Chapter 6: Neuromuscular Control Flashcards
Define neuromuscular control:
The efferent (motor) response to sensory information
Name the 3 sources of sensory information that are essental for producing adequate muscle activity and dynamic joint stability.
- proprioception
- kinesthesia
- force sense
Define proprioception
Conscious and unconscious appreciation of joint position
Define kinesthesia
The sensation of joint motion or acceleration
Define force sence
- perception of force
- ability to estimate joint and musculotendinous loads
Conscious awareness of joint motion, position, and force is essential for….
- otor learning
- anticipation of movements
Unconscious proprioception modulates ______ function and initiates _____ ______ stabilization.
- muscle
- reflexive joint
Neuromuscular control encompasses _____ output that is responsible for producing ______ and providing _____ _____ stability and _____ stability.
- motor
- movement
- dynamic joint
- postural
What are the 2 motor control mechanisms that are involved with interpreting afferent information and coordinating efferent responses?
- feedforward
- feedback
Define feedforward neuromuscular control.
Planning movements based on “real-time” sensory information that is integrted with learned somatosensory patterns from past experiences.
Define feedback neuromuscular control.
Continuous regulation of muscle acitivity through reflex pathways.
Feedforward mechanisms are responsible for what type of muscle activity? What about feedback processes?
- preparatory muscle activity
- reactive/reflexive muscle activity
Dynamic restraint is achived through _____ and _____ neuromuscular control.
- preparatory
- reflexive
Muscle activity enhances dynamic joint stability by:
- increasing joint congruency
- providing eccentric absorption of external forces applied to the body
- increasing muscle stiffness
Many joint (eg. ______ and _____) possess limited bony congruency and are, therefore, reliant on ____ _____ to limit loading of passive _______ structures.
- GH and tibiofemoral
- muscle activation
- capsuloligamentous
An enhancement in joint stability can be achieved via muscle activity by…
- Increasing compressive force across the joint
- increasing joint contact area
- limit loading of passive tissues by providing eccentirc absorption
The level of muscle activation, whether it is preparatory or reactive, reatly modifies the muscle’s ______ _____.
Stiffness properties
From a mechanical perspective, muscle stiffness refers to…
The ratio of the change of force to the change in length
Muscles that are stiffer resist lengthening more ______ and provide more effective _____ ______ to joint pertubation.
- effectively
- dynamic restraint
Muscle stiffness generated by _____ neuromuscular activity prior to joint loading is one of the most mechanisms for _____ _____ of joints. However, high levels of muscle stiffness would restrict the _____ joint motions necessary.
- feedforward
- dynamic restrant
- fast
The objective of neuromuscular control activities is to…
Refocus the patient’s awareness of peripheral sensations and process these signals into more coordinated motor strategies.
Neuromuscular control muscle activity serves to protect joint structures from excessive _____ and provides a ______ mechanism to reccurent injury.
- strain
- prophylactic
Peripheral mechanoreceptors within _____ and ______ structures mediate neuromuscular control by conveying joint motion and position sense to the ______.
- articular
- tensomuscular
- CNS
Injury to articular structures results not only in a mechanical disturbance that manifests a joint laxity, but also in …
A loss of joint sensation
Define deafferentation.
- Damage to microscopic nerves arising from peripheral mechanoreceptors within articular structures.
- disruption of sensory feedback necessary for effective neuromuscular control and joint stabilization
Injury to the joint reduces _____ stability and often diminishes the capability of the _____ _____ system, rendering the joint functionally unstable.
- mechanical
- dynamic restraint
Explain the concept of mechanical vs functional stability using ACL-deficient and ACL-reconstructed patients.
- some ACL-deficient patients are capable of high levels of function and dynamic joint stability (via rehab), even though there is mechanical instability
- ACL-reconstructed patients have increased mechanical stability, but sensations of “giving way” which is indicative of functional instability
- Sx + rehab = dynamic restraint system
Rehabilitation of the pathological joint should address the ______ and ______ neuromuscular control mechanisms required for joint stability.
- feedforward
- feedback
The 4 elements crucial for reestablishing neuromuscular control and functional stability are:
- joint sensation (position, motion, and force)
- dynamic stability
- preparatory and reactive muscle characteristics
- conscious and unconscious functional motor patterns
The dynamic restraint system is informed by specialized nerve endings called ______.
Mechanoreceptors
How does a mechanoreceptor work?
