THERAPEUTIC NEUROMOTOR
)STAGES OF MOTOR CONTROL
APPROACHES
- Neurodevelopmental techniques
NORMAL MOTOR DEVELOPMENT
- Developmental Sequence
• Physical manifestation of neural
maturation
- Simultaneously the child gradually
acquires sensory perceptual, cognitive
& personality skills
- As child progresses through postural
activities within the developmental
sequence, normal motor control is
acquired
- Recapitulation of sequence
• may be most effective means of re-
establishing control/“Return of
function”
ASPECTS OF MOTOR DEVELOPMENT
1.) CEPHALOCAUDAL - PROXIMODISTAL
- Usual direction in motor control
development
- Head → downwards
2.)AUTONOMIC HOMEOSTASIS
- Sympathetic → Parasympathetic →
Homeostasis (EVOLUTION)
3.)REFLEX DOMINANCE INTEGRATION
- At Birth
• motor behavior is dominated by reflex
activity, resulting in primitive, stereotype
movement patterns (no volition)
- As maturation progresses,
• Primitive movements are integrated &
greater variety of movements become
available
• Integration:suppressed or integrated to
normal actions
- Individual movement occurs when cortical
control is gained
- Reflex integration
• follows an orderly predictable manner
- Spinal & Tonic reflexes → Righting
Reactions (midbrain) → Equilibrium &
Proprioceptive Reactions (cortex)
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4.
- Mobility
- Stability
- Controlled mobility
- Skill
• MOBILITY (TO MOVE JUST TO MOVE)
- Random mobility at first three months
- Movement is erratic, reflex based & lacks
purpose
- Adults mobility stage refers to
• Availability of ROM to assume posture
• Presence of sufficient motor unit activity
to initiate movement
- Ex. Knee extension,Hand closure, etc.
• STABILITY (TO HAVE STABLE BOS)
- Divided into 2 levels: tonic holding &
co-contraction
• Both develop in cephalocaudal direction
- TONIC HOLDING: (Superman)
• ability of tonic postural muscles to
maintain contraction against
gravitational or manual resistance
• Developed in deep postural extensors
when the pivot prone posture is
maintained against resistance or gravity
- COCONTRACTION: (Sitting)
• simultaneous contraction of
antagonistic muscles around a joint to
provide stability in weight bearing
posture or maintain a midline position
• CONTROLLED MOBILITY
- Mobility + Stability
- For head neck and trunk:
• Ability to rotate around the long axis
• Ex: sitting & turning
- For extremities:
• Ability of the proximal segment to move
over the distal part while the distal
segment is fixed in weight bearing
• Example: rocking
**STATIC-DYNAMIC ACTIVITY**
• Stage between controlled mobility & skill
• Example: in weight bearing, one limb is
lifted (quadruped + one limb lifted)
• SKILL (Highest Level of Motor Control )
- Manipulation & exploration of environment
- Distal component: mobile
- Proximal component: provides dynamic
stability to the limb
- Example: ball catching, shooting, passing
5.) SEQUENCING OF POSTURE AND
ACTIVITIES
- Prone progression
- Upright progression
• PRONE PROGRESSION
- Prone (ventral aspect of baby on floor)
• Neck rotations due to neck righting
reflex
- Pivot Prone (SUPERMAN)
• Integration of symmetrical tonic reflexes
• Facilitated by optical, vestibular and
body on head righting reactions
• Head control must be achieved
• Counterpart in supine:
- Total Body Bridging Position
- Prone on Elbows (+ Head Control)
• Co-contraction of Upper Trunk & UE
- Prone on Hands (Creeping learned)
• Integration of symmetrical tonic reflexes
• Facilitated by optical and body on head
righting reactions
• Counterpart in supine:
- Total Body Bridging Position
- Quadruped (Rolling must be learned)
• Co-contraction of Lower trunk
• Contact of 2 knees & elbows
• occurs at same time as bridging
• UPRIGHT PROGRESSION
- Supine Flexion
• Flexion movements: supine position
• Decreased dominance of symmetrical
Tonic labyrinthine reflex for midline hand
play
- Rolling (head control & trunk rot achieved)
- Prone to supine (4 months)
• Supine to prone (7 months)
• Segmental rotation
• Log rolling
- Sitting
• Usually occurs simultaneously with
quadruped
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- Full plantigrade/modified plantigrade
• standing with support, not full stepping
