Neuromuscular
coordination
Saima Abdul Aziz
BSPT, MSPT
IPM&R, DUHS
Objectives.
• At the end of this lecture, the students will be able to learn
about:
• Neuromuscular coordination and its main controlling centers
• Briefly describe the effects of sensory, CNS and motor
coordination abnormalities.
• Treatment of ataxia with Frenkel’s exercises
Re-education
• The use of alternative nervous pathways
• The condition of the muscles
Principles of re-education
• Weakness or flaccidity of a particular muscle group:
To correct the imbalance by emphasis on the activity of weak
muscle
To restore the normal integrated action of muscle in the
performance of patterns of functional movement.
• Spasticity of muscle:
To promote relaxation
To stimulate effort
To give confidence in the ability to move and to train rhythm
Cerebellar ataxia
• Loss of coordinating impulses.
• Hypotonic muscles
• Postural fixation is disturbed
• Balance is difficult
• Movements are irregular, swaying and inaccurate
Aim of treatment
• To restore stability of the trunk
• Proximal joints to provide a stable background for movement
• When the muscular weakness is severe, strengthening methods
must be used first but the main emphasis in treatment is to
holding (isometric exercises)
Loss of kinaesthetic sense
• Information as to the whereabouts of the body in space
• The position of the joints
• Tension in muscle
• Lesions causes:
Hypotonicity of the muscle
Incoordinated movement
Identification of Fall Risk Factors
• Risk factors for falls are divided into two categories:
• Intrinsic Risk Factors
Dizziness, weakness, gait abnormalities, poor balance, confusion,
poor coordination, ROM, cognitive impairment
• Extrinsic Risk Factors
Floor surface, poor lighting, cluttered furniture, obstacles, non-level
surface, poor shoes
Falls are a result of loss of
postural control.
Normal Postural Control (Balance)
• Balance requires keeping the “Center of Mass”
(COM) over the “Base of Support” (BOS) during
static and dynamic situations.
• Neural components of postural control:
• Sensory processes
visual, vestibular, somatosensory
• Central processing
a higher-level integrative process
• Effector component
• sometimes referred to as the neuromuscular component
• postural alignment, ROM, muscle force, power & endurance
Normal Postural Control
Adaptive postural control requires modifying sensory and
motor systems to changing tasks and environmental
demands.
Tabes Dorsalis
• Degeneration of the dorsal roots of the spinal nerves and
posterior columns of the spinal cord
• Gastric crisis with severe pain and vomiting is most common
• Pain, urination problems, paresthesias, ataxia, diplopia, vertigo,
deafness
Tabes Dorsalis
• Signs: Reduced lower cord reflexes, Romberg sign, sensory
loss, atonic bladder, Charcot’s joints, optic atrophy
• Personality changes, memory loss, apathy, megalomania,
delusions, dementia (Garcia von Lin syndrome)
Frenkel’s exercises
• Definition :
a series of gradual progressive exercises designed to increase
coordination
Aim :
Establishing control of movement by use of any part of sensory
mechanism which remain intact as sight & hearing to
compensate for the loss of kinethetic sensation.
• a-concentration of attention
• b-precision
• c-Repetition
Technique
The patient is positioned and suitably clothed so that he can see the
limbs throughout.
A concise explanation and demonstration of exercise is given before
movement is attempted, to give patient a clear mental picture of it.
The patient must give his full attention to the performance of
exercise to make movement smooth and accurate.
The speed of movement is dictated by physiotherapist by means of
rthymic counting, movement of her hand or the use of suitable music.
The range of movement is indicated by making the spot on
which the foot and hand is to be placed.
The exercise is repeated many times until it is perfect and
easy. It is then discarded and a more difficult one is substituted.
All these exercises are very tiring at first, frequent rest periods
must be allowed. The patient retains little of no ability to
recognize fatigue, but it is usually indicated by a deterioration
in the quality of movement, or by a rise in pulse rate.
Frenkel’s exercises cont
• I-lying ---------
• flexion-extension
• Abduction – adduction
• Each movement will be performed unilaterally fast then slow
then interrupted by hold
• bilateral performance simultaneusely then alternatively
Frenkel’s exercises cont
• Sitting :
• 1-Slide heel to reach a mark on the floor
• 2-change standing and sit again
• Standing :
• 1-transfer weight from foot to foot
• 2- walking side ways
• 3-placing foot on specific marks
Frenkel’s exercises cont
• For arms :
• Sitting with arm supported on a table and placing hand at
specific mark
• Try to reach an object
• Picking up objects
• Put the hand in a ring or hole
THANK YOU
