Neuromuscular Rehabilitations: Types and Strategies

Introduction:

The neuromuscular system is the one that helps the movement and coordination of any individual for activities of daily living. For the activities to be done, the brain, spinal cord, and nerves coordinate even complex activities. If there is a lesion or damage to the brain, there can be incoordination in the movements. It can either be acquired or congenital (from birth). Some examples of neuromuscular disorders are:

Why Is Neuromuscular Rehabilitation Done?

Neuromuscular rehabilitation is done to restore the form and function of the affected muscles and to ease the patient of debilitating symptoms. Neurorehabilitation is done through various therapeutic tools and exercises. It also helps in training the individual about structural abnormalities. After undergoing physiotherapy, the patient tends to have an improved quality of life. Treatment plans are designed based on the needs of the patient and are goal-oriented, and it is aimed at getting rid of deformities if any.

What Are the Various Therapeutic Technologies in Neuromuscular Rehabilitation?

Many technological inventions have been enhancing physiotherapeutic treatment. A few of them are discussed here:

1. Electromyography (EMG): Nerve conduction studies and needle electromyography are commonly referred to as electrodiagnostic or EMG studies. It is used for both diagnosis and treatment. EMG studies help identify the nerve that is abnormal or any kind of lesion (tissue damage) present. Surface EMG (SEMG) is a technique used to stimulate the nerves that help in the activation of muscles that are affected. It is widely used in ergonomics and sports science. It has also been useful for diagnosing gait (walking pattern) abnormalities.

2. Balance Training: Most of the tasks an individual performs in a day need balance. Standing straight, walking, cycling, sitting in a chair, and many other activities require balance to do with efficiency. It can be damaged in any neurologic problems like stroke, peripheral diseases such as musculoskeletal injuries, or sensory loss. Treatment of musculoskeletal disorders is important to address balance constraints such as weakness, reduced range of motion, reduced flexibility, and improper postural alignment. Exercises are customized and unique for each of the organs affected.

3. Functional Electrical Stimulation (FES): It is also known as functional neuromuscular stimulation (FNS) or neuromuscular electrical stimulation (NMES). Neuroprosthesis is a term used to refer to devices that use electrical stimulation to activate the affected nervous system to perform a task. A sufficient amount of electric current is passed to the nerve through electrodes, and a depolarization (ion exchange) will occur at the axon (part of the brain cell that helps in the effective transfer of signal) of the nerve. It can also be applied to the paralyzed muscles to restore function.

4. Environment Control and Assistive Devices: The environment of the affected individual has to be changed in order to ease their movements and reduce the discomfort in performing any difficult activity. The use of assistive devices such as grab bars, hand-held showers, and handrails in the bathroom is beneficial for the individual. These can be useful for the individual to perform daily activities of living.

5. Wheelchair Design and Seating Technology: Wheelchairs have been used for people with difficulty walking. Manual wheelchairs have various problems, like pressure ulcers, vibration injuries, and accidental falls. Hence new inventions like push-rim activated power-assisted wheelchairs and electric-powered wheelchairs have been designed to overcome these challenges. Scooters are designed for people with poor body control and limited walking ability. The speed can be controlled manually.

6. Orthoses: They are external devices that help assist and restrict movement between body parts. Common types of orthoses include foot orthosis (FO) for correcting ankle and foot deformities, ankle foot orthosis (AFO) for correcting foot drop, and functional knee orthoses (KO) for athletic injuries. These devices apply forces to resist or transfer motions and loads.

7. Virtual Reality: Virtual reality is a technology in which an environment is created in simulation. Virtual reality technologies have been used as a treatment tool in rehabilitation. It helps in rewiring the brain after damage. Virtual environments provide the opportunity for repeated learning.

How Is Symptom-Specific Neuro-Rehabilitation Done?

• Sensory and Motor Dysfunctions:

1. Chronic Pain: Chronic pain can occur due to a wide range of reasons. They can be treated by functional electrical stimulation and virtual reality techniques to educate the affected parts to perform normally.