• Supported by adult, Foot PF
- Supported standing
• Supported by object
- Standing
- Walking
- Running, skipping, jumping
LOWER TRUNK PROGRESSION
A. Lower trunk rotation
B. Bridging
C. Kneeling (sitting)
D. Tall kneeling (prayer)
E. Half – kneeling (propose)
F. Supported Standing
G. Standing Alone
H. Walking Supported
- Prone→ Head control → Pivot → P Elbow
→ P Hands → Creeping → Rolling & Trunk
Rotation → Quadruped & Bridging →
Crawling → Supported Sitting →
Unsupported Sitting → Kneeling → Tall
Kneel → Half Kneeling→ Supported
Standing → Unsupported Stand → Walking
OUTLINE OF TREATMENT APPROACHES
- Devised for Cerebral Palsies or applied
from adult neurology for cerebral palsy
- Also used for treatment of children with
other conditions of developmental delay
and for TBI and adult hemiplegia
W.M. Phelps
- Specific diagnostic classification of each
child, diagnosed Five types of C.P. &
many subclassifications
- 15 modalities/methods for TX
- Braces/Calipers
• to correct deformity, obtain upright
position & control athetosis
- Muscle education activation of muscles
antagonistic to spastic muscles
- 15 MODALITIES (NTK maybe)
A. Massage of Hypotonic Muscle
B. PROM
C. AAROM
D. AROM
E. Resisted motion
 F. Conditioned Motion
G. Confused motion/Synergistic motion
H. Combined motion
I. Relaxation technique
J. Movement from relaxation
K. Rest
L. Reciprocation (bicycling, crawling,
stepping)
M. Balance
N. Reach & grasp & release
O. Skills of daily living
PLUM & MOLHAVE
- Advocated strengthening spastic
muscles & their antagonists.
- Plum exercised spastic muscles in their
outer ranges since muscles are usually
shortened
- Antagonists are exercised in their middle
and inner ranges
TEMPLE FAY “Theory of Evolution”
- Progressive movement patterns
according to development in evolution
- Ontogenetic pattern as recapitulation of
Phylogenetic pattern
- In general, suggested building up motion
• Reptilian Squirming, Amphibian
Creeping, Mammalian Reciprocal,
Primate Erect Walking
- Unlocking reflexes to reduce hypertonus
Progressive Pattern Movements
Stage 1: Prone lying head & trunk rotation
from side to side
Stage 2: Homolateral stage (amphibian
creeping) = opposite flexed
Stage 3: Contralateral Stage
Stage 4: On hands & knees, Reciprocal
crawling and stepping (bear walking
Stage 5: walking patterns sailor’s walk
DOMAN – DELACATO
- Follows basics beliefs of Fay with
additional methods such as:
• Periods on inhalation of Co2 from a
breathing sack
• Hanging patient upside down &
whirled around (wtf)
• Restriction of fluid intake
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• Development of cerebral hemisphere
dominance
- Attempted by principal use of
dominance eye, hand, foot, and arm,
and other methods
- Patterning Therapy: practiced passively
at least 5x daily
SIGNE BRUNNSTROM (PT siya)
- Synergistic movement patterns
• set for one movement (eg; flex only)
- Production of motion by provoking
primitive movement patterns or
synergistic patterns
- Initial use of reflex responses →
voluntary control of reflex patterns
• if old person can no longer grasp try to
stimulate palmar grasp (rubbing hand)
- Control of head and trunk: use of
attitudinal reflexes (TNR, TLR) associated
reactions & other reflex responses.
- Associated reactions
• Used as well as hand reactions (ex:
hyperextension of the thumb produces
relaxation of the finger flexors)
• Reciprocal inhibition: contract one to
relax another
- Sensory stimulation
• Use of proprioceptive and other stimuli,
such as tapping or stroking for adult
hemiplegia.
HERMAN KABAT (PNF) (MAGASAWA)
- Proprioceptive Neuromuscular Facilitation
- Neurophysiologist & psychiatrist in the US
- System of movement facilitation
techniques and for inhibition of hypertonus
- Promote movement & inhibit hypertonic
muscle contraction
- Methods include diagonal movement
patterns, sensory stimuli & use of
special techniques
SPECIAL PNF TECHNIQUES
- Irradiation (Overflow of action)
• Stimulation of one muscle to stimulate
another within the same synergy
• Reinforcement of action of one part of
the body stimulation action in another
 part of the body but it must be within the
synergy
• Flex biceps in order for the wrist flexors
to flex.
