Neuromuscular Rehabilitation in Manual and Physical Therapy – Principles to Practice – Elsevier Churchill Livingstone

179 Pages·2016·18.71 MB·English

by  Lederman E.

Neuromuscular Rehabilitation in Manual
and Physical Therapies
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Neuromuscular
Rehabilitation in
Manual and
Physical Therapies
Principles to Practice
Eyal Lederman
DO PhD
Director, Centre for Professional Development in Manual and Physical Therapies,
London, UK
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2010
Dedicated to Tsafi, Guy, Mattan and Pinooki
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Preface
This book is for individuals who would like to help The contents and organization
other individuals to recover their control of of the book
movement.
Neuromuscular rehabilitation is straightforward
and uncomplicated: we all do it naturally all of the The book starts by identifying the main unifying
time.Throughoutourliveswelearnnewmovement model/principles for motor rehabilitation (Ch. 1),
patterns or recover our control after an injury. The including the importance of a functional approach,
means by which we achieve these changes are no skill- and ability-level rehabilitation and the code
different to neuromuscular rehabilitation. They all for neuromuscular adaptation. The following
rely on the same neurophysiological, psychological chapters discuss several areas that are relevant to
and behavioural processes. neuromuscular rehabilitation. They include how
Neuromuscular rehabilitation integrates several movement is organized (motor control, Ch. 2) and
branches of knowledge. They include medical, how it is constructed from underlying control com-
neurophysiological, psychological-behavioural and ponents called motor abilities (Ch. 3). These abil-
motor-controlsciencesaswellasmanualandphysi- ities are affected in various neuromuscular and
cal therapy fields. The enormity of available in- musculoskeletal conditions and may, therefore,
formation from these diverse sources can be become the target of rehabilitation. Also, proprio-
overwhelming,inparticularwhentryingtotranslate ception plays an important role in movement
this information into a practical clinical approach. control and is often affected by musculoskeletal
The main aim in writing this book was to collate and central nervous system damage (Ch. 4).
and integrate all this information and present it in Thenextimportantissueinrehabilitationishow
a practical, user-friendly format. to sustain the motor recovery in the long term.
Over the years of working in clinics I have Chapter 5 discusses motor learning and adaptation
observedthatneuromuscularrehabilitationofaper- principles and how to integrate them into the clini-
son after joint surgery or musculoskeletal injury cal management. The consequences of learning,
bears close resemblance to the clinical management neurophysiological/neuromuscular plasticity and
ofastrokepatient.Itwascleartomethatthereisa adaptation are discussed in Chapter 6.
unifying model for neuromuscular rehabilitation. Inmusculoskeletalinjuriesthemotorsystemreorga-
However, it took a good decade and a half to put nizes movement to prevent further damage (Ch. 7).
it together into a coherent and cohesive model, Themotormanifestationofthisreorganizationwillbe
andonewhichisstillbeingtinkeredwith.Thisuni- discussed as well as the indications for introducing
fied model for neuromuscular rehabilitation is neuromuscularrehabilitationafterinjuryidentified.
described throughout the book. Once an individual acquires an injury, their
The information in the book is derived from sev- beliefs,attitudesandbehaviourmayhaveimportant
eralsources. Itis a combination of myown research implications for recovery. Furthermore, the way a
in the neurophysiology of manual therapy, the vast person uses their body or schedules their activities
researchinallthefieldsdiscussedabove,myclinical during the day may put them at risk for injury.
experience of 23 years and my experience of teach- These cognitive and behavioural factors are dis-
ingneuromuscularrehabilitationforthelast15years. cussed in Chapter 8. This theme is continued in
These experiences have made me aware of the aca- Chapter9,examiningnon-traumaticpainconditions
demicandpracticalneedsofthepractitionersinthis suchastrapeziusandjawmyalgia,andchronicneck
area. This is reflected in the contents of this book: pain. In this group of conditions the individual
it aims to bridge the gap between science and the develops localized and debilitating pain without a
