Neuromuscular Re-education

Introduction

Neuromuscular re-education training

Neuromuscular re-education is a technique used by rehabilitation therapists to restore normal movement. Together, your nerves and muscles work to produce movements. Nerves send signals between your muscles and your brain about when, where, and how fast to move. It is a complex process. Theorists believe that over time, nerve tracts are reinforced and muscle movement (motor) patterns are learned and stored in your memory. For example, this explains why you remember how to go up steps and automatically know how to adjust your movements for tall or short steps.

Muscle movement patterns are affected when nerves or muscles experience damage or injury. This can result from trauma, medical conditions, and neurological conditions, such as stroke and traumatic brain injury. Neuromuscular re-education is one method used by rehabilitation therapists to facilitate the return of normal movement in persons with neuromuscular impairments.

These techniques require an understanding of the relationship between stabilizing and mobilizing muscles, proper sequencing and optimal biomechanical motion patterns for a variety of daily tasks, occupational activities and sports-specific physical performance.

In these approaches, tasks are broken down into their most simple component single-joint movement patterns. These patterns are perfected with proper alignment, breathing, and muscle stabilization in non-weight bearing postures using manual or mechanical assistance. As the specific single-joint component pattern is mastered, without symptoms, the training becomes more complex and might include one or more of the following advances:

  • Multi-joint movement

  • Non-linear motion (circular or diagonal)

  • Weight bearing postures

  • Proprioceptive challenges (eyes closed, unstable surfaces, etc…)

  • Progressive resistance

  • Variable speeds and durations

An assortment of techniques, tools and apparatus’ can be used to provide neuromuscular re-education and movement training including: one-to-one instruction, motion and task modeling, tactile cueing, taping and bracing, imagery, audiovisual aids, pressure biofeedback, EMG, balance boards, dumbbells, and other devices.

The end goal with these types of approaches is to move a patient through a process that begins with:

  1. Unconscious movement incompetence (they don’t know what they don’t know), as it relates to efficiency and economy, to

  2. Conscious movement incompetence (they know what they don’t know), to

  3. Conscious movement competence (they learn through practice and repetition – this is the longest phase), and finally,

  4. A state of unconscious movement competence (Mastery). The last phase represents an integrated pattern of task performance that is safe and injury-resistant

Treatment

At your initial evaluation, your rehabilitation therapist will ask you about your symptoms and medical history. The therapist will examine your posture, balance, and joint movement. Measurements will be taken to see how strong your muscles are and how far you can move your joints. Your rehabilitation therapist will assess your balance and posture while you are standing and sitting. You should state your concerns and goals. A neuromuscular re-education treatment plan will be designed based on your initial functioning.

Your neuromuscular re-education program will consist of repetitive movements, posturing, and stimulation designed to reinforce nerve signals for functional movements. It is theorized that when the nerve signals are “retrained” and appropriate muscle movements are repeated, movement patterns become automatic again. Neuromuscular re-education is usually done along with other types of treatment to promote functional muscle movement.

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