reflexes? When was the INPP Method Developed? What has been your Personal Experience Since then? 19

1.12 What is the Difference between the INPP Method, Sensory Integration (SI), Vojta Therapy, Bobath Therapy and Others Working with Primitive Reflexes? What are the Criteria for Referral to a Particular Therapy? 20

The INPP method 20

Sensory Integration (SI) therapy 21

Vojta therapy 22

Bobath therapy 26

1.13 What are the Top Five Medical Diagnoses Where Referral to INPP Should Routinely be considered After Checking the Reflexes by Clinicians? 27

1.14 Screening Tests 27

How to use the screening test 28

References 28

2 Screening Test for Use with Children 32

2.1 General Instructions 32

2.2 Scoring 32

2.3 Tests 33

The Romberg test 34

One-leg stand or Unipedal Stance Test (UPST) 37

Tests for ‘soft signs’ of neurological dysfunction:: The Tandem and Fog walks 39

The Tandem walk 40

The Fog walk (1963) (walking on the outsides of the feet) 42

Finger and thumb opposition test 44

2.4 Tests for Primitive Reflexes 46

Asymmetrical Tonic Neck Reflex (ATNR) 46

Test procedure:: Ayres quadruped test for the ATNR 47

Adapted Hoff–Schilder test for the ATNR (from seven years of age) 48

The Symmetrical Tonic Neck Reflex (STNR) 50

Tonic Labyrinthine Reflex (TLR):: Erect test 52

The Moro reflex 54

2.5 Sample Score Sheets 56

2.6 Sample Observation Sheets 57

2.7 Interpreting the Scores 58

Children 58

References 59

3 Neuromotor Immaturity in Adults 61

3.1 The Role of the Vestibular System and Its Connections 61

3.2 Historical Background to Links between Vestibular–Cerebellar Dysfunction and Anxiety, Agoraphobia and Panic Disorder 64

3.3 Vestibular Dysfunction:: Cause or Effect? 68

3.4 Rationale for a Somatogenic/Psychosomatic Basis to Some Anxiety Disorders 68

3.5 Postural Righting Reactions 71

Labyrinthine Head Righting Reflexes (LHRRs) 71

3.6 The Moro Reflex:: A Trigger for Panic? 72

3.7 How to Use the INPP Screening Test 74

3.8 The INPP Adult Screening Questionnaire 76

3.9 Interpreting the INPP Adult Screening Questionnaire 79

References 80

4 INPP Screening Test for Signs of Neuromotor Immaturity in Adults 83

4.1 General Instructions 83

4.2 Scoring 83

4.3 Screening Tests for Use with Adults 83

4.4 Tests for Balance and ‘Soft Signs’ of Neurological Dysfunction (ND) 84

4.5 Tests for Balance and Proprioception 86

The Romberg test 86

The Mann test (advanced Romberg test) 89

The tandem walk 91

The Fog walk (1963) (walking on the outsides of the feet) 93

4.6 Tests for Primitive Reflexes 95

Asymmetrical Tonic Neck Reflex (ATNR) 95

Ayres quadruped test for the ATNR 96

Asymmetrical Tonic Neck Reflex adapted Hoff–Schilder (erect) test 97

The Symmetrical Tonic Neck Reflex (STNR) 99

Tonic Labyrinthine Reflex (TLR):: Erect test 101

Moro reflex 103

Erect (drag) test for the Moro reflex 105

4.7 Adult screening test 107

4.8 Interpreting the scores 109

References 110

Resources 111

Index 121