Neuromuscular Control Flashcards
1
Q
What is Neuromuscular Control?
A
- The body’s reaction, interpretation, and motor response to sensory info
- Input/Output
~ Required for efficient movement and
dynamic stabilization of the joints.
~ Input/Sensory Information - Afferents
provide input about:
> Proprioception (awareness of
joint position)
> Kinesthesia (awareness of
motion)
2
Q
Afferent Input: Vision
A
- Position of head relative to environment
- Orientation of head relative to horizontal
- Direction and speed of head movement
3
Q
Afferent Input: Vestibular System
A
- Semicircular Canals
~ Heads rotational acceleration - Otoliths
~ Heads linear acceleration and
position - Fluid in canals move when the body moves which triggers nerves in order to tell the brain of position
4
Q
Afferent Input: Mechanoreceptors
A
- Tenomuscular
~ Specialized nerve endings that detect
changes in muscle length and tension. - Articular
~ Specialized nerve endings that sense
mechanical deformation of
connective tissue (stretching,
compression).
> Joint capsule, skin
5
Q
Tenomuscular Mechanoreceptors
A
- Muscle Spindle (reflexes)
~ Embedded within skeletal muscle
~ Reflexively causes the muscle to
contract when length is increased
quickly or beyond normal lengths.
~ Also gives brain muscle length info - Golgi Tendon Organ
~ Located within the tendon and
muscle/tendon junction
~ Reflexively causes the muscle to relax
when under excessive or prolonged
tension.
~ Also gives brain muscle tension info
6
Q
Articular Mechanoreceptors
A
- Pacinian Corpuscle
~ Located throughout the joint capsule,
ligaments, and skin.
~ Sensitive to compression during joint
movement
> Nerves attached will send
impulses to brain when
compression occurs about
tension/position. If a tear/strain
occurs, input is obstructed - Ruffini Endings
~ Located in the joint capsule,
ligaments, and skin.
~ Stimulated by stretch/tension
7
Q
Feedback Systems
A
- How the body integrates the input from all sources for proper output.
~ Internal
~ External
8
Q
Internal Feedback
A
- Muscular activity (output) is driven by info from the Mechanoreceptors during movement
- Muscular output is constantly modified to achieve joint stability and efficient movement based on the information given by the sensory receptors.
9
Q
Internal Feed-Foward
A
- Muscular activity is driven by previous mechanorector activity
~ The muscle tension is preactivated in
anticipation of the movements and
associated joint loads. - Often referred to as “Muscle memory”
~ But it’s the brain remembering not
the muscles
10
Q
Feedback and Feed-Foward
A
- Both feedback and feed-forward pathways are used to enhance joint stability and desired movements.
~ Repetition of movements increases
the efficiency of the two systems
> Neuromuscular control systems
can be trained and retrained
(rehab)
11
Q
External Feedback
A
- Info provided by an external source which provides info about performance of a task (neuromuscular control)
~ Knowledge of Results
~ Knowledge of Performance - Allows the patient to associate the outcome with what is being felt internally.
12
Q
External Feedback: Knowledge of Results and Knowledge of Performance
A
- Knowledge of Results (quantity)
~ used after completion of a
movement provides info about
overall results
> Kind of like training a dog.
• Good, Yes, No
> Experiencing the end product. - Knowledge of Performance (quality)
~ provides info about the quality of
the movement
> too fast/slow, more/less of
something etc. - Using a mirror during rehab can help modify the feels vs the actual results
13
Q
Neuromuscular Retraining
A
- When the musculoskeletal system is injured the information from the mechanoreceptors is limited or modified.
- The new mechanoreceptor configuration must be retrained to restore dynamic joint stability and efficient movement.
~ Rehab stimulates the
mechanoreceptors that are linked to
the injured joint so proper
proprioception and kinesthesia can
be achieved.
> Results in joint stability and
efficient movement. - If neuromuscular control is responsible for joint stability and efficient movement, then the best rehabilitation for retraining the system will include activities, which ask the system to stabilize the joint and create efficient movement.
~ SAID
~ Exercises that provide input and
require output.
~ AAROM is the way to go due to input/
output usage
14
Q
Which Exercises train the neuromuscular system best?
A
- Not so good
~ Non-functional
~ Lab-like
~ Isolated
~ Gravity Confused
~ Boring
~ Back yard
~ Protocols - Good
~ Functional
~ Life-like
~ Integrated
~ Gravity User
~ Fun
~ Front yard
~ Thinking and adapting
15
Q
Exercise to Enhance Neuromuscular Control
A
- Any exercise that asks the injured area to stabilize and produce efficient movement.
