Athetoid:

Athetosis means involuntary, uncontrollable, unpredictable and purpose less movements. The
child who has these movements is called athetoid child. These abnormal movements occur due to
change in tone. This continuous change is tone is called fluctuation. Those fluctuations can be
visible from head to foot in all joins. If fluctuations are strong then movements will also be
strong.
As we inhibit spasticity, in the same way athetoid movements should also be inhibited. There are
some types of athetiods.
1) Pure Athetoid: In this type, child feels some spasm in hands and feet only. Although
spasm may be present in whole body but there power is so weak that at big joints usually
no major abnormal movement is seen. Because hand & feet comprise of small joints, so
abnormal movements can be seen. As there is no problem with proximal stability so child
milestones are not delayed. However child will face difficulties in fine motor skills.

Rx Concepts: Concentrate on fine motor skills e.g. writing, painting, doing activities of
daily life after weight bearing exercises on hands and fingers. During speech sessions,
use centre oriented approach. Survival rate is usually normal.

2) Dystonic Athetoid: This child is basically floppy having quite low postural tone. All
milestones are grossly delayed. When athetoid movement comes in, his tone increases to
high level and child becomes stuck in one extreme posture usually total extension. Once
this spasm is over, child again goes into low tone condition. Dystonic athetoids is one of
the serve form of disability. Survival rate is not so good due to recurrent complications.
Rx Concept: When spasm comes in, try to inhibit pattern of that spasm which is usually
strong extension of whole body. Keeping the inhibition for extension pattern, one can
facilitate the tone by weight bearing and compression etc..
3) Spastic athetiod: This child has strong spasticity with athetoid movements of whole
body. A symmetrical tonic neck reflex is very strong i.e. when head turns to right then
right side arm goes into extension while left arm goes into flexion. So body gets strong
asymmetry. This asymmetry makes the child difficult to use both hands in mid line.
 4) Choreoathetoid: These children have athetoid movements around mid positions of the
joints. Movements are usually rhythmic in nature.
Some common problems of Athetoid
1. Upper side is usually more affected than lower side.
2. Asymmetry of body (Try to create symmetry)
3. Spasms in extension of head with turning to one side, scapula retraction and back
extension. Spasm in legs are like (spastic diplegic pattern) i.e. adduction/ internal
rotation, mild flexion at hips and knees (try to inhibit the spasm)
4. Facial spasms (these are usually linked with body spasm)
Rx Concepts of Spastic &Chroroathetoid
A. Very young child: usually young children are floppy so facilitate the tone body
positioning, exercises and handling e.g.
i. Bottom up exercise

ii. Bridging exercise

iii. Prove on elbow

iv. Turning over facilitation

 If child had strong extension spasm, than supine and prone usually are harmful positions.
Try side lying position for this child with pillow supports. Or proper lap position is
important i.e. keep head slightly flexed, both scapula protracted and trunk in slight
flexion.
  Best treatment may be possible in sitting position especially bench/ bock sitting. Don’t
use rollers and Gym balls because athetoid need a stable base during treatment sessions.
Keep both arms straight and in front. Bring body weight over it. Keep hands on block and
help child to stand as shown.

Give all games in centre and in front.

During speech talk to child from low and in front. Initially don’t encourage this child for weight
shifting to right and left. But if condition improves i.e. child can maintain central position for
long time, than slowly shift may be tried.

Rx of a Standing Child
If a child can stand then use;
Placing reactions i.e. Place both hands in centre and in front and bring weight of body over it.
Try to keep this posture for some time.
For walking both arms should be in protraction, push the abdomen slightly back to inhibit
extension of spine and slowly walking facilitation.
In sitting if child shows a lot of head spasm, then taping technique (alternate touch) may be used
to inhibit spasm.
Feeding Technique:
i. Avoid use of metal spoons because these may increase hypersensitivity in oral region.
Always use wooden or plastic spoon.
ii. During swallowing make sight flexion of head.
iii. Deep breathing exercise and suitable poisoning for lying may be tried to increase
sleep span (by Abdominal manual facilitation )