Background

Neurophysiological motor control models are based on using neurological development and functioning models to inform rehabilitation intervention. In this chapter, we discuss four neurophysiological models: The Rood approach, Brunnstrom’s stages of motor recovery, proprioceptive neuromuscular facilitation (PNF), and neurodevelopmental treatment (NDT). Each model focuses on the components of function. For example, this could involve focusing on decreasing tone, in order to prepare the client to participate in an occupation.

These motor control models relate to our classroom discussions on range of motion, strengthening, and functional mobility. We have learned about synergy patterns and how they can be used to help a client participate in functional activities. These theories can be used when working with a client after a stroke or with someone who has a high tone in a limb. They can also be used during functional mobility exercises.

Introduction: Neurophysiological Interventions

This video discusses neurophysiological and neuroplastic motor control models. In general, neurophysiological models focus on function components whereas neuroplastic models focus on occupational performance.

Video is licensed under CC BY 4.0.

Introduction Neurophysiological Interventions Video Transcript

Interventions Using Rood’s Approach

This video discusses techniques to improve function by increasing or decreasing tone using Rood’s Approach.

Video is licensed under CC BY 4.0.

Interventions Using Rood’s Approach Video Transcript

Increasing Tone Tips

• Tapping: This triggers the stretch reflex to increase muscle tone.
  • Palpate to find the agonist muscle for the desired motion.
  • Take a few fingers and tap quickly and forcefully over the muscle belly.
• Vibration: This triggers the stretch reflex to increase muscle tone.
  • Palpate to find the agonist muscles for the desired movement.
  • Hold the vibration tool on the targeted muscle belly.

Decreasing Tone Tips

• Stretching: This inhibits tone to get antagonist movement to be easier.
  • Palpate to locate the high-tone antagonist muscle for the desired movement.
  • Stretch the muscle using slow, low force, and hold at the end range for 60-90 seconds.
• Tendon Pressure: This sends a signal to decrease tone.
  • Locate the muscle tendon at the muscle belly.
  • Sustain pressure at the muscle belly for 60-90 seconds.

Weight-Bearing

This video discusses putting weight through a limb of interest to improve motor control.

Video is licensed under CC BY 4.0.

Weight-Bearing Video Transcript

Weight-Bearing Tips

• Weight-Bearing: This provides joint compression, improves proprioception, and normalizes muscle tone.
• Grading and Safety: These are weight-bearing issues to consider.
  • Weight-bearing can be graded by changing the amount of weight, the posture, and the length of time.
  • Stabilize the client and the affected limb to ensure safety.

Brunnstrom Stages of Motor Recovery

This video discusses Signe Brunnstrom’s stages of motor recovery.

Video is licensed under CC BY 4.0.

Brunnstrom Stages of Motor Recovery Video Transcript

Synergies Tips

• Synergies: These are stereotypical patterns of muscle co-activation.
• Synergy Patterns: These are some common synergy patterns.
  • Flexion synergy pattern: Scapular retraction and/or elevation, shoulder abduction and external rotation, elbow flexion, and forearm supination.
  • Extension synergy pattern: Shoulder protraction, shoulder horizontal adduction and internal rotation, elbow extension, forearm pronation.

Brunnstrom Stages of Stroke Recovery Tips

• Six Stages of Stroke Recovery: These stages range from flaccid to isolated joint movements.
  • Flaccidity: No muscle movements can be initiated.
  • Spasticity appears: Weak flexor and extensor synergies are present.
  • Increased spasticity: Voluntary movement causes muscles to act in synergy patterns.
  • Decreased spasticity: Muscles begin to activate selectively outside of synergy patterns.
  • Complex movement combinations: Most movement is willful and independent of synergy patterns.
  • Spasticity disappears: Willful and controlled functional movement returns.

Proprioceptive neuromuscular facilitation

This video discusses how proprioceptive neuromuscular facilitation (PNF) is based on stimulating proprioception through movement patterns involving flexion/extension and agonist/antagonist muscles.

Video is licensed under CC BY 4.0.

Proprioceptive Neuromuscular Facilitation (PNF) Video Transcript

PNF Stretching Technique Tips

• Stretching: This stimulates the proprioceptive system.
  • Stretch the muscle.
  • Hold your client’s stretch position while they contract and push against your hold.
  • Relax the muscle for 2-3 seconds.
  • Stretch your client’s muscle even further, then allow the initial passive stretch.
  • Hold your client’s stretch, and have them contract and push against your hold.
  • Relax the muscle for 2-3 seconds.

PNF Diagonal Movement Patterns Tips

• PNF Diagonals: There are two diagonals. Diagonal one on your left; diagonal two on the right.
• Upper Extremity Diagonal One (D1)
  • D1 Flexion: Have your client bring their arm up across their body, rotating their thumb to point up.
  • D1 Extension: Have your client bring their arm down and to the side, rotating their thumb to point down.
• Upper Extremity Diagonal Two (D2)
  • D2 Flexion: Have your client raise their arm up and out to the side, rotating their thumb to point up.
  • D2 Extension: Have your client bring their arm down and across their body, rotating their thumb to point down.

Neurodevelopmental Treatment

This video discusses neurodevelopmental treatment therapy techniques (NDT) that can be used to help your client feel normal movement, which will create new neuropathways, promote neural recovery, and help them to achieve functional movement.

Video is licensed under CC BY 4.0.

Neurodevelopmental Treatment (NDT) Video Transcript

Neurodevelopmental Handling Tips

• Handling: These are techniques to control key points with a focus on controlling the following:
  • Base of support
  • Body segment alignment
  • Muscle activation
  • Weight shift
  • Movement patterns
• Scapulohumeral Rhythm: The following are techniques to apply to maintain scapulohumeral rhythm during shoulder movement:
  • Place one hand on your client’s scapula and the other hand under your client’s axilla. Use this hand position to correct the client’s trunk position and upwardly rotate the scapula.
  • Maintain the scapula position, and move your other hand to the distal humerus.
  • Rotate the humerus into a slight external rotation.
  • Bring the humerus into approximately 60 degrees of flexion. At the same time, use your hand on the scapula to help the scapula move into upward rotation.

Resources

• A Comparison of Neurorehabilitation Techniques Used To Treat The Effects Of Cerebrovascular Accidents by Lauren Doss, OTR/L
• Neurology Treatment Techniques, Physiopedia