NEUROMUSCULAR

COORDINATION
COORDINATED MOVEMENT
 Smooth, accurate and purposeful movement
 Required characteristics
 Integrated action of muscles
 Efficient postural activity
GROUP ACTION OF MUSCLES
 Prime mover(agonist)
 Antagonist

 Synergists
 Alter the direction of pull
 Stabilize in case of two joint muscle

 Fixator
 To fix the bone of origin or insertion(in case of reverse action
of muscle)
NERVOUS CONTROL
AFFERENT AND EFFERENT PATHWAY

 afferent pathway  the nerve structures through which an

impulse, especially a sensory impression, is conducted to
the cerebral cortex

 efferent pathway  the nerve structures through which an

impulse passes away from the brain, especially for the
innervation of muscles, effector organs, or glands
PATHWAY OF SENSORY IMPULSE FROM
RECEPTOR TO BRAIN
NERVOUS CONTROL
 Ascending pathways
Afferent impulses

 Cerebellum
 Receives information from afferent pathways, Convey
impulses of kinesthetic sensation,
 From periphery,
 To cerebral cortex and vestibular nucleus

 Cerebral cortex
 C. cortex plan the movement based on previous memories
NERVOUS CONTROL:
 Kinesthetic sensation
 from proprioceptors in muscles, tendon and joint
Function of kinesthetic sensation;
 Recordcontraction and stretching of muscles
 Knowledge of movement and position of limbs
NERVOUS CONTROL
 Descending pathway;
 A.H.C (anterior horn cells)
 Information are conveyed to A.H.C.
 By extra pyramidal tract descending pathway
 Impulse reach to effector organ and produce response.
INCO ORDINATION
INCO ORDINATION
 Jerky, arrhythmic and inaccurate movement
 Result from the interference with the function of factor
which contribute to the development of co-ordinated
movement.
 Treatment is according to causation
 CAUSATION OF INCO ORDINATION
1. Upper motor neuron lesion
2. L.M.N lesion
3. Cerebellar lesion
4. From loss of kinesthetic sensation
CAUSATION OF INCO ORDINATION
 L.M.N lesion
 Weakness/faccidity
 Poor condition of muscle

 U.M.N lesion
• Spasticity
 Motor area of cerebral cortex
CAUSATION OF INCO ORDINATION
 Cerebellar lesion
 Cerebellar ataxia (a-without, taxia-order)
 Irregular and swaying with intention tremor
 Marked Hypo tonicity, tire easily, inadequate Fixator action

 Loss of kinesthetic sensation

• (sensory inputs which recognize the orientation of the
different parts of the body in relation to other parts as
well as the rates of movement of body part)
o Sensory ataxia/ tabes dorsalis / tabetic ataxia
 Due to Loss of proprioception
 Eyes closed: patient cant tell the position of body and joint
 Hypo tonic, tire easily
ATAXIA
RE-EDUCATION
RE-EDUCATION
 Coordinated movement is natural to body and tends to
remain still if only inco coordinated movement is posible
 encourage the patient in making effort to over come in-
coordinated movements.
 Persistence and patience of Therapist

 Individual attention

 Group action of muscle

THE USE OF ALTERNATING PATHWAY
 Encourage the use of remaining intact pathways
 Develop alternating pathways
 Itwill be difficult at start
 Become easier
 Same pathways is used every time
THE CONDITION OF MUSCLES
 Muscles are effectors
 Must be prepared to receive co-ordinating impulses
 So that reaction to impulse is normal
 Relax the spastic or tense muscle
 Strengthen the weak
 Prevent disuse atrophy
PRINCIPLES OF RE-EDUCATION
WEAKNESS/FACCIDITY OF MUSCLE
 Characteristics:
 In coordination is not tolerated by body.
 In coordination is avoided by altering the pattern of
movement
 Function of muscle is transferred to other group
 Trick movement
 Functionally effective but wastage of energy
WEAKNESS/FACCIDITY OF MUSCLE
 Treatment/Interventions
 Correct imbalance
 Emphasis on weak muscle group
 Normal pattern of movement
 Restore normal integrated action of muscle.
 Slow reversal with normal timing
SPASTICITY OF MUSCLES
 Characteristics:
 Spasticity modify reaction to stimulus
 difficulty relax to allow movement
 Reluctance to active movement
 Non efficient movement
SPASTICITY OF MUSCLES
 Treatment/Interventions
 Promote relaxation
 Stimulate effort
 Give confidence in ability to move
 Rhythmical exercises to reduce fatigue and induce relaxation.
 Proximal and large joint movement are basic and are used
first
SPASTICITY OF MUSCLES
 Treatment/Interventions
 As much as possible independent movement perform, or
assistance provided when required
 Rhythmical counting or music, rhythm of bouncing of ball
for smooth speed
 Fine movement and small joint movement are delayed until
basic and rhythmical pattern are established.
CEREBELLAR ATAXIA
 Characteristics:
 Cerebellum is coordinating center
 Loss of cerebellar function result in loss of coordinating
impulses
 Hypotonic muscle
 Postural fixation is disturbed
 Balance is difficult
 Movement is irregular, swaying and inaccurate
CEREBELLAR ATAXIA
 Treatment/Interventions
 Use of remaining intact pathways
 Cerebrum can compensate to some extent
 Restore stability of trunk and proximal joints to provide
stable background for movement
 Strengthening
 Main emphasis on isometric (multiple angle)
 Increase resistance in isometric
 Functional movements
 Resisted exercises in pattern
related functional movement
LOSS OF KINAESTHETIC SENSATION
 Information about body in space, position of joints and
tension in muscles
 Characteristics of loss:
 Hypo tonicity
 In coordinated movement
LOSS OF KINAESTHETIC SENSATION
 Treatment/Interventions
 Substitutionby sense of sight is basis of re-education
 Maintaining normal body patterns
 Undamaged and redundant nervous pathways can transmit
impulses of kinaesthetic sensation
Frenkel’s Exercises