After our thorough consideration, although both the neurodevelopmental treatment (NDT) FoR and the sensory integration (SI) FoR are adopted in activity 1, we agreed that the NDT FoR should be prioritised before the SI FoR. As the NDT mainly targeted postural control and movement patterns with tone management especially for cerebral palsy (CP) cases, which should be the main focus of our intervention. We understand that some primitive and tonic reflexes, such as the tonic labyrinthine reflex, symmetrical tonic neck reflex (STNR) and asymmetrical tonic neck reflex (ATNR), may be triggered during the course of activity1 as head and neck movements are involved. According to the NDT approach, those tonic reflexes have to be inhibited in order to counteract the abnormal tone. It is important for the therapists using the NDT approach to spend time on reducing abnormal tone, so that the child would be ‘prepared’ for the movement afterwards (Levitt & Addison, 2018). Therefore, before activity 1, a 5-minute stretching session is applied to the client as a method of preparation. According to Levitt and Addison (2018), prone lying is a factor reducing presence of involuntary reflex. Therefore, in activity 1, we adopted this element by asking Maser to prone lie on the scooter board, hoping to reduce the athetotic reflexes, while at the same time, extensor muscles of Maser can still be strengthened. Whereas another article suggested that specific reflex integration approach, which includes a wide range of interventions particular to different retained primitive reflexes, can be used to inhibit abnormal reflexes in children with CP (Wagh, Malawade & Vardharajulu, 2019). For instance, providing proprioceptive input can decrease Palmar reflex, while prone head lift and vestibular stimulation can reduce ATNR. Therefore, client’s positioning in activity 1 (i.e. prone-lying with head lifting up to place rubber rings), along with the vestibular and proprioceptive input provided when pushing forward on scooter board, can all be seen as ways to prevent possible abnormal reflexes during the activity. Reference Levitt, S., & Addison, A. (2018). Treatment of cerebral palsy and motor delay. John Wiley & Sons. Wagh, S. C., Malawade, M. R., & Vardharajulu, G. (2019). Effect of specific reflex integration approach on primitive reflexes in spastic cerebral palsy in children. International Journal of Health Sciences and Research, 9(6), 87-93.
