Re-education

of muscle BY

DR.SAFA AHMED

RHEUMATOLOGIST (MSC.)

Definition

It is the regaining of normal or near normal functioning of an injured or denervated muscle or a muscle with lack of control by appropriate therapeutic technique.

Objectives

To develop motor awareness and voluntary motor response.

To develop strength and endurance.

Indications

Diseases causing subnormal muscle control.

Lower motor neuron lesions (LMNL)

Dyskinetic movement ( spasticity, rigidity, ataxia, tremor).

Upper motor neuron lesion (UMNL)

After prolonged immobilization or disuse

After tendon transfer or muscle transplantation

After arthroplasty

Techniques of muscle re-

education

Activation

Strength

Coordination

Endurance

I. Activation

If the patient can’t voluntarily contract a

portion of a muscle or group of muscles

then re-education must begin with

applying certain techniques to activate

LMN through :

1. Focusing procedure

2. Proprioceptive stimulation

Focusing procedure:

All re-education techniques should start with

demonstration or discussion of the routines to be used

to the patient. It includes:

1. Passive ROM ( for completely denervated muscle)

2. Cutaneous stimulation (by using the fingers,

brushes, basic massage, ice)

3. Electrical stimulation (to produce muscle

contraction)

4. EMG and BFB (biofeedback) equipments with both

visual and auditory output (in spotty muscle

weakness and for muscle reactivation after

transplant)

Proprioceptive stimulation:

Is an activation method to stimulate muscle contraction.

The receptors can be stimulated by:

1. Passive movements

2. Positioning in various attitudes

3. Balance in sitting and crawling

4. Kneeling and standing (to stimulate vestibular system)

5. Weight bearing

6. Traction

7. Approximation

8. Quick stretches

9. Resistance

Stretching and resistance

Muscle tissue responds best when

extended and put under some tension

(stretching).

To obtain strength and co-ordination it

must be based on techniques of

resistance training.

Sudden stretch and sudden release of

muscle leads to facilitation of active

response.

Reflex stimulation

Which is essential in muscle re education

for muscle contraction and equilibrium.

II. Strength

Ability of muscle to generate force at a

definite velocity.

Recovery of strength is due to:

1. Increase in circulation and blood supply

to muscle

2. Development of muscle sensation through the proprioceptive system.

III. Coordination

Is the ability to use the right muscle at the

right time with the right intensity to

achieve the desired movement.

It is achieved through conditioned reflex

training (subconscious not voluntary).

IV. Endurance

Ability to repeat motor tasks or sustain the

activity over a prolonged period of time.

Achieved through the same exercises for

strengthening but with less demands on

the neuromuscular system.

Exercise to increase strength:

Require increase effort and decreased repetitions.

Exercise to increase endurance:

Require increased repetitions and decreased effort.

Grade 0: passive movements, splinting, IDC.

Grade 1 & 2: (with intact nerve supply)

Passive movement, electrical stimulation, brief icing

and brushing

For grade 2 active assisted exercise can be used.

Grades 3, 4 & 5: free active and active resisted exercises can be used.