Appendix C – Health and Safety Concerns

Movements That Interfere With Athlete Performance

Some Motor Activity Training Program athletes may have very limited motor skill development. We are all born with approximately 100 reflexes including primitive reflexes, which are involuntary responses to stimuli. Stimuli for a reflex can include the position in which the athlete is placed, bending or turning of the head, a touch or a noise. At this early stage of development, athletes will have little control over their posture and a limited amount of voluntary control of movement. Further motor development depends upon the existence of these reflexes and the athlete's increasing ability to control them. Failure to lose or integrate these reflexes into a higher level of motor skill development interferes with more advanced movements. When a Motor Activity Training Program athlete remains at the early primitive stage of motor development, his/her athletic performance will be affected.

In order to plan appropriate activities for Motor Activity Training Program athletes, Certified Motor Activity Training Program coaches must have knowledge of the movements that interfere with an athlete's performance. Some of these movements create problems during the performance of sport activities while others prevent an athlete from doing a sport skill without assistance. Athletes may have a limited ability to rotate or move their trunk, poor balance or poor head control. Others may start a movement for a sport skill and have some part of the movement, a noise or other stimulus in the room trigger an abrupt movement of part of the body or the whole body. This causes unwanted, uncontrolled movements that can jeopardize the safety or positioning of the athlete. Along with severe or profound intellectual disability, some Motor Activity Training Program athletes may have signs of damage to their central nervous system including:

Altered muscular tone
Poor head control
Retention of primitive reflexes and reactions
Limited ability to rotate or move their trunk
Involuntary movements
Altered gait
Poor balance
Lack or altered awareness of their body parts

Motor Activity Training Program coaches must have knowledge of the differences in muscle tone and reflexes and reactions in order to prevent serious injuries to the athletes and to help them perform as many sport activities as possible. In order to obtain this information, coaches should consult with parents, caregivers, adapted physical educators, physical therapists, occupational therapists, and/or nurses. The following muscle tones, reflexes and reactions are included in the Motor Activity Training Program Coach Training Program.

Muscle Tone
Muscle tone, the tension (stiffness) in a muscle, is controlled by the central nervous system. Muscle tone is used to maintain posture and provide coordination for movement and activities in general. Although muscle tone is controlled by the central nervous system, individuals may voluntarily change the tension of a muscle (i.e. flex a muscle). Abnormal muscle tone may affect an athlete's strength, flexibility, agility, fitness, endurance, cardiovascular ability and overall performance of a sport skill.

There are three types of muscle tone created by problems of the central nervous system that may influence the movement of an Motor Activity Training Program athlete. They are hypotonic, hypertonic and fluctuating muscle tone. Hypotonic muscle tone is a condition in which there is too little or no tension in the muscle. These athletes are said to have low muscle tone. Many of the athletes with Down syndrome have very flexible joints (floppy joints) because the muscles surrounding the joints are hypotonic. Hypertonic muscle tone is a condition in which there is too much tension in the muscle or muscle groups. This interferes with the athlete's ability to move the limbs or joints controlled by the hypertonic muscles. Fluctuating muscle tone is a condition in which an athlete may have muscles that shift back and forth between too little and too much muscle tone.

Palmar Grasp
The Palmar Grasp is a reflex that causes an individual to grasp an object placed in the palm of his/her hand. Athletes who are functioning at the first developmental stage should be able to grasp a finger or object placed in the palm of their hands. If they have progressed to the second developmental stage, they can grasp a ball and release it to pick up another object or ball. Many athletes may be able to grasp a ball or racquet but cannot release it because of the reflex (perseveration of the reflex). It may take a lot of patience on the part of the coach and a considerable amount of time for the athlete to learn to release the object.

Startle Reflex
The startle reflex causes the athlete to suddenly arch the back and extend the arms and legs. The stimulus for the startle reflex can be a loud noise, a sudden movement of the athlete's head, a bright light or even a touch on the abdomen. After the initial reflex occurs, the athlete will relax and assume his/her original position. It is important for a coach and/or peer coach to know which athletes retain the startle reflex. An athlete who has the startle reflex and is left unattended or improperly secured in his/her chair may sustain severe injury.

Response to Gravity
Responses to gravity are triggered when you place an athlete on his/her back or stomach. Gravity acts on the head and pulls the athlete toward the support surface (floor). These responses to gravity are designed to help individuals develop the ability to voluntarily move limbs, and maintain posture and balance. Movements include straightening the arms and legs, folding them into the body and lifting them against the pull of gravity. The following reflexes and reactions can interfere with an athlete's performance.

Tonic Labyrinthine Prone Reflex (TLP)

The Tonic Labyrinthine Prone Reflex occurs when the athlete is placed on the stomach. The athlete's limbs and head will be involuntarily pulled toward the support surface in a flexed position. In this case the head bends toward the chest while the hips, knees, elbows and shoulders bend or fold toward the surface or under the athlete's stomach. The reflex may be so strong that the hips are raised off the floor. The Tonic Labyrinthine Prone Reflex is more obvious when you place an athlete on a scooter board and the limbs and head bend toward the floor.