- Rhythmic stabilizations: (resist:ex&flx)
• Stimuli alternation from agonist to its
antagonist in isometric muscle work
• usually done in the trunk
- Stimulation of reflexes
• The mass flexion or extension which are
now no longer used.
- Repeated contractions of one pattern
using any joint as a pivot (strengthen)
- Reversals from one pattern to its
antagonist
- Relaxation
- Timing in using various techniques
EIREEN COLLIS
- Neuromotor development
- Pioneer PT for CP in Britain with main
points of management including
• Mental capacity would determine result
• Early treatment before abnormal
patterns could be established
• Use of “management” than “treatment”
• STRICT developmental sequence
• CP therapist (disliked separated PT, OT,
SP)
KARL & BERTA BOBATH
- Neurodevelopmental treatment with reflex
inhibition & facilitation
- Disliked use of reflexes
- REFLEX INHIBITORY PATTERN:
• inhibit abnormal tone associated with
abnormal movement patterns and
abnormal posture
- SENSORY MOTOR EXPERIENCE:
• Feedback & guide more normal motion
• Motion should have purpose &
sensation
- Facilitation techniques for mature postural
reflexes
- Keypoints of control
• head & neck, shoulder, &
pelvic girdle (most important)
- Developmental sequences
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MARGARET ROOD
- Afferent Stimuli: sensory stimulation for
facilitation & inhibition of motor response
- Muscles: classification of muscles “heavy
work” or “light work”
- Reflexes used in therapy
- Ontogenetic developmental sequence
ONTOGENETIC DEVELOPMENTAL
SEQUENCE
A. Total Flexion/Withdrawal pattern (in
supine)
B. Roll over (flexion of arm and leg on the
same side and roll over)
C. Pivot prone (prone with hyperextension of
head, trunk and legs)
D. Co-contraction neck (prone head over
edge for co-contraction of vertebral
muscles
E. On elbows
F. All fours
G. Standing Upright
H. Walking
VACLAV VOJTA
- Developed from works of Fay & Kabat
- Main features of his methods include:
• REFLEX CREEPING & ROLLING:
creeping/rolling patterns involving head,
trunk and limbs are facilitated at various
trigger points or reflex zones
• Sensory stimulation
• Resistance to muscles
ANDRAS PETO
- Conductive Education
- Main features is the integration of
education and therapy which includes
• Conductor
• Group of children
• All day programmed with fixed timetable
• Movement sessions
• Rhythmic intention
• Individual sessions
• Learning principles
JEAN AYRES “similar to Rood’s”
- Interpret, integrate and use spatial-
temporal aspects of sensory
information form the body and the
 environment to plan and produce
organized motor behavior
- Sensory integration expects an
appropriate motor response or action in
response to sensory input
PRACTICAL APPLICATIONS OF
TREATMENT APPROACHES
THE ROOD APPROACH (1950’s)
- Sensory stimuli to Inhibit/Facilitation
• For tone normalization & evocation of
desired muscular responses
• Also used to reverse spasticity
- Combined controlled sensory stimulation
& developmental sequences to achieve a
purposeful muscular response
- Motor control allows the body to regulate
or direct mechanisms position
- Sensory stimulus & their relationship to
motor functions: major role in analysis of
dysfunction & application of treatment.
Basic Principles of ROOD’s Approach
1. Normalization of Tone:
• Sensory stimulation: Facilitate & Inhibit
muscle activity, helps tone normalization.
2. Ontogenic developmental sequence:
sensory motor control is developmentally
based
3. Purposeful Movement
4. Repetition of Movement
ROOD’s Basic Concepts
1. Mobility & Stability of Muscles
- Muscle group categorized to type of work
done & responses to specific stimuli
- Phasic Muscles “Light Work/Mobility”
• For skilled movement patterns with
reciprocal inhibition of antagonist muscle
- Tonic Muscles “Heavy Work/Stability”
• For joint stability with co-contraction of
muscles which are antagonists in normal
movement.
- Phasic, similar to Type II fibers
- Tonic, similar to Type I fibers
2. Ontogenic Sequence (2 Categories):
- MOTOR DEVELOPMENT SEQUENCE
• Leads to skilled & finely coordinated
movements.
