NEUROMUSCULAR FUNCTIONAL RE-ABILITATION Movement challenges out of context
Movement challenges within context and similar CONDITION TIMELINE
Figure 5: Challenging motor abilities within and out of context. Out-of-context challenges do not resemble functional motor control. They therefore have limited scope in recovering full functional movement. This group of challenges is used mostly for patients who are unable to perform functional movement, often during the initial part of the treatment. Once the patient demonstrates an improvement in control, the motor abilities should be challenged within context.
Swiss ball. In this situation, the balance is similar but movement is performed in sitting and out of the context of standing. The rehabilitation can be both dissimilar and out of context – for example, straight leg-raising (dissimilar) practised on the floor (out of context). The recovery of motor control
can be facilitated by introducing the five adaptive code elements into the clinical management. This promotes a functional recovery that is more likely to benefit the patient in their daily activities. The results are more likely to be maintained in the long term and could help to reduce the overall duration of the treatment programme.
DEVELOPING A NEURO- MUSCULAR REHABILITA- TION PROGRAMME Much of NR is the marrying of the three concepts discussed so far (4): n Focus on functional movement n Principle of skill/ability level rehabilitation n Code for motor adaptation. Through a simple three-step
procedure, the therapist decides which level of rehabilitation will be used and applies the motor adaptation elements to the treatment programme. Many of the remedial challenges are selected from the patient’s own movement repertoire. These principles can be applied to any condition in which the neuromuscular system is implicated,
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such as conditions with an intact motor system, eg. n Neuromuscular changes associated with musculoskeletal injuries, sports injuries, post-surgery, back pain and other musculoskeletal pain conditions n Conditions where certain behaviours impede recovery or may lead to injury or pain n Non-traumatic pain conditions such as trapezius myalgia, chronic neck pain and painful jaw and conditions where there is damage to the central nervous system, eg. n Stroke n Head trauma n Post-CNS surgery n Degenerative conditions.
The alternative rehabilitation for this patient could be to use extra-functional challenges such as introducing a wobble board, resistance bands or exercise machines at the gym, activities in which the patient has no experience or particular interest. Is one approach more effective? Which is the patient more likely to maintain?
SUMMARY
Neuromuscular rehabilitation aims to help the individual recover their movement control. Functional movement is the movement repertoire of an individual. Functional rehabilitation uses the patient’s own movement
repertoire to help them recover their movement losses. NR has three basic recurring
concepts: n It aims to be functional. n It uses the skill/ability level rehabilitation concept. n It uses the learning/adaptation code to optimise motor control changes. For the full text and a video demonstration of NR, see Lederman (4). For information on courses, see
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cpd@cpdo.net.
IS DEFINED IN NR AS THE UNIQUE MOVEMENT REPERTOIRE OF AN INDIVIDUAL
THE AUTHOR
Professor Lederman is the director of the Centre for Professional Development in Osteopathy and Manual Therapy in the UK and visiting professor at Unitech Osteopathic College, New Zealand. He graduated from the British School of Osteopathy and completed his PhD at King’s College, London, where he researched the neurophysiology of manual therapy. He also researched and developed osteopathic harmonic technique and is involved in research examining the physiological effects of manual therapy and the development of osteopathic neuromuscular re-abilitation.
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FUNCTIONAL MOVEMENT
References 1. Lederman E. The science and practice of manual therapy. Elsevier 2005. ISBN 9780443074325 2. Lederman E. The effect of manual therapy techniques on the neuromuscular system. Doctoral thesis, King’s College, London, 1998 (for copies, contact Senate House and British School of Osteopathy library) 3. Newham DJ, Lederman E. Effect of manual therapy techniques on the stretch reflex in normal human quadriceps. Disability and Rehabilitation 1997;19:326–331 4. Lederman E. Neuromuscular rehabilitation in manual and physical therapy. Elsevier 2009. ISBN 9780443069697 5. Schmidt RA, Lee TD. Motor control and learning, 4th edn. Human Kinetics 2005. ISBN 9780736042581 6. Asseman F, Caron O, Cremieux J. Is there a transfer of postural ability from specific to unspecific postures in elite gymnasts? Neuroscience Letters 2004;358:83–86 7. Heitkamp HC, Horstmann T, Mayer F, Weller J, Dickhuth HH. Gain in strength and muscular balance after balance training. International Journal of Sports Medicine 2001;22:285–290 8. Faber MJ, Bosscher RJ, Chin A, Paw MJ, et al. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: a multicenter randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2006;87:885–896 9. Sale DG. Neural adaptation to resistance training. Medicine and Science in Sports and Exercise 1988;20:5 10. Cratty BJ. Movement behavior and motor learning, 2nd edn. Henry Kimpton 1967. ASIN B002K6INOW 11. Dragana MC, Golubović J, Bratić M. Motor learning in sports. Physical Education and Sport 2004;2:45–59 12. Osgood CE. The similarity paradox in human learning: a resolution. Psychology Review 1949;56:132–143
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