Transducing mechanical deformation of tissue (eg. stretching, compression) into frequency modulated neural signals
Mechanoreceptor signals provide sensory information concerning what?
Internal and external forces acting on the joint
3 morphological types of mechanoreceptors in joints:
- Pacinian corpuscles
- Meissner corpuscles
- free nerve endings
Quick adapting mechanoreceptors:
Cease discharging shortly after the onset of a stimulus
Slow adapting mechanoreceptors:
Continue to discharge as long as the stimulus is present
In healthy joints, quick adapting mechanoreceptors are believed to provide ….., while slow adapting mechanoreceptors are believed to provide…..
- conscious and unconscious kinesthetic sensations in response to joint movement or acceleration
- continuous feedback. Proprioceptive information relative to joint position
Muscle spindles embedded within skeletal muscle detects what information to send to the CNS?
- muscle length
- changes in muscle length
- rate of muscle lengthening
Type Ia afferent neurons carry what information? What does it contribute to?
- changes in muscle length
- rate of change in muscle length
- contributes to the sensation of kinesthesia
Type II afferent neurons carry what information? What does it contribute to?
- input regarding muscle length
- contributes to proprioception
Muscle spindles are also innervated by small motor fibres called _____ _____.
Gamma efferents
Activity of gamma efferents permits the muscle spindle to become more ______, and accommodates for changes in _____ _____ while continuously transmitting _____ _____.
- sensitive
- muscle length
- afferent signals
Muscle spindle afferents project directly on skeletal motorneurons through ______ ______. When muscle spindles are stimulated, they elicit a _____ contraction in the _____ muscle.
- monosynaptic reflexes
- reflex
- agonist
- eg. knee jerk reflex
GTOs are _____ detectors and are able to protect the tenomuscular unit by ….
- force
- reflexively inhibiting muscle activation when high tension might cause damage
Generally, with high muscle tension, GTOs would have the ______ effect of muscle spindles by producing….
- opposite
- a reflex inhibition (relaxation) in the muscle being loaded.
What receptors located in the skin are thought to contribute to proprioception, kinesthesia, and force sense?
Pressure and stretch
Research demonstrates improvements in proprioception and neuromuscular control with the use of _____ devices.
Compression (eg. bandages, neoprene sleeves, athletic tape).
Encoded signals concerning joint motion, position, and force are transmitted from ______ receptors, via _____ pathways, to the spinal cord.
- peripheral
- afferent
Within the spinal cord, ______ link ascending pathways to the _____ _____ to permit conscious appreciation of ______, ______ and _____.
- interneurons
- cerebral cortex
- proprioception
- kinesthesia
- force
2 reflexive pathways couple articular receptors with ____ nerves and _______ receptors in the spinal column. A third _____ reflex pathway links the muscle spindles directly with motor nerves.
- motor
- tenomuscular
- monosynaptic
Sensory information from periphery is used by the cerebral cortex for ______ awareness and ______ neuromuscular control, whereas balance and postural control are processed at the ______.
- somatosensory
- feedforward
- brainstem
Balance is influenced by the same peripheral afferent mechanisms that mediate ____ ______ and is partially dependent on the inherent ability to integrate ______ _____ with _____ and the _____ apparatus.
- joint proprioception
- somatosensory input (jt position sense and kinesthesia)
- vision
- vestibular
What is frequently used to measure sensorimotor integration and functional joint stability? Why?
- balance
- deficits can result from aberrations in the afferent feedback loop of the lower extremity
What in the spinal cord links afferent fibres from articular and tenomuscular receptors with efferent motor nerves?
Synapses
What within the spinal column connects articular receptors and GTOs with large motor nerves innervating muscles and small gamma motor nerves innervating muscle spindles?
Interneurons
What is the final common input?
Muscle spindles integrate peripheral afferent information and transmit a final modified signal to the CNS.
The final common input feedback loop is responsible for…
Continually modifying muscle activity during locomotion via the muscle spindle’s stretch reflex arc.
By coordinating reflexive and descending motor commands, ____ ______ is modified and _____ _____ is maintained.
- muscle stiffness
- dynamic stability
Increases in muscle length excite ____ ____ ____. The resulting afferent volleys results in spinal medium-latency and long-latency _____ ______ responses.
- muscle spindle afferents
- stretch reflex
Mechanoreceptors in ligament have been demonstrated to elicit _____ responses in the musculature ______ to the imposed loading.