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- VITAL FUNCTION SEQUENCE
• Leads to well-articulated speech.
MOTOR DEVELOPMENT SEQUENCE
The ontogenic-motor patterns are:
I. Supine withdrawal (supine flexion)
II. Roll over (Towards side lying)
III.Pivot prone (Prone extension)
IV.Neck co-contraction (co-innervation)
V. Prone on elbows
VI.All Fours/Quadruped
VII.Standing
VIII.Walking
- Rood categorized these patterns under
four phases, using concepts of light and
heavy work:
- I.Mobility/Reciprocal innervations
• Near mobility pattern, primarily reflex
governed by spinal & supraspinal
centers.
• Includes supine withdrawal, roll over, &
pivot prone.
- II.Stability/Co-contraction
• Simultaneous contractions of
antagonists & agonists to stabilize
and maintain posture of the body.
• Includes pivot prone, neck co-
contraction, prone on elbow, quadruped
and standing.
- III. Mobility superimposed on stability
• Movement of proximal limb segments
with distal ends of limbs fixed on BOS
• Includes weight shifting in prone on
elbows, quadruped, and to and fro
rocking that later on can be promoted to
crawling in different directions.
- IV.Skill/Distal mobility with proximal
stability
• Skilled work with emphasis on
movement of distal portions of the
body in a finely coordinated pattern,
requires control from highest cortical
level.
VITAL FUNCTION SEQUENCE
- The ontogenic patterns are:
- Inspiration: intake of air
- Expiration: breathing out air
- Sucking: draw into the mouth by
contracting the muscles of the lip & mouth
to make a partial vacuum.
- Swallowing liquids: allows something to
pass down the throat.
- Phonation: Production/utterance of
speech sounds.
- Chewing & swallowing solids: bite &
work (food) in the mouth with the teeth,
especially to make it easier to swallow.
- Speech: Expression of or ability to express
thoughts & feelings by articulate sounds.
3. Appropriate Sensory Stimulation
- Utilized the anterior horn cell excitability by
using sensory stimulus
- Four types of receptors which can be
stimulated and in order to get desired
muscular response:
• Proprioceptive receptors
• Exteroreceptive receptors
• Vestibular receptors
• Special sense organs
4. Manipulation of ANS
- Activation of Sympathetic nervous system :
• hypotonic somnolent patients
- Parasympathetic nervous system activate:
• Hypertonic, hyperkinetic, hyper
excitable patients
- 2 Groups of ANS stimuli:
- Sympathetic nervous system stimuli:
icing, unpleasant smells or tastes, sharp
and short vocal commands, bright flashing
lights, fast tempo & arrhythmical music.
- Parasympathetic nervous system
stimuli: slow, rhythmical, repetitive
rocking, rolling, shaking, stroking the skin
over paravertebral muscles, soft & low
voice, neutral warmth, contact on palms of
hands, soles of feet, upper lip or abdomen,
decreased light, soft music & pleasant
odors.
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TECHNIQUES OF ROOD’S APPROACH
FACILITATORY
Cutaneous Facilitation Techniques
• Don’t use if patient is crying
- Fast brushing
• Usually for head control
• Applied over dermatomes of the same
segment the muscle supplies for 3 to 5
secs and repeated after 30 sec
- Icing
• usually at lips, sternal notch,
• applied over skin in 3 quick swipes (A
fibers) or pressed to the muscle to be
stimulated for as long as 30 mins (C
fibers)
- Light moving or touching
• Can be applied with a fingertip, a cotton
swab, or a camel hair brush for three to
five strokes and allow a 30-second
elapse period to prevent overstimulation.
Proprioceptive Facilitation Techniques
(usually for joints & muscles)
- Heavy joint compression
• Facilitates contraction of the joint
combined with developmental patterns
- Vibration
• (Give toys with vibration)
• For tactile stimulation to desensitize
hypersensitive skin and to produce tonal
changes in muscles. The duration
should not exceed 1-2 mins per
application. Prone position may be best
for vibrating flexor muscle group; Supine
position for extensor muscle group.
- Quick stretch
• activates proprioceptors in selected
muscles and imply the principle of
reciprocal innervation.
- Intrinsic stretch
• promotes stability of scapulohumeral
region.
