Can Asymmetrical Tonic Neck Reflex (ATNR) manifest unilaterally in patients with cerebral stroke?

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From the Guidelines

The Asymmetrical Tonic Neck Reflex (ATNR) can manifest on either one or both sides in patients with stroke, depending on the location and extent of brain damage. In stroke patients, ATNR typically manifests on the hemiplegic (paralyzed) side of the body, corresponding to the side opposite the brain lesion. When a stroke patient turns their head to the affected side, the arm on that side may extend while the opposite arm flexes. The reflex is more commonly observed as a unilateral phenomenon in adults with stroke, particularly during the early stages of recovery when neurological function is most compromised. This primitive reflex, normally present in infants but suppressed during normal development, re-emerges following brain injury due to damage to the higher cortical centers that typically inhibit these reflexes. The presence and persistence of ATNR in stroke patients is often associated with poorer functional outcomes and may interfere with rehabilitation efforts, particularly activities requiring bilateral coordination. Physical therapists often assess for this reflex during neurological examinations and may incorporate specific techniques to inhibit it during rehabilitation sessions, however, the provided evidence does not directly discuss ATNR, but it does discuss spasticity which is a related concept 1. Some key points to consider in the management of stroke patients with spasticity include the use of positioning, passive stretching, and range of motion exercise to provide relief, as well as the potential use of oral medications such as tizanidine, baclofen, and dantrolene to reduce spasticity and pain 1. It is essential to note that the management of ATNR and spasticity should prioritize the individual patient's needs and goals, and may involve a multidisciplinary approach to optimize functional outcomes and quality of life. Key considerations in the management of ATNR and spasticity include:

  • The use of physical therapy techniques to inhibit the reflex and improve functional outcomes
  • The potential use of oral medications to reduce spasticity and pain
  • The importance of individualized patient care and goal-setting to optimize outcomes
  • The need for a multidisciplinary approach to manage the complex needs of stroke patients with ATNR and spasticity.

From the Research

ATNR Manifestation in Stroke Patients

  • The provided studies do not directly address the question of whether ATNR (Asymmetrical Tonic Neck Reflex) manifests only on one side in patients with stroke 2, 3, 4, 5, 6.
  • The studies focus on the treatment of spasticity in stroke patients using botulinum toxin type A, and its effects on muscle tone, disability, and function.
  • There is no mention of ATNR or its manifestation in stroke patients in the provided studies.
  • Therefore, there is no evidence to support or refute the idea that ATNR manifests only on one side in patients with stroke.

Related Concepts

  • Spasticity is a common complication of stroke, and botulinum toxin type A is a recommended treatment for it 2, 3, 4, 5, 6.
  • The studies demonstrate the efficacy of botulinum toxin type A in reducing muscle tone, improving function, and reducing disability in stroke patients.
  • However, these findings do not provide insight into the manifestation of ATNR in stroke patients.

Limitations

  • The provided studies do not investigate the phenomenon of ATNR in stroke patients.
  • As a result, there is a lack of evidence to inform the question of whether ATNR manifests only on one side in patients with stroke.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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