NEUROMUSCULAR FUNCTIONAL RE-ABILITATION

it empowers the patient to self-care. There are exceptions to the functional approach in rehabilitation. There are circumstances, for example, where the patient requires specific, extra-functional exercises for particular motor losses. This would be useful in situations where the individual is physically unable to perform functional activities, such as patients who have had surgery or have CNS damage that limits their functional repertoire.

REHABILITATION LEVELS Movement rehabilitation and motor normalisation following injury occur naturally for most individuals. After injury, most humans take physical actions that support their spontaneous and unaided recovery. This happens without any special knowledge or understanding of the underlying physiological principles underpinning their recovery. In this form of rehabilitation, the individual attempts to, partially or fully, execute the movement that has been lost. Attempting to walk becomes the rehabilitation for the person who has lost the ability to walk. Similarly, if an individual with an arm injury is unable to reach, then their repeated attempts in that pattern would often be their rehabilitation. The focus in this form of movement recovery is on the overall skill of performing the particular movement. This is loosely referred to as “skill rehabilitation” (4). This approach, however, does not

always lead to the intended results. Individuals who are in pain or who have motor losses may develop movement patterns that circumvent their losses. A patient may present with walking difficulties due to losses in the control of balance and coordination. Using the similarity principle, one would imagine that by encouraging the patient to increase their walking, walking would train balance and coordination during walking. However, what may happen is that the patient will get better at using their compensatory pattern – walking slowly, using a wider gait and shorter steps – rather than truly improving their control of balance and coordination during walking. Balance and coordination are part

of several control building blocks that make up skilled movement (5). These building blocks are called “sensorimotor abilities”. A therapeutic approach that targets the various motor abilities

www.sportEX.net Skills

Composite abilities

balance co-ordination

transition time, motor relaxation Synergetic abilities

Parametric abilities co-contraction a reciprocal activation

force velocity, length, endurance

Rehabilitation Re-abilitation

Figure 2: The motor complexity model. Some of the important abilities underlying movement control

is termed “re-abilitation” (4). At this level of rehabilitation, the aim is to recover control losses associated with particular abilities. Hence, in the walking scenario described above, the rehabilitation would aim to challenge balance and coordination in dynamic and upright postures, ideally during walking (Fig. 2). The different motor abilities are described in Table 1. Skill rehabilitation and re-abilitation are both clinically important and are often used in combination. However, there may be a shift of focus towards one of these particular approaches, depending on the individual’s condition and phase of recovery.

THE CODE FOR NEURO- MUSCULAR ADAPTATION Neuromuscular rehabilitation is a straightforward process – anyone can

TABLE 1: MOTOR ABILITIES AND THEIR DESCRIPTION MOTOR ABILITY

Parametric abilities

Force

Force relaxation Maximal force

Force grading (dynamic or static) Length (also range or angle)

Maximum length

Maximum shortening Length grading

Velocity Maximum

Grade acceleration/ deceleration Neuromuscular endurance

Synergistic abilities

Co-contraction

Dynamic and static Reciprocal activation

Composite abilities

Coordination Balance and postural stability Transition time

The ability to regulate the rate of movement or velocity of contraction/elongation in muscles

The ability to maintain a physical activity until it can no longer be continued

The ability to control the active stability of joints

The ability to control local paired movement at a joint

The harmonious and synchronous control of two or more joints or body masses

The ability to maintain upright movement or stance efficiently and minimal physical stress

The duration needed to reorganise movement between two dissimilar tasks and to carry out the subsequent task skillfully

Motor relaxation

The ability to reduce neuromuscular activity to anoptimal level necessary for maintaining a motor task or to become inactive

27 DESCRIPTION

The ability to provide adequate force for optimal execution of movement

The ability to effectively regulate the range of movement

MOTOR COMPLEXITY