• MUSCLE – RE EDUCATION

• Definition

The art of training (or) strengthening the muscles that lies in

certain condition in which they are called upon to work full
capacity against resistance with gradual increase.

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 Objectives of m. re-education:
1. To develop motor awareness & voluntary motor response

2. To develop strength & endurance in patterns of movement that are

necessary, safe & acceptable.

• We must initiate development of motor awareness & voluntary motor

responses before we can set up a program to develop strength &
endurance.

• On the other hand, some degrees of strength & endurance are necessary
to the development of motor awareness & effective voluntary response.

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 Necessary & Effective
• Are used to emphasize a well-designed program of muscle re-
education, which must be based on very specific & practical
demands for: the patient & his environment.

Safe
• Safe patterns: which minimize the hazards of trauma & deformity
that might → abnormal stress & strain.

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 Indications of M. Re-education

1. Diseases causing subnormal voluntary control.

2. LMNL → mild and severe flaccid paralysis & weakness of
motor response
3. Subclinical neuromuscular syndromes
4. After prolonged immobilization or disuse.
5. After tendon transfer or m. transplantation.
6. After arthroplasty.

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 Contra-indications

Inflammation
pain
 Uses

1.To regain the muscle power and tone

2.To regain the contracting property of muscle
3.To increase ROM
4. To strengthen the muscles
5. To keep the muscles in normal functional status
 Techniques of M Re-education
As muscle re-education is devoted to the:
1. Recovery of voluntary control of skeletal muscle, or
2. Development of motor control (active, strong, coordinated,
enduring), so
• The primary OBJECTIVES must follow a certain
REASONABLE order:
I. Activation
II. Strength
III. Co-ordination
IV. Endurance

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 I. Activation

• At that time muscle re-education program must begin by applying

certain techniques to activate these LMNU.
• Techniques to activate LMNU:
A. Focusing procedures
B. Proprioceptive stimulations

• No one technique alone is adequate in all problems,

PT must know & use all possible techs. in whatever
combination → give optimum response.

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 A. Focusing Procedure
• All re-education techniques should be started with: a
discussion or demonstration of the routines to be
used.
• Patient may not only know what is:
1. Being done? , but
2. Expected to do?:
1. if he is to relax, he must know
2. if he is to attempt to contract & when?,
All depends on the pt’s age & intelligence

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 Passive Motion (PROM) .1

• 1st step in starting activating LMNU.

• Can be done for completely denervated muscle.
• Make the patient aware of desired movement by:
feeling & seeing the mov as they
are carried out

• Stimulates proprioceptive reflexes of flex, ext & stabilization.

• Passive mov is difficult to be executed properly until desired
responses are obtained.
• Begins within limits of pain & tightness, then progress.

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 Cutaneous Stimulation .2
• Assist patient to concentrate on areas under care, he can better
see & feel contraction in specific muscles.
• Proprioceptive stimulation through tickling & scratching
various areas.
• The PT may use:
1. His fingers to: stroke or tap ms & tendons.
2. A brush or a rubber hammer.
3. Basic massage (effleurage, petressage, tapotement).
4. Cryotherapy (“brief“ ice application).
5. Brief painful stim..
 Electrical stimulation .3

• Cause muscle contraction

• 1--» patient see & feel m. cont.
2 --» sensations of value in sensory reflex
stimulation.
3 --» muscle tension

4 --» proprioceptive stimulation.

B. Proprioceptive Stimulations
Is an activation method → stimulation of muscle contraction by proprioceptive stimulation
(jt, muscle, tendon), these receptors can be stimulated by
1. Passive movement.
2. Positioning in various attitudes
3. Balance in sitting & crawling
4. kneeling & standing (righting reactions) → vestibular stim.
5. Weight bearing
6. Traction
7. Approximation
8. Quick stretches
9. Resistance

We must use posture, passive mov, active mov to → stretching, resistance & reflexes
necessary → stim. proprioceptive system.
 Stretching & Resistance
• Muscle tissue responds best when:
extended & put under some tension (stretching).
• Obtaining strength & co-ordination must be based on
techniques requiring muscle to contract against resistance
when partially elongated.
• Sudden stretching of muscle or sudden release of tension
→ facilitate active response.

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 II. Strength

• Definition:
1. Ability of muscle to generate force or torque at a definite
velocity.
2. Ability of a muscle to develop force for providing:
1. stability (keep muscle stable).
2. mobility (strength to move).
3. Ability of a muscle to continue successive exertions under
conditions where a load is placed on it.
• Strength can be obtained only through muscle work
(force x distance).

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 III. Coordination
Is the integration of different kinds of movements in a single pattern.

• Is the ability to use the right muscle at the right time & right intensity to
achieve a desired movement.

• Coordinated patterns are: those with

which the neuromuscular & musculoskeletal systems can most efficiently &
safely function.

• Is achieved through conditioned reflex training (subconsciously).

• Coordination mechanisms are highly complex, with

many of the components of the movement at a subconscious level beyond
voluntary control.

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 IV. Endurance
Definitions:
• Ability to carry out repetitive movement essential to prolonged
activity.
• Ability to repeat motor tasks or sustain motor activity over a
prolonged period of time.
• Ability to maintain effort with demands placed upon the muscle.
* Patterns of movement to ↑ endurance are similar to that used to
obtain strength, except that the demands on neuromuscular system
are less.
• Ex. to ↑ strength require ↑ effort & ↓ repetitions.
• Ex. to ↑endurance require ↑repetitions & ↓effort.
• Endurance can also be developed by
↑ repetitions & R.
• Strength without endurance is inefficient.
• Strength & coordination without endurance are
impractical.

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 Examples
• According to the intensive evaluation, paralysis or severe weakness
with grade:
0: - ↑ sensory input by splinting, passive mov, -
interrupted direct currents.
1&2 but with intact nerve:
- passive mov, EMS (faradic & HVG), brief icing, brushing,
quick stretch, approximation, hydrotherapy, isometric exs.
- Grade 1: static exs
- Grade 2: A A (suspension, sh wheel, finger ladder,
bicycle ergometer & PNF techs).
3,4 & 5:
- Active exs (AF, AR) via hydrotherapy, pulley, weights, slings,
biofeedback, functional exs as up & down stairs, PNF, etc.,

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