Neuromuscular Re-Education Treatment Approaches

Following CVA and TBI, patients experience varying degrees of deficits in central nervous system processes which are necessary for normal movement. The level of motor impairment and potential for functional recovery is evaluated by the physical therapist. A summary of examination processes are included in the Interactive Lecture: Neuromuscular Examination Elements.


Typicall Vs. Atypical Motor Control

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Prerequisites for Motor Control

Typical Motor Control Components

Atypical Motor Control Components

cognition - perception


able to:

  1. attend to environment
  2. perceive environment
  3. remember and relate to past experience




memory impairments


range of motion


normal alignment of body segments

normal length-tension on muscle and connective tissue



increased connective tissue formation (stiffening)

disuse atrophy



intact, two-way communication between sensory and motor systems


somatosensory and kinesthetic deficits

slow velocity

decreased accuracy


appropriate effort and force production in a muscle

reduction of motor units available for activation

selective atrophy (decreased fast twitch)

reduced firing rate of motor neurons



tension between origin and insertion of a muscle






patterns of contractions which are variable and flexible

stabilize body segments during movement

produce movement


Non-selective movement patterns

Stereotypic and predictable movement patterns

flexor synergies

extensor synergies



ability to modify motor programs and make predictions/plan based on the environment; integration of

  • body position
  • amplitude of movement
  • speed, force, posture, and accuracy requirements
  • sensory and environmental conditions


Rigid and inflexible responses to initiating/producing movement

  • increased tone
  • loss of selectivity
  • lack of automatic movement
  • difficulty moving in anti-gravity positions
  • poor fine/graded motor control
  • slow movements

 Example of Synergies Post-Stroke

Standing_R_Hemiparesis.png 18-21.jpg


Techniques to Reduce Spasticity

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