Fundamentals of Neuromuscular Re-Education

Goals of Physical Therapy

1. Use movement analysis and determine the patient's:
1. movement strategies, postural responses, and appropriate feedback
2. skills and abilities - prerequisites for movement
3. missing components of normal movement
2. Active patient-participation in movement
3. Movement transfers to activities of daily living (functional exercise)
4. Apply frequent practice in a variety of environments for maximum adaptability

Decision-Making Framework for Selecting Interventions

D.W. Fell introduced a clinical decision-making framework for selecting and progressing interventions in this population. All interventions typically applied in this population (e.g., gait and locomotion training, functional training, balance and coordination training, conditioning and reconditioning) can be selected and progressed based on clinical decisions that fall into one or more of these three categories:

• Progressing function through motor learning principles
• type of practice (components, variety)
• feedback (extrinsic to intrinsic)
• environment (closed to open, simple to complex)
• Progressing function through addressing characteristics of movement / task
• amplitude, velocity, amount (frequency, intensity, duration)
• endurance
• single to multi-joint motions
• Other parameters
• developmental sequence
• supportive and assistive devices
• level of assistance (physical, verbal cues, etc.)

 

In clinical practice, there are a variety of manual techniques used to facilitate functional recovery in patients with neuromuscular impairments. In laboratory practice, we will learn and practice the technical aspects of a few, selected rehabilitation techniques (e.g. manual contact, direction of force, cues, etc.).

During skill checks, you are graded on your ability to technically perform the selected techniques with some level of accuracy. In clinical practice (and practical examination), you will select appropriate interventions based on how you can best help the patient relearn movement patterns and restore postural control.

 

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