practiceofneuromuscular rehabilitation. history of tissue trauma.
Preface
Chapter 10 explores the principles of functional movement challenges described in the book and
movement, motor control and learning/adaptation, DVD are derived from several sources. Some are
and their use in rehabilitating patients with central research-based, others I have developed and used
nervous system damage. in clinic. Over many years of teaching I have
Chapter 11 describes how to develop a rehabili- observed professionals from different disciplines
tation programme using the key principles identi- and their approach in rehabilitating movement con-
fied in the book. Chapter 12 describes some of trol. Their wealth of experience and knowledge is
the assessments and challenges of motor abilities part of this library of movement rehabilitation. It
and similarly for proprioception in Chapter 13. A is a source book that aims to provide ideas and not
summary of the book can be found in Chapter 14. recipes or treatment protocols for rehabilitation.
The book is supplemented by a DVD demon- I hope you will find it useful.
strating some of the assessments and challenges of
the motor abilities and their use in clinic. The London 2010 Prof Eyal Lederman
viii
Lederman, E. (2010) Neuromuscular Rehabilitation in Manual and Physical
Therapy – Principles to Practice – Elsevier Churchill Livingstone
1
Introduction
This book explores how manual and physical thera- skills). For one person their functional repertoire
pists can help individuals to recover and optimize may include playing tennis, for another standing on
their control of movement. Musculoskeletal injury, their head (yoga) or playing the piano and so on.
painexperiencesandcentralnervoussystemdamage Once a person learns a movement or a new skill
are all associated with diverse neuromuscular and it becomes a part of their movement repertoire
movement control changes. The aim of this book is and, therefore, their behaviour. Movement which
to provide the theoretical and practical basis for isoutsidethenormalrepertoireofanindividualwill
neuromuscularrehabilitationfortheseconditions. be termed here as extra-functional (Fig. 1.1).
This book is intended for manual and physical Functional rehabilitation is defined here as the
therapistsofalldisciplines(physiotherapists,osteo- processofhelpingapersontorecovertheirmovement
paths,chiropractors,sportsmassagetherapists,etc.) capacity by using their own movement repertoire
who work with patients whose conditions involve (whenever possible). Hence, for a person who has
the neuromuscular system. The book will also be motor losses at the knee and is unable to walk or
useful for personal trainers, Alexander method tea- run, the rehabilitation will be in walking, then run-
chers,Pilatesinstructors,posturalintegrationteachers, ning, jumping and stair-climbing, etc. If this person
Rolfing practitioners, sports trainers and individuals plays tennis, this activity will also be used in the
whoexperiencelossesinmovementcontrol. rehabilitation programme.
However,rehabilitationislikelytobelesseffective
A functional approach iftheremedialmovementpatternsortasksareoutside
in rehabilitation the individual’s experience (extra-functional). For
example, it would be less helpful for a tennis player
withaleginjurytobegivenrehabilitativeexercisesuch
A functional approach in rehabilitation is the key as football, or leg presses in the gym or leg exercise
concept underpinning the management described lyingonthefloor(Ch.2).Forthisparticularpatient,
in this book. rehabilitation that incorporates tennis tasks is more
Functional movement is defined here as the likelytobeuseful.Forapersonwhoissufferingfrom
uniquemovementrepertoireofanindividual.Apor- lowerbackpainandenjoysyoga,afunctionalrehabili-
tionofthisrepertoireinvolvesthemovementbeha- tationwouldconsistofthesharedfunctionalactivities
viourassociatedwithdailyneedsanddemands,such (general skills), but may also include some of the
as feeding, grooming, going places, etc. (general uprightposturesfromyoga(specialskills).Alesssuit-
skills). Some movement behaviour may be partly ablerehabilitationapproachwouldbetoprescribeten-
shared with others whilst some may be unique to nis to this individual. This may seem obvious;
particular individuals; examples include physical however, movement rehabilitation often prescribes
hobbies, sports and occupational activities (special extra-functional tasks such as core stability training