- reflexive
- antagonistic
Define nueromuscular control.
The efferent response of muscles transforming neural information into physical energy
Preactivated muscle tension suggests that prior ____ _____ (experience) concerning the task is used to ______ muscle activation patterns.
- sensory feedback
- preprogram
Feedforward neuromuscular control uses ______ information about a task, usually from ______, to determine the most ______ strategy for executing the impending functional task.
- advance
- experience
- coordinated
Name the functions of preparatory muscle activity that contribute to the dynamic restraint system.
- incresed stiffness of the tenomuscular unit
- improved stretch sensitivity of the muscle spindle system
- reduced electromechanical delay
What is electromechanical delay (EMD)?
The period that elapses between the arrival of a neural impulse (electrical) initiating muscle contraction and the development of force (mechanical).
Heightened stretch sensitivity and stiffness could improve the reactive capabilities of muscle by …
Providing additional sensory feedback and superimposing stretch reflexes onto descending motor commands.
Preactivated muscles provide quick compensation for _____ _____ and are critical for _____ _____ stability.
- external loads
- dynamic joint
What factors leads to voluntary muscle activation failure following capsuloligamentous injury (Arthrogenic muscle inhibition)?
- partial differentiation
- inflammation
- joint effusion
- joint laxity
- pain
Arthrogenic muscle inhibition (AMI) can be present ______ following ________ injury.
- billaterally
- unilaterl
Both feedforward and feedback neuromuscular control can enhance dynamic stability if…
The sensory and motor pathways are frequently stimulated
Frequent facilitation of pathways enhances:
- the memory about taxks for preprogrammed motor control
- reflex pathways for reactive neuromuscular control
NMC rehab exercises must be executed in what way for physiological adaptations to occur?
- technical precision
- repetition
- controlled progression
In the acute phase of healing, joint ______ and ______ can compound sensory deficits, however, this cannot account for the chronic deficits in ______ and _______ associated with pathological joints.
- pain
- inflammation
- proprioception
- kinesthesia
Capsuloligamentous ______ and ______, coupled with traditional rehabilitation is one option that appears to restore some kinesthetic awareness, although not equal to that of ______ limbs.
- retensioning
- reconstruction
- noninvolved
The objective of neuromuscular rehabilitation is to…
Develop or reestablish afferent and efferent characteristics that enhance dynamic restraint capabilities with respect to in vivo loads
4 basic elements for reestablishing NMC and functional stability:
- proprioceptive and kinesthetic sensation
- dynamic joint stabilization
- reactive NMC
- functional motor patterns
Name the 7 afferent and efferent characteristics that contribute to the efficient regulation of the basic elements and the maintenance of NMC.
- sensitivity of peripheral receptors
- facilitation of afferent pathways
- muscle stiffness
- onset rate and magnitude of muscle activity
- agonist/antagonist coactivation
- reflex muscle activation
- discriminatory muscle activation
The ______ of the neuromuscular system to change is what permits rapid modifications during rehab that ultimately enhance ______ and _____ muscle activity.
- plasticity
- preparatory
- reactive
NMC techniques include:
- open/closed kinetic chain
- balance training
- eccentric and high reps/low-load exercises
- reflex facilitation through reactive or “pertubation” training
- stretch-shortening activities
- biofeedback training
To restore dynamic muscle activation necessary for functional stability, one must employ simulated positions of ______ that necessitate ____ _____ stabilization.
- vulnerability
- reactive muscle
Closed kinetic chain exercises create _____ loads that maximally stimulate _____ receptors, especially near the end ROM while _______ receptors are excited by changes in length and tension.
- axial
- articular
- tensomuscular
Open chain activities require more ______ awareness of limb position because of the non-constrained and free moving distal segment.
Conscious
How can chonic athletic participation enhance proprioceptive and kinesthetic acuity?
By repeatedly facilitating afferent pathways from peripheral receptors.
Muscle stiffness has a significant role in preparatory and reactive dynamic restraint by ______ and ______ joint loads.
- resisting
- absorbing
What types of loading should be used to increase muscle stiffness?
- eccentric
- isometric
The GTO receptor is normally associated with muscle _____, and thus protects the tenomuscular unit from ____ ____.
- inhibition
- excessive strain
Chronic overloading of the musculotendinous unit may result in ______ ______ ______ around GTOs that desensitizes this ______ to muscle tension.