- Any exercise related to the activity that will be returned to following rehab. (functional)
- Any exercise that trains the input components of neuromuscular control. (everything)
~ Proprioception
~ Kinesthesia
16
Q
Open Chain vs. Closed Chain
A
- Open Chain Exercise - distal segment isn’t fixed
- Closed Chain Exercise - distal segment is fixed
- Closed chain exercises do increase mechanoreceptor activity.
~ If a limb that contains the injured
joint works mostly in a closed chain
manner the end stages of rehab
should focus on this to ensure
proper training of the
neuromuscular system.
~ If a limb that contains the injured
joint works mostly in an open chain
manner the end stages of rehab
should not focus on closed chain
activity - Closed vs Open chain rehab is based on sport specific movements
17
Q
Static Balance/Postural Control
A
- Static Balance
~ ability to maintain center of gravity
over base of suport to remain upright
> Base of Support (BOS) - Larger
the base the more stable.
> Center of Gravity (COG) -
Stability increased as COG is
lower and centered over BOS
18
Q
Dynamic Balance/Postural Control
A
- ability to move COG over the base of support and remain upright
~ BOS and COG are still the main
factors, but here good balance is the
ability to move COG to the limits of
BOS.
19
Q
Balance/Postural Control
A
- The ability to maintain balance depends on muscular reaction to sensory input to maintain COG during movement.
~ Proprioception - Gives specific
information about joint and limb
position.
~ Vision - Gives info about general
position in relation to the
environment.
~ Vestibular System - Detects
movement.
20
Q
Where the System Goes Wrong
A
- CNS Damage
~ diminished sensory organization
~ diminished neuromuscular
efficiency: activation of motor units - Damage to structures containing proprioceptors.
~ Joint
~ Muscle - Visual Disturbance
- Inner Ear Injury/Infection
- Muscle injury - modifies input and output
21
Q
Testing Static Balance
A
- Romberg’s/ Unilateral Stance
~ Manipulate:
> Vision
> Head Position
> Arm Position
> Opposite Leg Position
> Stance Leg Position - Balance Error Scoring System
~ Three stances tested on floor and
on foam. (hold stance for 20 sec)
> Double Leg
> Single Leg - Contralateral side in
20-30 degreas of hip fexion and
40-50 degrees of knee flexion.
> Tandem
~ Error Points - Subject returns to
desired stance as quickly as possible
following an error. - Timed Balance Beam Test
- Modified Force Platforms
22
Q
Testing Dynamic Balance
A
- Balance Reach Test
~ Good measure of the person’s ability
to balance dynamically and load/
unload.
~ Objective Measure - distance reached
~ Exercise is the test and the test is the
exercise.
> Good for LE injuries due to
loading/unloading requirements - Timed Balance Beam Test
- Modified Force Platform
23
Q
Testing Proprioception
A
- Testing proprioception is difficult since it has to do with identifying position only.
~ Testing set-up and collecting
objective measures are difficult.
~ Is it really important to test this?
> Not really, it’s a component of
balance and neuromuscular
control, which can be tested
24
Q
Balance Exercise Manipulation/Progression
A
- Manipulate BOS
~ Size/Orientation
~ Stability - Manipulate COG
~ Height v. BOS
~ Position over BOS
~ Dynamic Manipulation
~ Load - External Distraction or Perturbations
~ Throw a ball
~ Push them while they’re balancing - Limit or Modify Sensory Input
25
Q
Neuromuscular Control Intensive
A
- Exercises are more neuromuscular control intensive when the sensory portion of the system is manipulated or overloaded.
- A Lunge can be made harder by:
~ manipulating COG w/ weight over
head
~ change direction of lunge
~ unstable surface
~ speed it up / slow it down
~ dynamic like jumping
26
Q
Training Kinesthesia
A
- Kinesthetic sense will be trained specific to the activities chosen.
~ If rehab exercises are chosen that are
components of desired, end stage
activities then proper kinesthetic
sense will be developed.
~ Use care when rehab exercises
approach actual skill involved in a
sport.
~ “Overloading” a skill may lead to
trouble performing the skill in
real life situations
~ Remember the SAID principle
27
Q
Do “balance” exercises train neuromuscular control?
A
Yes, it trains sensory input and output required to move
28
Q
Which exercises don’t train neuromuscular control?
A
None, some are better than others though
