Chapter: Neuromuscular
Co-ordination
Topic:
General
and
Procedu
ral
principl
Name: Rishbha Tiku
Roll no: 182102038
nd
Year: 2 es of
th
Semester: 4
Subject: ExerciseFrenkel
Therapy
’s
Exercis
e
COORDINATION
Coordinated movements are smooth, accurate and purposeful movements
which is brought about by the integrated action of many muscles,
superimposed upon a basis of efficient postural activity.
The muscles concerned are grouped together as prime movers,
antagonists, synergists and fixators according to the particular function
they have to perform.
INCOORDINATION
Incoordination are jerky, arrhythmic or inaccurate movements which are
called so because the harmonious working of the muscles together is
disturbed.
Causes:
a. Weakness or Flaccidity
b. Spasticity
c. Cerebellar lesions
d. Loss of kinaesthetic sensations
a. Weakness or Flaccidity
Lesion of LMN type which prevents the appropriate impulses from
reaching the muscles, or the condition of the muscles modifies their
normal reaction to these impulses.
b. Spasticity
Lesions affecting the motor area of the cerebral cortex, or the UMN result
in spasticity of muscles.
When some appropriate impulses are able to reach them the condition of
the muscle is such that their response to them is abnormal.
c. Cerebellar lesions
Marked hypertonicity of the muscles is seen.
Inadequate fixator action is seen not only in the muscles directly
concerned with the group action, but the body generally.
Movement is irregular and swaying, with a marked intention tremor.
d. Loss of kinaesthetic sensations
Seen in cases like sensory ataxia or tabetic ataxia.
Tabes Dorsalis
Tabes Dorsalis is a demyelination of posterior columns, dorsal roots and
dorsal root ganglia.
It is a type of a neurosyphilis disorder.(tertiary syphilis)
Posterior spinal root and posterior column dysfunction account for
symptoms
Symptoms:
Lancinating pains
Gait ataxia
Bladder disturbances
Visceral crises
Cardinal Signs:
Areflexia in legs
Impaired vibration/position sense
Positive Romberg’s Sign
Argyll Robertson pupils which fail to constrict to light but accommodate.
FIGURE:
Tabes Dorsalis: Disruption of posterior root nerves by meningeal fibrosis leads
to Wallerian degeneration of the posterior columns (shaded area)
FRENKEL’S EXERCISE
Introduced by H.S. FRENKEL
He made a special study of tabes dorsalis and devised a method of
treating the tabetic ataxia by means of a systemic and graduated
exercises.
It was originally developed in 1889.
Tabes dorsalis was the condition from which the advent of Frenkel’s
exercise began.
It is a neurological rehabilitation technique which improves
incoordination.
Therapeutic exercises used to improve coordination:
Frenkel’s exercises
Proprioceptive Neuromuscular Facilitation (PNF)
Neurophysiological Basis of Developmental techniques
Sensory Integrative Therapy
General instructions for Frenkel’s Exercises
1. Exercises can be performed with the part supported or unsupported
unilaterally or bilaterally.
2. They should be practised as smooth, timed movements performed at a slow
even tempo by counting out load.
3. Consistency of performance is stressed and a specified target can be used to
determine range.
4. Four basic positions are used: lying, sitting, standing and walking.
5. The exercises progress from postures of greatest stability (lying, sitting) to
postures of greatest challenge (standing, walking).
6. As voluntary control improves, the exercises progress to stopping and starting
on command, increasing the range and performing the same exercises with eyes
closed.
7. Concentration and repetition are the keys to success.
GENERAL PRINCIPLES
The general principles are as follows:
a. Concentration of the attention
b. Precision
c. Repetition: constant repetition of a few motor activities.
The ultimate aim is to establish control of movement so that the patient is able
and confident in his ability to carry out those activities which are essential for
independence in everyday life.
PROCEDURAL PRINCIPLES
1. Use of sensory cues (tactile, visual, proprioceptive) to enhance motor
performance.
2. Increase of speed of activity over time.
3. Activities are broken down into components that are simple enough to be
performed correctly.
4. Assistance is provided whenever necessary.
5. Whenever a new movement is trained, various inputs are given like
instructions (auditory), sensory stimulation (touch), or positions in which the
patient can view the movement (visual stimulation) to enhance motor
performance.
TECHNIQUES
1. The patient is positioned and suitably clothed so that he can see the limbs
throughout the exercise.
2. A concise explanation and demonstration of the exercise is given before
movement is attempted, to give the patient a clear mental picture of it.
3. The patient must give full attention to the performance of the exercise to
make the movement smooth and accurate.
4. The speed of movement is dictated by the physiotherapist by means of
rhythmic counting, movement of her hand, or the use of suitable music.
5. The range of movement is indicated by marking the spot on which the foot or
hand is to be placed.
6. The exercise must be repeated many times until it is perfect and easy. It is
then discarded and a more difficult one is substituted.
7. As these exercises are very tiring at first, frequent rest periods must be
allowed. The patient retains little or no ability to recognize fatigue but is usually
indicated by a deterioration in the quality of the movement, or by rise in the
pulse rate.
PROGRESSION
Made by altering the speed, range and complexity of the exercise.
Alteration in speed of consecutive movements, and interruptions which
involve stopping and starting to command, are introduced.
Wide range and primitive movements in which large joints are used give
way to movements which involve small joints, limited range and a more
frequent alteration of direction.
Simple movements are built up into sequences to form specific actions
which require the use and control of a number of joints and more than one
limb, walking.
According to the degree of disability ,re-education exercises start in lying
with the head propped up and with the limbs fully supported and progress
is made to exercises in sitting, and then to standing.
REFERENCES
The Principles of Exercise Therapy-Dena Gardiner
Physiopedia-Coordination Exercises (General instructions for frenkel’s
exercise)
Principles of Neurology-Victor Adams (Tabes Dorsalis)
Neurology and Neurosurgery Illustrated-Kenneth Lindsay
(Tabes Dorsalis)
[Link]/medicine and dentistry
(Tabes Dorsalis diagram)
