Neuromuscular Re-education

Recovering from a neurological incident, such as a stroke or spinal cord injury, requires intense rehabilitation.  Physical therapists utilize specific interventions to target areas that have lost function.  Neuromuscular re-education focuses on helping the patient to regain use of muscles that have lost their function. Some techniques of neuromuscular re-education can also be used in orthopedic conditions where muscles have significant loss of function.  We often use the concept of forced-use to achieve neuromuscular re-education.  An example would be manually assisting a stroke patient to achieve a standing position, even though they cannot perform the task on their own.  While in a weight bearing position, the patient will ideally experience muscle activation achieved through a reflexive type response.  Eventually, this can become more volitional and the patient will begin performing movement in the affected regions on their own and with less assistance.  Each patient is different and overall results are unpredictable.  However, by putting the patient in a position and environment where they can participate in neuromuscular re-education, significant improvements can be achieved.

A case example can illustrate how neuromuscular re-education can inhibit progress in rehabilitation. An otherwise healthy 60 year old female with a chronic hamstring tear presented to physical therapy. The patient complained of pain in her buttock area with her Yoga routine limiting her participation although she had no other pain during any of her other functional or sporting activities. The patient presented with strong hip, knee, ankle and core muscle strength except her left pelvic floor muscle group. The patient was able to perform all of her hamstring and hip extension exercise without fatigue or pain at her torn hamstring. This result implied that she would not progress due to inability to activate her hamstring muscle. Neuromuscular re-education was performed  and she achieved fatigue without pain resulting in a beautiful rehabilitation and return to Yoga.