Autoreflex prenatal and postnatal positions: A clinical concept for postural control rehabilitation

Impaired postural control is one of the main determinants of functional recovery in patients with neurological disorders. Clinically, it is reflected not only in reduced stability, but also in a reduced ability to organise movement under changing task and environmental conditions. It is often associated with deficits in sensory integration, anticipatory postural adjustments, trunk control, and movement adaptability (Hodges & Richardson, 1997; Krakauer et al., 2019; Massion, 1992; Shumway-Cook et al., 2023). Contemporary models of motor control emphasise that movement emerges from the interaction between prediction (feedforward), feedback mechanisms, sensory integration, and task constraints (Krakauer et al., 2019; Newell, 1986; Shumway-Cook et al., 2023). From this perspective, postural stability is not a static ability to maintain balance, but a dynamic process of continuously organising motor behaviour according to current conditions. Despite this shift in the understanding of motor control, some rehabilitation approaches are still focused mainly on movement execution or isolated muscle function. Less attention is paid to the systematic manipulation of sensorimotor conditions that shape movement organisation. In this context, there is a need for a clinical concept that connects current motor control knowledge with practical application in neurorehabilitation. The aim of this contribution is to describe the Autoreflex Prenatal and Postnatal Positions (APPP) concept as a clinically applicable framework for postural rehabilitation grounded in contemporary principles of motor control.The concept is based on the assumption that changes in sensorimotor input may alter central processing and consequently reorganise motor output. APPP therefore does not represent only a set of therapeutic positions, but a structured clinical system in which specific positions and postural setups are used purposefully according to the nature of the postural problem and the therapeutic goal (Košinová & Oravcová, 2019; Krakauer et al., 2019; Newell, 1986; Shumway-Cook et al., 2023). This concept incorporates a broad repertoire of specific therapeutic positions and postural configurations derived from prenatal and postnatal ontogeny (Košinová & Oravcová, 2019). The repertoire progresses from highly supportive positions in supine and side-lying to sitting, standing, and stepping tasks, allowing the intervention to be graded according to the patient's functional status. These positions are not used in isolation or in a schematic way, but as clinical situations in which body position, support conditions, and task demands are systematically modified. In this way, afferent input, stabilisation demands, and error signals can be changed, which may influence the organisation of postural control (Hodges & Richardson, 1997; Krakauer et al., 2019; Massion, 1992; Newell, 1986; Shumway-Cook et al., 2023). Developmental kinesiology is therefore used in APPP not as a stand-alone explanation of mechanism, but as a reference model for selecting positions and setting sensorimotor conditions. Clinical application of the concept involves selecting an appropriate position and sensorimotor setup according to the patient's postural impairment and therapeutic goal.The concept generates testable clinical hypotheses suggesting that systematic changes in sensorimotor conditions may lead to measurable changes in the organisation of postural control. Expected effects include improvements in trunk control, postural symmetry, anticipatory postural adjustments, limits of stability, and movement adaptability within a specific task context (Hodges & Richardson, 1997; Krakauer et al., 2019; Massion, 1992; Shumway-Cook et al., 2023). An advantage of the concept is the possibility of grading the intervention from highly supportive and stable conditions to more complex functional and locomotor tasks, which increases the potential for transfer into daily activities. These changes can be assessed using posturographic parameters, limits of stability assessment, trunk control measures, and functional balance tests. APPP can therefore be understood as a clinically applicable framework that integrates a specific therapeutic repertoire of positions with contemporary principles of motor control. Its clinical potential lies in the targeted manipulation of sensorimotor conditions to optimise postural organisation and facilitate transfer to functional activities.Acknowledgements: This work was prepared as a conceptual contribution within the ongoing professional and clinical development of the APPP concept.