NEUROMUSCULAR

COORDINATION-2
REVIEW OF LAST LECTURE
 What is incoordination
 Causes of incoordination
• Upper motor neuron lesion
• Lower motor neuron lesion
• Cerebellar ataxia
• Loss of kinesthetic sensation
o Principles of re education
• In weakness and flaccidity of muscles
• In spasticity of muscles
• In cerebellar ataxia
• In loss of kinesthetic sensation
o Exercises for treatment of incoordination
• Frankel’s exercises
FRENKEL’S EXERCISE
 Dr H S Frenkel
 Study on tabes dorsalis

 Advised treatment for ataxia with systemic and

graduated exercises

 Tabes dorsalis
 isa slow degeneration of the sensory neurons that carry
afferent information
FRENKEL’S EXERCISE
 These exercises can also be used for in-coordination
because of other diseases. E.g. disseminated sclerosis
 disseminated sclerosis (Multiple Sclerosis)
 inflammatory disease in which the fatty myelin sheaths
around the axons of the brain and spinal cord are damaged,
AIM OF TECHNIQUE
 Voluntary control of movement by using sense of sight,
sound and touch, After loss of kinesthetic sensation
 Ultimate goal is to establish independent voluntary
control over activities of daily living
 Just like learning new activity
ESSENTIALS OF TECHNIQUE
 Concentration of the attention
 Precision

 Repetition
TECHNIQUE
TECHNIQUE OF FRENKEL’S EXERCISES
 Position
 Explain and demonstrate

 Patient’s attention

 Speed

 Range of movement

 Repetition

 Rest periods
POSITION
 Suitably positioned and clothed so that he/she can see
his/her moving limb
EXPLAIN AND DEMONSTRATE
 To make an mental image of what to do
 To gain patient confidence
PATIENT’S ATTENTION
 To gain Smooth and accurate movement
SPEED
 Prescribed and dictated by therapist
 By
 Rhythmic counting
 Movement of hand
 Use of music
RANGE OF MOVEMENT
 By spotting a mark to touch with hand or to place foot
REPETITION
 Repeated again and again to gain accurate and perfect
movement
 Then proceeded to next difficult exercise
REST PERIODS
 Patient retain little or no sense of fatigue in joint or
muscle
 Indicated by
 Deteriorating quality of movement
 Increase pulse rate
PROGRESSION
 By altering
 Speed
 Range
 Complexity of exercise
ALTERING SPEED
 Quick movement require less control and effort than
slow speed.
 Altering speed of consecutive movements

 Stopping and starting to command

ALTERING RANGE
 Wide range and large joints at start
 Progress to Limited range and small joints
COMPLEXITY OF EXERCISE
 Movement of particular joint or muscle at start
 Progress to simple functional movement which require
use and control of number of joints and limbs.
 E.g. walking
EXAMPLES OF FRENKEL’S
EXERCISES
EXERCISES FOR LEGS IN LYING
 Lying: head raised
 A. Hip abduction and adduction
 B. One hip and knee flexion and extension
 C. One leg raised and place on specified mark
 D. hip and flexion and extension, abduction and adduction
EXERCISES FOR LEGS IN SITTING
 Sitting:
 One leg stretching, to slide heel to a position to a mark
specified on the floor
 Alternate leg stretching and lifting to place the heel or toe on
specified mark
 Stride sitting
 Change to standing and then sitting again. Feet drawn back
and trunk lean forward to bring COG over base. Then patient
pull himself up by grasping wall bar or some other suitable
apparatus
EXERCISES FOR LEGS IN STANDING
 Stride standing:
 Transferweight from one foot to other
 Walking sideways placing feet on specified mark on floor

 Standing
 Walking, placing feet on marks, length of stride is varied
according to patient capacity
 Turning, helped by marks on the floor
 Walking and changing directing to avoid obstacles
EXERCISES FOR LEGS IN STANDING
 Walking gives confidence to move around, change
direction and stop if he/she wishes
 Climbing stairs
EXERCISES FOR ARMS
 Sitting
 Shoulder flexion or extension to place hand on specified
mark
 One arm stretching to thread it through a small hoop or ring
 Pitting up objects and putting them down on specified mark

 Diversional activities
 Buildingwith toy bricks
 Drawing on board
 Using knife or fork
 Doing buttons
 Doing hairs
EXERCISES TO PROMOTE MOVEMENT
AND RHYTHM
 All exercises are repeated in rhythm or with music
 Sitting
 Hip flexion and adduction to cross one over the other, then
repeated in reverse
 Lean forward and take weight on the feet, then move along the
seat as if to make room for someone
 Half lying
 One leg abduction to bring leg on the edge of plinth, then one
knee bending to place foot on the floor, repeated in reverse
 Standing
 Arm swing forward and backward
 (Standing Or walking) bounce and catch or throw and catch a
ball
 EXERCISES TO PROMOTE MOVEMENT
AND RHYTHM
 Marching to music
 dancing

 Swimming
SUMMERY
 Technique of frankel’s exercises
 Position
 Range
 Patient attention
 Speed
 Range of movement
 Repetition
 Rest period

 Progression of frankel’s exercises

 Alternating range
 Alternating speed
 Complexity of exercises

 Example of frankel’s exercises

 In lying
 In sitting
 In standing
 Exercises for arm
 Exercises to promote movement and rhythm
ANY QUESTION?