- connective tissue proliferation
- mechanoreceptor
During functional activities, GTO inhibition ______ and may actually ______ muscle recruitment.
- reverses
- enhance
Increased muscle stiffness resulting from low loads and high repetitions can be attributed to…
Fibre type transition
How does endurance training enhance stiffness?
Increasing the baseline motor tone and cross-bridge formation time
How does power training enhance muscle stiffness?
Alters the rate and magnitude of muscle tension during preactivation
Which type of athlete has more vigorous reflex responses?
Sprint and/or power trained individuals
What types of training has been found to improve reflex muscle activation in studies?
- pertubations to patients on unstable platforms
- agility type training
The key instructions during pertubation is to…
Match the pertubation but not under or over react.
Overstiffening of a muscle/joint complex may provide stability but is not _______, while understiffening may permit episodes of _____ _____ or _____.
- functional
- giving way
- buckling
What is ligamentization after surgical reconstruction?
Controlled loading of the graft via rehab starts the morphological properties of a tendon autograft gradually reflecting those of the ligament, and mechanical stability is restored.
Why is sensory information compromised after surgical reconstruction?
Due to the loss of mechanoreceptors in the native ligament
Why is the rehab process important after surgical reconstruction?
- Facilitate reinnervation of graft tissue by peripheral receptors.
- reestablishment of ligament stress-elicited reflexes
In addition to reactive muscle firing, unconscious control of muscle activity is critical for _____ and _____ _____ ____.
- coordination
- balancing joint forces
Restoring the force couples of agonists and antagonists might initially require ______, ______ muscle activation before unconscious control is reaquired.
- conscious
- discriminative
Benefit of biofeedback training:
- Provides instantaneous sensory feedback concerning specific muscle contractions.
- can help patients correct errors by consciously altering or redistributing muscle activity
The objective of biofeedback training is to…
Reaquire voluntary muscle control and promote functionally specific motor patterns, eventually converting these patterns from conscious to unconscious control.
The objective of kinesthetic and proprioceptive training is to…
- Restore the neurosensory properties of injured capsuloligamentous structures
- enhance the sensitivity of uninvolved peripheral afferents
Joint compression is believed to maximally stimulate ______ receptors and can be accomplished with _____ _____ exercises throughout the available _____.
- articular
- closed chain exercises
- ROM
Why are early joint repositioning tasks important?
- Enhance conscious proprioceptive and kinesthetic awareness,
- eventually leads to unconscious appreciation of joint motion and position.
How does applying a neoprene sleeve or elastic bandage provide additional proprioceptive and kinesthetic information?
- By stimulating cutaneous receptors
- enhanced somatosensory function leads to improved neuromuscular function during motor tasks
Exercises that simultaneously involve the non-injured limb may help reestablish ______ awareness of ______ ______, ______ and ______ in the injured extremity. To increase level of difficulty, these can be performed under _____ loads.
- conscious
- joint position
- motion
- load
- moderate
The objective of dynamic joint stabilization exercises is to…
Encourage preparatory agonist/antagonist coactivation.
Efficient coactivation restores the ____ _____ necessary to balance ____ ____ and increase ____ ____, thereby reducing the loads imparted to the _____ structures.
- force couples
- joint forces
- joint congruency
- static
Dynamic stabilization from muscles requires _____ and _____ to joint loads.
- anticipating
- reacting
Dynamic stabilization includes placing the joint in positions of vulnerability where….
Dynamic support is established under controlled conditions
What kind of exercises require both preparatory and reactive muscle activity through feedforward and feedback systems?
- balance
- stretch-shortening exercises (plyometrics)
What type of exercise is excellent for inducing coactivation and compression?
Closed kinetic chain
Reactive neuromuscular training focuses on stimulating the reflex pathways from _____ and _____ receptors to _____ muscle.
- articular
- tenomuscular
- skeletal
What is the objective of reactive neuromuscular training?
To generate joint pertubations that are not anticipated, stimulating reflex stabilization.
Why is persistant use of reflex pathways important in reactive neuromuscular training?
Can decrease response time and develop reactive strategies to unexpected joint loads
All reacctive neuromuscular training exercises should induce….
Unanticipated joint pertubations.
What is the objective of functional rehabilitation?
To return the patient to preinjury activity levels while minimizing the risk of reinjury.
