do it. Indeed, we all do it all the time. Every day we take actions that result in movement and behaviour changes; we can self-modify our motor control. Furthermore, the neuromuscular system has the capacity for self-recovery and to reorganise in response to injury. This means that within our behaviour there are certain elements that facilitate the recovery of movement control. There are five elements that can help to optimise neuromuscular adaptation (Fig. 3) (1,4): n Cognition n Being active n Feedback n Repetition n Similarity.

In order to learn a new task, modify our behaviour or help our system recover, we need to be aware of what we are doing (cognition), and we have to actively perform the action that we aim to recover (being active). In order to correct our movement, we rely on internal information from our senses or depend on guidance from someone else (feedback), and we have to practise the task many times (repetition). One of the adaptive code

elements that determines the physical manifestation of the rehabilitation programme is the “similarity principle”. In essence, the practice during rehabilitation has to closely resemble the movement that we aim to recover. It seems that for learning or recovering particular movement patterns, the practice should be both similar and within the context of the task. This suggests that if a patient cannot balance during walking, then rehabilitation should focus on balance during walking (6–8). Equally, if force losses impede stair-climbing, than leg strength should be challenged during that or a very similar activity (9). If the patient, due to lack of coordination, cannot raise their arm to eat, then rehabilitation should focus on coordination within similar movement patterns. Under these circumstances, the individual parts of the whole movement are being practised simultaneously – that is, the relationships between them are being rehearsed (5). Practising movement that is similar and within context is more likely to transfer to related daily activities. Transfer is the ability to take

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motor/behaviour adaptive state

One

n cognition n being active n feedback n repetition n similarity

motor/behaviour adaptive state

Another

Figure 3: Experiences that contain the five code elements are more like to promote adaptive changes within the neuromuscular system resulting in movement and behavioural changes. (With permission Lederman E. Neuromuscular rehabilitation in manual and physical therapy. Elsevier, 2009 (to be published))

Highly transferable

Least transferable Dissimilar

Rehabilitating: trunk control during walking

out of context

n Lumbo-pelvic tilts practiced on the floor n core tensing or bracing n extension exercise on the floor

Similar out of context

n Laying on the floor moving both legs in a walking-like pattern

Dissimilar within context

(this may seem surprising. As long as the person is walking the dissimilar movement is redundant as far as

motor learning)

Figure 4: Similarity and context principle in rehabilitation. The effectiveness of practice can be assessed by examining how similar it is and whether it is in the context of the goals of training. Rehabilitation is likely to be more effective if is similar and within the context of the movement goals of the treatment. (With permission Lederman E. Neuromuscular rehabilitation in manual and physical therapy. Elsevier, 2009 (to be published))

PART OF SEVERAL CONTROL BUILDING BLOCKS THAT MAKE UP SKILLED MOVEMENT

BALANCE AND COORDINATION ARE

a motor experience from one situation and apply it to another (10–12). Practising a dissimilar movement pattern or movement that is out of context may reduce the likelihood of transfer (Fig. 4). Imagine a patient who has standing difficulties due to a balance problem. The treatment will be dissimilar if strength exercises, such as standing knee squats, are used to challenge standing balance (4). The strength challenge is the dissimilar element as it fails to challenge balance; however, it is still performed within the context of standing. The rehabilitation will be out of context if the training for balance is practised sitting on a

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

n Core tensing or bracing in walking

Similar n Walk within context