Neuromuscular

coordination
Saima Abdul Aziz
BSPT, MSPT
IPM&R, DUHS
Objectives.
• At the end of this lecture, the students will be able to learn
about:

• Neuromuscular coordination and its main controlling centers

• Briefly describe the effects of sensory, CNS and motor

coordination abnormalities.

• Treatment of ataxia with Frenkel’s exercises

 Re-education

• The use of alternative nervous pathways

• The condition of the muscles

Principles of re-education
• Weakness or flaccidity of a particular muscle group:
 To correct the imbalance by emphasis on the activity of weak
muscle
 To restore the normal integrated action of muscle in the
performance of patterns of functional movement.

• Spasticity of muscle:
 To promote relaxation
 To stimulate effort
 To give confidence in the ability to move and to train rhythm
 Cerebellar ataxia
• Loss of coordinating impulses.

• Hypotonic muscles

• Postural fixation is disturbed

• Balance is difficult

• Movements are irregular, swaying and inaccurate

 Aim of treatment
• To restore stability of the trunk
• Proximal joints to provide a stable background for movement
• When the muscular weakness is severe, strengthening methods
must be used first but the main emphasis in treatment is to
holding (isometric exercises)
Loss of kinaesthetic sense
• Information as to the whereabouts of the body in space
• The position of the joints
• Tension in muscle

• Lesions causes:
 Hypotonicity of the muscle
 Incoordinated movement
Identification of Fall Risk Factors
• Risk factors for falls are divided into two categories:

• Intrinsic Risk Factors

Dizziness, weakness, gait abnormalities, poor balance, confusion,
poor coordination, ROM, cognitive impairment

• Extrinsic Risk Factors

Floor surface, poor lighting, cluttered furniture, obstacles, non-level
surface, poor shoes
Falls are a result of loss of
postural control.
Normal Postural Control (Balance)
• Balance requires keeping the “Center of Mass”
(COM) over the “Base of Support” (BOS) during
static and dynamic situations.
• Neural components of postural control:
• Sensory processes
visual, vestibular, somatosensory
• Central processing
a higher-level integrative process
• Effector component
• sometimes referred to as the neuromuscular component
• postural alignment, ROM, muscle force, power & endurance
Normal Postural Control

Adaptive postural control requires modifying sensory and

motor systems to changing tasks and environmental
demands.
Tabes Dorsalis
• Degeneration of the dorsal roots of the spinal nerves and
posterior columns of the spinal cord

• Gastric crisis with severe pain and vomiting is most common

• Pain, urination problems, paresthesias, ataxia, diplopia, vertigo,

deafness
Tabes Dorsalis
• Signs: Reduced lower cord reflexes, Romberg sign, sensory
loss, atonic bladder, Charcot’s joints, optic atrophy

• Personality changes, memory loss, apathy, megalomania,

delusions, dementia (Garcia von Lin syndrome)
Frenkel’s exercises
• Definition :
a series of gradual progressive exercises designed to increase
coordination
Aim :
Establishing control of movement by use of any part of sensory
mechanism which remain intact as sight & hearing to
compensate for the loss of kinethetic sensation.
• a-concentration of attention
• b-precision
• c-Repetition
 Technique

 The patient is positioned and suitably clothed so that he can see the
limbs throughout.

 A concise explanation and demonstration of exercise is given before

movement is attempted, to give patient a clear mental picture of it.

 The patient must give his full attention to the performance of

exercise to make movement smooth and accurate.

 The speed of movement is dictated by physiotherapist by means of

rthymic counting, movement of her hand or the use of suitable music.
The range of movement is indicated by making the spot on
which the foot and hand is to be placed.

 The exercise is repeated many times until it is perfect and

easy. It is then discarded and a more difficult one is substituted.

 All these exercises are very tiring at first, frequent rest periods
must be allowed. The patient retains little of no ability to
recognize fatigue, but it is usually indicated by a deterioration
in the quality of movement, or by a rise in pulse rate.
Frenkel’s exercises cont
• I-lying ---------
• flexion-extension
• Abduction – adduction
• Each movement will be performed unilaterally fast then slow
then interrupted by hold
• bilateral performance simultaneusely then alternatively
Frenkel’s exercises cont
• Sitting :
• 1-Slide heel to reach a mark on the floor
• 2-change standing and sit again
• Standing :
• 1-transfer weight from foot to foot
• 2- walking side ways
• 3-placing foot on specific marks
Frenkel’s exercises cont
• For arms :
• Sitting with arm supported on a table and placing hand at
specific mark
• Try to reach an object
• Picking up objects
• Put the hand in a ring or hole
THANK YOU