- Secondary ending stretch
• combination of resistance and stretch to
facilitate ontogenic patterns
- Stretch pressure
• if you feel pt is flaccid
• Pads of thumb, index, and middle finger
are given firm, downward pressure and
 stretching motion is achieved if the
thumb moves away from the fingers.
- Resistance (rarely used)
• Heavy resistance is used to stimulate
secondary & primary endings of the
muscle spindle. Intermittent resistance
which is graded to the desired motion
can also be used for alleviating tight
muscles.
- Tapping
• fingertips are percussed 3-5 times and
may be done before or during the time
the patient is voluntary contracting the
muscles.
- Vestibular Stimulation
• Ball used.
• Can be either facilitatory or inhibitory
depending on the stimulation rate. Slow
rhythmic rocking tends to relax while fast
rocking tends to stimulate.
- Inversion
• Lethargic Patients
• Inverted position, static vestibular
system produces increased tonicity of
the muscles of the neck, midline trunk
extensors and selected extensors of the
limbs. This type of therapy should be
used with extreme care and is
contraindicated for most clients with
cardiovascular disease.
- Osteopressure
• Involves pressure that is applied on the
bony prominences and can be used to
either inhibit or facilitate voluntary
muscles.
INHIBITORY
- Neutral warmth
• Client in supine & his or her body is
wrapped in a cotton blanket for 10 to 15
minutes.
- decreasing muscle tone &
promoting relaxation
- Gentle rocking or shaking
• Rhythmical circumduction of the head
and slight approximation is given. Can
be used on UE/LE
- Slow stroking
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• The client is prone while the therapist
provides moving rhythmic deep pressure
over the dorsal distribution of the
primary posterior rami of the spine.
• Should not exceed 3 min
- Slow rolling
• The client is gently and slowly rolled
from a side-lying position to a prone
position and back again in a rhythmical
manner.
- Light joint compression/approximation
• This involves joint compression of body
weight or less than body weight
- Inhibit spastic muscles near &
around the joint.
- Tendinous pressure
• Manual pressure applied across long
tendons/tendinous insertion of a
muscle.
- Produces a dramatic inhibitory
effect on spastic/tight muscles.
- Maintained stretch
• positioning in elongated position to
cause lengthening of the muscle
- Rocking in developmental patterns
• Shifting weight forward & backward
progressing to side to side then diagonal
patterns.
ROOD’S THEORY
A. Normalize muscle tone
B. Treatment begins at developmental level
of functioning
C. Movement is directed towards functional
goals
D. Repetition is necessary for re-education
of muscular response
E. Sensory stimulation to evoke movement
response
EXAMPLES
- Tapping over muscle belly to facilitate
(increase) muscle tone and apply deep
pressure to muscle belly to elicit inhibitory
LIMITATIONS
- Passive nature of the sensory stimulation
(it is applied to an individual)
- Short-lasting
- Unpredictable effect of some sensory
stimulation
SUMMARY
- Goals: - Use of cutaneous stimulations for local
• To activate postural responses (stability) reinforcement of flexor & extensor muscle
• To activate movement (mobility) once or muscle groups
stability is achieved
- Primarily sensory systems utilized to effect BASIC LIMB SYNERGIES
a motor response, tactile, proprioceptive, - Mass movement patterns in response to
kinesthetic stimulus or voluntary effort or both
- Treatment activities include sensory • Gross flexor movement (flexor synergy)
stimulation, such as tapping, brushing, • Gross extensor movement (extensor
icing) synergy)
- Clinical population includes adults post- • Combination of the strongest
CVA, children with neuromotor disorders components of the synergies (mixed
such as CP & developmental delay synergy)
- Appear during early spastic period of
THE BRUNNSTROM APPROACH recovery
- Reflexes represent normal stages of - Strongest synergies usually appear
development BASIC LIMB SYNERGIES: UE & LE
- Can be used when CNS has reverted to
an earlier developmental stage as in
hemiplegia.
- Used for totally flaccid/no movement
- Proprioceptive & Exteroreceptive stimuli
also can be used therapeutically to evoke
desired motion/tonal changes
- Reflexes are elicited when no movement
exists
- Emphasize on development of synergy
in spastic groups of muscles.
• helps in development of voluntary
movement
- Associated Reaction
• Movement of sound extremity causes
movement of affected extremity.