The goals of functional rehab include:
- restoring functional stability and sport-specific movement patterns or skills
- using functional tests to assess the patient’s readiness to RTP.
Functional activities incorporate all of the available resources for…
- stimulating peripheral afferents
- muscle coactivation
- reflex and preprogrammed motor control
In functional rehab, emphasis should be placed on what?
- Sport-specific techniques
- positions and maneuvers where the joint is vulnerable
In functional rehab, the use of repetition and controlled intensity can lead to…
Muscle activity (preparatory and reactive) gradually progressing from conscious to unconscious motor control.
LE NMC techniues should focus on ______ muscle groups that require attention and progress from no weight to ____ ____.
- individual
- weight assisted
How can you do PWB in open and closed chain environments?
- in pools
- unloading devices
Closed chain exercises creates joint compression, enhancing joint ______ and ______ feedback, while minimizing ______ forces on the joints.
- congruency
- neurosensory
- shearing
Early dynamic joint stabilization exercises begin with _____ training and ______ weight bearing on stable surfaces, progressing to _____ weightbearing on _____ surfaces.
- balance
- partial
- partial
- unstable
Strength exercises should focus on ______ and _____-type activities in a _____ kinetic orientation.
- eccentric
- endurance
- closed
How do strength exercises further enhance dynamic stability?
- increases in preparatory muscle stiffness
- Increases in reactive characteristics
LE eccentric loading is accomplished by activities such as…
- forward and backward stair climbing
- backward downhill walking
LE strength and balance exercises can be combined and executed with ______ _____ _____ to increase the level of difficulty.
light external forces
How does biofeedback help with developing coactivation?
- provides additional information concerning muscle activation
- encourages voluntary muscle activation by facilitating efferent pathways
Why is stretch-shortening exercises important for NMC rehab?
- plyometrics
- conditioning the neuromuscular apparatus to respond more quickly and forcefully
- permit eccentric deceleration followed immediately by explosive concentric contractions
Should stretch-shortening exercises be withheld until the late stages of rehab?
No. Modify intensity and type.
How can you control the intensity of stretch-shortening exercises?
- load
- ROM
- reps
Stretch-shortening movements require what type of muscle activity?
Both preparatory and reactive
In stretch-shortening exercise, the preparatory muscle activation prior to ______ loading is considered to be a combination of _______ and ______ motor commands.
- eccentric
- preprogrammed
- reactive
List some examples of plyometric activities that can be done right after WB is achieved (easy).
- unweighted walking in a pool
- low impact hopping
List some examples of intermediate LE plyometric exercises:
- double leg bounding
- alternate-leg bounding
- single leg hopping
List some examples of advanced LE plyometric exercises:
- hopping with rotation
- lateral hopping
- hopping onto various surfaces
Why should rhythmic stabilization exercises be included during early rehab?
To enhance LE neuromuscular coordination and reaction to unexpected joint pertubations.
How is the intensity of rhythmic stabilization increased?
Applying greater joint loads and displacements
What type of equipment is used to manually induce linear and angular pertubations to the joint?
Unstable platforms
The use of unstable platforms for pertubations can facilitate adaptation to _____ pathways mediated by ______ afferents, resulting in _____ _____ ____.
- reflex
- peripheral
- reactive muscle activation
Why does incorporating ball tossing in conjunction with balance exercises increase the difficulty?
- creates cognitive loads that may disrupt concentration and help promote reactive adaptations
- induces greater changes in location of the center of mass by requiring UE motion, making the task more challenging to the sensorimotor system
During the later stages of rehab, reactive neuromuscular activity incorporates _____ hopping.
Trampoline
Describe progressions of tramploline hopping.
- hopping and landing on both feet
- hopping on 1 foot
- hopping with rotation
- hopping while catching a ball
- hopping off of a trampoline onto various landing surfaces
Functional activities in LE always start with …
Restoring normal gait
How can we help with restoring normal gait?
- verbal instructions or mirror to internalize normal kinematics during stance or swing phases
- backwards walking
- pool or unloading device for crossover walking and figure 8s
- progress to jogging and hopping as tolerated
LE functional activities during PWB can help restore motor patterns without compromising ____ ______.
Static restraints
LE functional activities can be progressed on land by…
- acceleration/deceleration
- pivot
- jogging
- cutting
- cariocas
- gradually increasing speed
The most difficult functional activities are designed to stimulate…
The demands of individual sports and positions.