Tonic Labyrinthine Supine Reflex (TLS)

When an athlete who retains the Tonic Labyrinthine Supine Reflex is placed on his/her back, the response to gravity causes the head and limbs to extend. The back of the head presses into the floor and the arms and legs are also pulled toward the floor/support surface. In extreme cases, the back may arch so much that the trunk lifts off the floor leaving the athlete's weight resting on the shoulders and hips.

Some Motor Activity Training Program athletes may continue to demonstrate the TLP and TLS reflexes. When these two reflexes are present, athletes will have difficulty lifting the head or any limb against the force of gravity. They do not have the muscular strength to overcome the force of gravity, which is pulling them toward the ground. Placing these athletes on their backs and asking them to lift their head or raise an arm to hit a ball creates a situation in which they will often fail. Coaches should observe them carefully since they will become fatigued in a short time and have trouble sitting up or standing for any length of time. If they are sitting in a chair trying to hit a ball, they may slowly give into gravity and slide out of the chair or rest heavily on the support surface/table/tray.

Asymmetrical Tonic Neck Reflex (ATNR)
The Asymmetrical Tonic Neck Reflex occurs when the head is turned to the right or left. When the athlete's face is turned toward the right side of his/her body, the right arm and leg extend and the left arm and leg flex. This position is similar to a fencer's position. If the athlete's head is turned to the left, the opposite occurs. The arm and leg on the left side extend while the arm and leg on the right side flex.

When the Asymmetrical Tonic Neck Reflex is retained, athletes are unable to do certain movements. If an athlete attempts to throw a ball and turns his/her head to look at the ball, the arm on that side will extend. Since the arm is straight, the only way he/she can throw the ball from that position is to move the whole arm forward from the shoulder. Athletes could also avoid looking at the throwing arm, which would allow them to bend (flex) the arm and throw the ball. Retaining this reflex also interferes with the ability of athletes when they walk. Looking toward one side of the body may cause the opposite leg to collapse and the athlete to fall.

Athletes with the asymmetrical tonic neck reflex may also have trouble using the two hands or arms together. Turning their head toward one side or the other causes one arm to extend and the other arm to flex. Athletes who retain this reflex must have a ball or other piece of sport equipment placed at the midline of their body so that the head does not have to turn. If a ball or sport equipment is not placed near the middle of their body, the reflex will be triggered and they will be unable to perform the sport skill.

Symmetrical Tonic Neck Reflex (STNR)
The Symmetrical Tonic Neck Reflex occurs when the head (neck/chin) is bent forward or backward. The arms do the same movement as the head while the legs do the opposite movement. For example, when the athlete's head (chin) is bent toward the chest, the arms also flex while the legs extend. If you extend the athlete's neck, moving the head toward his/her back, the arms extend and the legs flex.

Athletes who still have this reflex will have trouble performing a variety of sport skills. For example, when an athlete attempts to putt a golf ball and bends his/her head down to look at the ball, the movement of the head triggers the symmetrical tonic neck reflex. This causes the athlete to not only flex the arms, which pulls the putter away from the ball but also causes the athlete to straighten his/her legs.

The Symmetrical Tonic Neck Reflex also interferes with walking. If an athlete is walking and looks up, the arms will extend and the legs will flex. This causes the legs to collapse, and the athlete to fall. The only way an athlete can walk is to keep the head in a neutral position without bending it down (forward) or backward. Activities for athletes demonstrating the Symmetrical Tonic Neck Reflex should be carefully selected in order to avoid putting the athlete in danger or interfering with the success of the athlete.

Positive Support Reflex
The stimulus for the Positive Support Reflex is contact of the ball of the foot with the ground or support surface. Athletes who have not integrated the Positive Support Reflex will lock their knees when the balls of their feet make contact with the floor or a hard surface. This rigidity or stiffness of the legs interferes with their ability to walk. Athletes who still retain the Positive Support Reflex have a tendency to walk on the balls of their feet and will not be able to put the heel down first in walking.

Retention of the Positive Support Reflex is also obvious when an athlete tries to sit down in a chair or rise out of a chair. If the ball of his/her foot hits the floor, the legs will extend forcefully (shoot out) and the athlete will fall into or out of the chair. Therefore, to get in and out of a chair, the athlete must put the whole foot or the heels down first. To do this, an athlete who is attempting to stand moves forward in the chair before placing his/her foot on the floor; while an athlete attempting to sit on a chair moves the hips back over the seat of the chair before sitting down.

Propping Reactions
The Propping Reactions, also called the Parachute or Protective Extension Reactions, are used to maintain balance. The first to appear is the Propping Reaction to the front. The athlete's hands are placed on the floor, in front of the body, with the palms down on the surface. At the first developmental stage, athletes will have the ability to maintain a balanced sitting position by placing their hands on the floor out to their sides. By the second developmental stage, they can sit by placing their hands on the floor in back of them.

Athletes who have only developed the ability to support themselves with the hands in front of their body should be watched carefully. If they take one hand off the floor to push a ball, it is highly possible that they will lose their balance and fall to the side or back. Coaches should be ready to provide additional support on each side and to the back of the athletes.