• Ex: flexion of normal UE causes
movement of flexion of affected limb
- AIM: Develop a synergy pattern in spastic MIXED SYNERGY OF UE
muscle & once developed the synergy is
broken
- During early recovery stages,
• Hemiplegic patient should be aided &
encouraged to gain control of basic limb
synergies.
- Once limb synergies can be performed, *THE TYPICAL HEMIPLEGIC POSTURE
• Modification of synergies begins to bring
out movement combinations that deviate
from synergies.

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*ATTITUDINAL AND POSTURAL 1. Tendon reflexes return & become
REFLEXES hyperactive.
TONIC NECK REFLEXES 2. Spasticity develops; resistance to
• STNR passive motions is felt.
3. Voluntary finger flexion occurs, it
facilitated by proprioceptive stimuli.
4. “Proprioceptive traction response”
• ATNR can be elicited.
5. Control of hand movements without
proprioceptive stimuli begins.
6. Grasp is greatly reinforced by tactile
stimuli in the palm of the hand,
• Tonic Labyrinthine Reflex Spasticity is declining
7. True grasp reflex can be elicited.
Spasticity has decreased further.

- Proprioceptive Traction Response

• aka “proximal traction response”
• Tonic Lumbar Reflex • Stretch of flexor muscles of one of the
joints of upper limb
- facilitates contraction of the flexor
muscles of all other joints resulting
• Tonic Thumb Reflex to total shortening of the limb.
- True Grasp Reflex
• Deep pressure over MCP and IP of all
five digits results to
- flexion of the joint or joints over which
ASSOCIATED REACTIONS the stimulus moves.
- Homolateral Limb Synkinesis - The response is weakest at the thumb
• Response of one extremity to stimulus joints.
will elicit same response in its - Instinctive Grasp Reaction
ipsilateral extremity • Stationary contact with palm of hand
- Raimiste’s Phenomenon results to closure of the hand
• Resisted abduction/adduction of the - Instinctive Avoiding Reaction
sound limb evokes a similar response in • With the arm elevated in a forward-
the affected limb upward direction, the fingers and thumb
- Yawning hyperextend: stroking the palm in a
• Flexor synergy elicited during initiation of distal direction exaggerates the posture
yawn - Souque’s Finger Phenomenon
- Coughing & Sneezing • Elevation of the hemiplegic arm beyond
• Evoke sudden muscular contractions of the horizontal results to extension &
short duration abduction of fingers

HAND REACTIONS BRUNNSTROM’S STAGES OF RECOVERY

- Restoration of hand function following
hemiplegia proceeds in a manner that
closely resembles the evolutionary one.
- Twitchell (1951) seven steps in the MOTOR STAGE ASSESSMENT
restoration of function of these patients:

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TREATMENT PRINCIPLES
A. Treatment progresses developmentally
B. When no motion exists, movement is
facilitated using reflexes, associated
reactions, proprioceptive facilitation and
or exteroreceptive facilitation to develop
muscle tension in preparation for
voluntary movement
C. Resistance (proprioceptive stimulus)
promotes a spread of impulses to
produce a patterned response while
tactile facilitates only the muscle related
to the stimulated area.
D. The responses of the patient from such
facilitation combine with the patient's
voluntary effort to produce semi-voluntary
movement
E. When voluntary effort produces or
contribute to a response, patient is asked
to hold the contraction (isometric). If
successful, an eccentric (contracted
lengthening) is performed and finally a
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concentric (shortening) contraction is
done.
F. Facilitation is reduced or dropped out as
quickly as the patient shows evidence of
volitional control
G. Correct movement once elicited is
repeated
H. Practice in the form of ADL.
TREAMENT GUIDELINES
- Encourage possible movement and using it
as a foundation for strengthening, sensory
stimulation, positive reinforcement, verbal
feedback and reflexes.
- Include tasks gradually increase in difficulty
levels but are achievable. For every task
completed, new goals should be set.
Patients are taught to use voluntary
movement that assists them in achieving
goals and tasks.
- Movement will be progressed in the correct
sequence. Abnormal movements occur first
following injury and usually there is a
normal pattern of recovery before the
normal patterns of movement are obtained
once more
Activities Improved by Brunnstrom
- Bed Posture
- Bed exercises
- Hand training
- Trunk bending & rotation
- Upper limb training
- Standing & walking
- Assisted walking
- Independent walking
- Obstacle walking
- Stair climbing