2. Loss of Somatic Sensation: Somatic sensation is the ability to interpret bodily sensations. Loss of somatic sensation can hamper the proper functioning of the patients. These can be corrected by repetitive training and exercises focused on tactile (pertaining to touch) discrimination, object recognition, joint position sense, and blindfolded motor tasks involving the reach and grasp of the objects.

3. Management of Spasticity: Spasticity is defined as excessive motor activity characterized by jerky movements, lack of skill, fatigability, and muscle weakness. These can be due to cerebral palsy (movement disorder), multiple sclerosis (autoimmune disorder attacking the individual’s own immune system), traumatic brain injury, and spinal cord injury. Physiotherapy involves daily stretching activities to improve the range of motion and to splint (for immobilization) that will help minimize the changes made by these exercises. Orthotic devices are also used to reduce tone and improve range of motion.

4. Arm and Hand Weakness: In order to rectify arm and hand weakness, strength training can be given.

5. Gait Disorder: Gait disorder can occur in many neuromuscular diseases, including Parkinson’s disease (nervous system disorder), paraplegia, and spasticity, and they can be treated by physiotherapeutic techniques such as electromyography.

• Cognitive Neuro-rehabilitation:

1. Aphasia: It is a language disorder typically from a stroke. Computerized systems enable users to select and string together pictures for communication and therapy.

2. Apraxia: It is a condition in which a person cannot use certain parts of the body to perform a task that the individual is well aware of. The therapeutic approach is to teach strategies to compensate for the apraxic defects. A 12-week course of strategy training where every two weeks, one activity is trained with therapeutic support concerning planning, executing, and controlling or correcting this activity.

3. Anosognosia: Anosogonia refers to a condition in which the individual has a deficit in self-awareness. It can be done by cognitive rehabilitation techniques such as sensory stimulation.

• C) Vegetative and Autonomic Dysfunction Neuro-Rehabilitation:

1. Comatose Patients: Coma is a vegetative state in which there is prolonged unconsciousness after an injury or trauma. Rehabilitation techniques like multisensory stimulation will help the recovery of comatose patients. Intensive, simultaneous administration of maximum-intensity stimuli of all five senses is done for 12 to 14 hours per day, six days a week. Prolonging such stimuli rapidly leads to noise habituation, and the patient gets accustomed to such environments.

• D) Disease-Specific Neuro-Rehabilitation:

1. Traumatic Brain Injury: Traumatic brain injuries occur most commonly due to road traffic accidents. Acute post-injury rehabilitation is difficult. However, over the course of time, a multi-disciplinary rehabilitation program is necessary to restore physical, cognitive, intellectual, behavioral and emotional, and personality problems.

2. Epilepsy: Epilepsy is commonly referred to as a seizure, and it occurs in recurrent episodes. The rehabilitation of epileptic patients should be aimed at minimizing cognitive defects and psychiatric disturbances that trigger an epileptic attack.

3. Parkinson’s and Other Movement Disorders: It is a neurodegenerative disorder that is characterized by tremors, rigidity, and akinesia (loss of voluntary movements). Physical therapy is aimed at enhancing balance and flexibility in large muscles, facial muscle exercises, and other types of passive therapies. Patients are taught techniques to improve balance.

4. Stroke: A stroke, also known as a cerebrovascular accident, occurs due to an interruption in blood supply to the brain resulting in brain damage. Functional electrical stimulation can be used to increase strength, increase range of motion, decrease edema and reduce muscle spasticity.

Conclusion:

Neuromuscular disorders tend to inhibit the muscular movement of the body and will cause disability in the affected individuals. Through rehabilitation, functional limitations can be cured. It can be used to minimize the symptoms and delay the disease progression as much as possible. Though the disease cannot be completely cured, it can help improve the quality of life of the affected individuals by giving them specific training to take care of their daily activities of living.