Neuro Topics

During the first year of life, the unimanual and bimanual skills of infants who are developing typically improve significantly. Yet infants who sustain a peripheral or central neural injury during the perinatal period often present with asymmetrical limb motion, thus are at risk for upper limb dysfunction. Conditions which may result in limb asymmetry include brachial plexus injury and perinatal stroke. Detection of asymmetrical upper limb motion could lead to effective early intervention strategies thus informing clinical practice for these conditions. These methods of motion assessment could also be used to monitor change following microsurgery and other forms of therapeutic intervention. This session will review the following: a) clinical conditions at risk; and b) current methods available to examine differences in limb motion including use of clinical assessments, inertial sensors, surface electromyography, and 3D motion capture. The advantages of all methods will be reviewed. Options for feasible clinical use will be discussed with the audience.

Hand therapists have long known academically and experientially that to effectively treat the hand and upper extremity one must include the brain. The drive to move, the program for movement, its intentionality, and intricate balance of dexterous movement can only be exquisitely coordinated by the brain, and, of course, the feedback of the body. 

This presentation, generously illustrated with videos, will encompass foundational principles of neurophysiology to support the case study in the keynote address. Key concepts include the reflex circuit, neuromodulation, and maturation of the circuit as foundation to coordinated movement. This concept of innate patterned movements, or reflexes, as building blocks of movement was first explored by the Nobel Prize winning British physiologist, Charles Sherrington in the late 19th century, whose research established many concepts of modern neuroscience, namely “the reflex is the simplest unit of nervous integration”. He coined the term synapse and elucidated Sherrington’s Law, the concept of reciprocal innovation. Additionally, he is the author of the term “reflex integration” and demonstrated that reflexes are not isolated automatic events, but are coordinated by the central nervous system and lead to purposeful behavior. 

Fast forward to modern day, and the research and practice of Svetlana Masgutova, PhD, has extrapolated this concept to effect real change in the human body by paving, or re-patterning, the reflex circuit. Familiar reflex patterns, such as asymmetric tonic neck reflex, and Robinson’s Hands Grasp seen in infants are revealed in a different light than certified hand therapists, both occupational and physical therapists, have been previously trained. The full circle is revealed to the hand therapist when this movement is observed in the paralyzed limb of an infant when the brain is tapped for its genetically encoded knowledge of the pattern.

Complex Regional Pain Syndrome (CRPS) is a complex pain condition in which successful treatment depends heavily on patient engagement and understanding. While this can be challenging in adults, the barriers are amplified in pediatric populations.

Pain neuroscience education (PNE) is a critical component of rehabilitation for children with CRPS. When delivered effectively, PNE helps young patients and their families understand why symptoms occur, reduces fear surrounding movement, and supports active participation in therapy.

This session will use a case-based approach to demonstrate how PNE can be adapted for pediatric patients with CRPS. Attendees will learn developmentally appropriate language, metaphors, and visual strategies to explain key concepts including central sensitization, nervous system dysregulation, and the impact of stress and fear on symptoms.

Participants will leave with practical scripts and immediately applicable tools to integrate pain neuroscience education seamlessly into treatment sessions, reinforcing concepts throughout the rehabilitation process and promoting functional progress.