Chapter 9

### Objectives

After completion of this chapter, the physical therapist should be able to do the following:

• Explain why neuromuscular control is important in the rehabilitation process.

• Define and discuss the importance of proprioception in the neuromuscular control process.

• Define and discuss the different levels of central nervous system motor control and the neural pathways responsible for the transmission of afferent and efferent information at each level.

• Define and discuss the 2 motor mechanisms involved with interpreting afferent information and coordinating an efferent response.

• Develop a rehabilitation program that uses various techniques of neuromuscular control exercises.

### What Is Neuromuscular Control and Why Is It Important?

The basic goal in rehabilitation is to enhance one's ability to function within the environment and to perform the specific activities of daily living (ADL). The entire rehabilitation process should be focused on improving the functional status of the patient. The concept of functional training is not new. In fact, functional training has been around for many years. It is widely accepted that to get better at a specific activity, or to get stronger for an activity, one must practice that specific activity. Therefore, the functional progression for return to ADL can be defined as breaking the specific activities down into a hierarchy and then performing them in a sequence that allows for the acquisition or reacquisition of that skill.

From a historical perspective, the rehabilitation process following injury has focused upon the restoration of muscular strength, endurance, and joint flexibility without any consideration of the role of the neuromuscular mechanism. This is a common error in the rehabilitation process. We cannot assume that clinical programs alone using traditional methods will lead to a safe return to function. Limiting the rehabilitation program to these traditional programs alone often results in an incomplete restoration of ability and quite possibly leads to an increased risk of reinjury.

The overall objective of the functional exercise program is to return the patient to the preinjury level as quickly and as safely as possible. Specific training activities should be designed to restore both dynamic stability about the joint and specific ADL skills. To accomplish this objective, a basic tenet of exercise physiology is employed. The SAID (specific adaptations to imposed demands) principle states that the body will adapt to the stress and strain placed upon it.130 Patients cannot succeed in ADL if they have not been prepared to meet all of the demands of their specific activity.130 Reactive neuromuscular training (RNT) is not intended to replace traditional rehabilitation, but rather to help bridge the gap left by traditional rehabilitation in a complementary fashion via proprioceptive and balance training in order to promote a more functional return to activity.130 The main objective of the RNT program is to facilitate the unconscious process of interpreting and integrating the peripheral sensations received by the central nervous system (CNS) into appropriate motor ...

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