BY DR EYAL LEDERMAN, OSTEOPATH

INTRODUCTION Neuromuscular re-abilitation (NR) was developed by the author of this article, at the British School of Osteopathy in the early 1990s (1). It originated from a doctoral research project in collaboration with the physiotherapy school at King’s College, London (2). The study examined the effects of manual therapy on motor control. The development of NR was in

response to the emerging knowledge that musculoskeletal injury, pain experiences and central nervous system (CNS) damage are associated with diverse neuromuscular and movement control changes. It was also evident that these central processes are well buffered against passive external influences (3). Passive manual techniques have little or no lasting effect on movement control and neuromuscular recovery (4). NR was developed from this clinical need to provide a therapeutic solution to an area lacking in manual therapy.

A FUNCTIONAL APPROACH One of the key principles in NR is the use of functional movement to help recover motor losses. Functional movement is defined in NR as “the unique movement repertoire of an individual” (4). Some of this repertoire is the movement behaviour associated with daily needs and demands such as activities of daily living (general skills). Some of this repertoire is partly shared by others and some may be unique to particular individuals, including physical hobbies, sports and occupational activities (special skills). For some people, their functional repertoire will include playing tennis; for others, it includes standing on their head (eg. yoga) or playing the piano. Once a person learns a movement or a new skill, it becomes a part of their movement repertoire and, therefore, their behaviour. Movement that is outside the normal repertoire of an individual is termed “extra-functional” in NR (Fig. 1) (4).

Functional rehabilitation is defined here as “the process of helping a person to recover their movement capacity by using their own movement repertoire (whenever possible)” (4). Hence, for a person who has motor

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NEUROMUSCULAR RE-ABILITATION

This article introduces neuromuscular re-abilitation (NR). The aim of NR is to help individuals recover and optimise their control of movement after musculoskeletal injury, pain conditions or central nervous system damage.

losses at the knee and is unable to walk or run, the rehabilitation will use gradual exposure, beginning with walking, and then moving on to running, jumping and stair-climbing. If the person plays tennis, for example, this activity will eventually be added to the rehabilitation programme. Rehabilitation, however, is likely to be less effective if the remedial movement patterns or tasks are outside the individual’s movement experience (extra-functional). For example, it would be less helpful for a tennis player with a leg injury to be given rehabilitative exercise such as football, leg-presses in the gym or leg exercises while lying on the floor. For this patient, rehabilitation that incorporates tennis tasks is more likely to be useful. For a person with lower back pain and who enjoys yoga, functional rehabilitation would consist of the shared functional activities (general skill) but may also include some of the upright postures from yoga (special skills); a less suitable rehabilitation approach would be to prescribe tennis, an extra-functional task, to this individual. This may seem obvious, but movement rehabilitation often prescribes extra-functional tasks such as core stability training on the floor, bracing the trunk or strength training with equipment. The question is how effective these activities are in recovering functional movement. The introduction of extra-functional activities during rehabilitation raises some problems. Extra-functional activities and exercises require learning a new task at a time when the patient is experiencing pain or loss of movement ability. This might not be the best time to enter a new exercise regime. Learning requires time

Functional repertoire

General skills

Extra function

Figure 1: Functional movement represents the movement repertoire of the individual. It includes all the general activities and special skills. Extra-functional movement are all activities outside the individual’s movement experiences

to be set aside, intense mental focus and physical effort. Often it means that the patient has to depend on others for instructions and guidance during training. A functional approach that aims to use the patient’s own movement resources does not require additional learning; the cognitive demands are less taxing and do not require protracted training. In addition, the time that has to be set aside for practice is more manageable for the patient. Furthermore, the rehabilitation programme seldom relies on any specialised exercise equipment. The remedial movement challenges are an integral part of the person’s daily activities and, therefore, can be practised anywhere and at any time. A functional approach is easy to apply and

TO HELP THE INDIVIDUAL RECOVER THEIR MOVEMENT CONTROL

NEUROMUSCULAR REHABILITATION AIMS

sportEX dynamics 2009;22(Oct):26-29

Special skills