Importance of neuromuscular rehab

Neurorehabilitation is a complex medical process which aims to aid recovery from a nervous system
injury, and to minimize and/or compensate for any functional alterations resulting from it

GOALS OF REHAB
 Physical independence

 Mobility

BOBATH NEURODEVELOPMENTAL APPROACH

 Used for patients with hemiplegia caused by stroke, brain injury, and cerebral palsy.

 Major goal is normalization of muscle tone, posture, movement, and function

POSITINING

Importance of Positioning

 prevent development of musculoskeletal deformities

 Contracture

 Ankylosis(stiffness and rigidty of joints)

 Pressure ulcers

 decreased vascular supply

 Thrombosis

 Edema

 The unconscious patient

Parosmia is a term used to describe health conditions that distort your sense of smell. If you
have parosmia

anosmia
the loss of the sense of smell, either total or partial. It may be caused by head injury,
infection, or blockage of the nose.
Neural plasticity can be defined as the ability of the central nervous system (CNS) to adapt in
response to changes in the environment or lesions.

Use it or lose it. If you do not drive specific brain functions, functional loss will occur.

ƒ Use it and improve it. Therapy that drives cortical function enhances that particular function.

ƒ Specificity. The therapy you choose determines the resultant plasticity and function.
 ƒ Repetition matters. Plasticity that results in functional change requires repetition. ƒ Intensity matters.
Induction of plasticity requires the appropriate amount of intensity.

ƒ Time matters. Different forms of plasticity take place at different times during therapy.

ƒ Salience matters. It has to be important to the individual.

ƒ Age matters. Plasticity is easier in a younger brain, but is also possible in an adult brain.

ƒ Transference. Neuroplasticity, and the change in function that results from one therapy, can augment
the attainment of similar behaviors.

ƒ Interference. Plasticity in response to one experience can interfere with the acquisition of other
behaviors.

Types of restraint included • Sling • Glove • Splint • Plaster • Total time of restraining – 90% of waking
hours. • 6 hours/day of intense therapy on consecutive weekdays. • 2 to 3 week period.

Minimum inclusion criteria – Upto 20 degree wrist extension – Upto 10 degree thumb abduction – Upto
10 degree finger extension.

To promote better compliance. • Protocol : – 30 mins of 1 to 1 therapy for 3 days a week; – 5 hours/day
in restraint (weekdays) for 10 weeks.

BALANCE :Control of center of mass over base of support

Types of Balance • Steady state (static) balance • Reactive balance (Dynamic Balance) • Proactive
(anticipatory) balance

Myotomes (if weakness is due to neurological involvement) -neck flexion: C1-C2 -neck side flexion:C3
-shoulder elevation: C4 -shoulder abduction/shoulder lateral rotation: C5 -elbow flexion and/or wrist
extension:C6 -elbow extension and/or wrist flexion:C7 -thumb extension and/or ulnar deviation:C8
-abduction and/or adduction of hand intrinsic:T1

Common test done in cervical spine are: -foraminal compression test(spurling’s test) -distraction test
-upper limb tension test -shoulder abduction test -vertebral artery (cervical quadrant) test