- may require input from the coaching staff
Give some examples of difficult LE functional activities integrated with sports/position demands.
Shuttle runs, carioca crossovers, retro sprinting and forward sprinting implemented with sport specific drills such as fielding a ball, receiving a pass, and dribbling a soccer ball.
Why are dynamic mechanisms even more crucial for maintaining functional stability in the UE vs the LE?
GH jt lacks inherent stability from capsuloligamentous structures
What is the function of the rotator cuff muscles?
- not suited for creating joint motion
- responsible for steering the humeral head in the glenoid fossa
Why do larger muscles with insertion sites further from GH joint work well initiating joint motion?
Greater mechanical advantage
Maintaining proper GH joint kinematics requires…
- Balancing the external forces and internal moments
- limiting excessive translation of the humeral head
- restoring appropriate coupling of rotator cuff and prime movers
Injuries to the static structures in the shoulder can result in diminished _____ _____ and altered kinematics of the _____ and _____ joints.
- sensory feedback
- scapulothoracic
- GH
Failure of the dynamic restraint system in the GH joint exposes the static structures to ______ or _____ loads, jeopardizing joint ______ and predisposing the patient to _____.
- excessive
- repetitive
- integrity
- reinjury
What is the most effective means of restoring sensorimotor function long term in the shoulder?
Surgery
In the UE, there is general agreement that having _____ ____ early in the rehab program is imperative.
Scapular control
In the UE, the starting position for all activities should be exercises that focus on….
Scapular retraction
- LFT
- serratus anterior
- minimize activation of UFT
Name some accessory exercises for scapular retraction:
- side lying ER
- side lying forward flexion
- prone extension
- prone horizontal abduction with ER
- push up plus
Why is closed kinetic chain activities early in UE rehabilitation prefered? Give some examples.
- to promote afferent feedback and coactivation
- introduces axial loads and muscle coactivation
- joint approximation stimulates capsuloligamentous mechanoreceptors
- ex. Weight shifts, table slides, wall slides
UE Stretch-shortening exercises in the overhead athlete has been shown to improve ______.
Proprioception
How can muscle stiffness be enhanced in the UE?
- using elastic tubing
- using plyoball with an inclined trampoline
- concentrating on eccentric phase
- high repetitions with low resistance
To complement elastic tubing exercises, what can we use for endurance training in the UE?
Upper extremity ergometers
Dynamic stabilization exercises for the shoulder use ______ _____ to create _____ and ______ joint displacement, maximally stimulating _____.
- unstable platforms
- linear
- angular
- coactivation
The intensity of dynamic stabilization exercises of the UE with unstable platforms is controlled by manipulating…
- the degree of joint displacement
- loading
Name 3 closed chain exercises that have been described to stimulate coactivation in the shoulder. Why are these exercises good?
- push ups
- horizontal abduction on a slide board
- tracing circular motions on a slide board
- progressing froma quadruped to a push up position
- multidirectional slide boards require dynamic stabilization while concurrently using feedforward and feedback neuromuscular control.
Plyometric exercises with varying ball weights and distances for advancement are excellent for conditioning _______ and _______ muscle _______.
- preparatory
- reactive
- coactivation
Reactive neuromuscular characteristics in the UE are facilitated by…
Manually pertubing the UE while the patient attempts to maintain a permanent position
How should rhythmic stabilization exercises for the UE change in the different phases of rehab?
- early phases: light loads with rhythmic stabilization exercises
- late stages: resistance added to maximize muscle activation
Rhythmic stabilization for the GH joint should incorporate positions where the joint is inherently ______, but under ______ _____.
- unstable
- controlled intenstiy
Functional training for the UE ost often involves developing _____ _____ in the _____ position.
- Motor patterns
- overhead
Describe the characteristics that UE functional activities must have:
- combination of strength training, balance, core stability
- multiple planes of movement
- incorporate the entire kinetic chain
- reproduce the demands of specific events
UE functional activities should begin with what types of activities? What should it progress to?
- Begin with slower velocities and conscious control.
- progress to functional speeds and unconscious control
What should the outcome measure be for UE functional activities?
Technique rather than speed
The speed and complexity of movements in athletic competition requires rapid integration of _____ ______ by _____ and ______ NMC systems.
- sensory information
- feedforward
- feedback
Dynamic joint stabilization is contingent upon both _____ _____ activation and _____ ______ activation.
- cortically programmed
- reflex-mediated muscle
