Motor control andPhysiotherapy and Sports in Neuromuscular disorder(NMD)

M O E I N K A D K H O D A P O U R , A M I R H O S E I N H A S H E M I A N , A L I A B A E I YA NS U P E R V I S O R : D R . A R S H I

S P R I N G 2 0 1 3

Table of Content

• Introduction of Motor control

• Physiotherapy and neuromuscular disorder

• Sport and neuromuscular disorder

Motor control

• The brain plays a major role in our body motoricity .Motor controls are the information processing activities carry out by our central nervous system that helps us organize , move and coordinate our movements and muscles.

• I. What Controls Movement

• II. What the Motor System Controls

• III. Mechanisms of Motor Control

• IV. Motor Memory

• V. Flexibility in Motor Control

• VI. Evolution of the Motor System

WHAT CONTROLS MOVEMENT

The motor system consists of two interacting parts: peripheral and central

• Peripheral Motor System

- Muscles

- Motor Neurons and Motor Units

• Central Motor System

- Spinal Cord

- Brain stem

- Diencephalon

- Telencephalon

Physiotherapy• Physiotherapy:

Physiotherapy is a health care profession primarily concerned with the remediation of impairments and disabilities and the promotion of mobility, functional ability, quality of life and movement potential through examination, evaluation, diagnosis and physical intervention carried out by physiotherapists.

• Neurological physiotherapy is a field focused on working with individuals who have a neurological disorder or disease

Effects of NMD on muscles

• As motor neurons die, muscles become weaker and stiffer. They gradually cease to work and waste away.

• associated joints become stiff and may contract and This, makes everyday activities increasingly difficult, and sometimes painful.

• Once the supply of motor neurons that control a particular muscle has degenerated, it cannot be regenerated by exercise or anything else. Nevertheless, muscle elasticity, joint range of movement and prevention of muscle shortening can be helped by regular exercises.

Types of physiotherapy treatment

• If the assessment takes place in the early stages of the disease, patient might start with simple exercises which can do himself. as the disease progresses, he will probably need to move on to a different regime of less active exercises

Treatments include:

• Range of Movement (ROM) exercises: to maintain joint range and prevent joint deformity and soft tissue shortening

• Massage and soft tissue mobilization: to increase circulation, reduce pain, aid relaxation, reduce spasticity.

• Breathing techniques: to facilitate respiratory effort and to aid clearance of secretions.

ExercisesExercises can be split into three categories: • Active exercises: when your muscles can perform the full

movement.

• Active-assisted exercises: when you can no longer move through a ROM exercise on your own, but a helper can assist the muscle through the movement.

• Passive exercises and stretches: when the muscles can no longer perform any of the movement and these are done completely by a helper.(Passive exercises work the joints but not the muscles.)

Moderation in exercising • Fatigue will only increase weakness and sap your energy

• exercise will not strengthen muscles that have been weakened by NMD. However, it is still invaluable, as by strengthening the healthy muscles, it enables them to help compensate for those muscles that are no longer working properly.

Objective Measures monitored inNMD clinic

• Range of Movement of joints and muscle length

• Timed Functional activities

• Balance

• Respiratory function, along with Pulmonary function testing

Range of Movement of joints and muscle length

For Muscular Dystrophies, muscles that are most often measured include:

• Hip flexors

• Hip abductors

• Hamstrings

• Calves

• Elbow flexors

• Wrist flexors

Timed Functional activities

Assessment of tasks that are important for everyday life completed for those who are able:

• Timed 10 meter walk/run

• Timed supine to stand up from lying on the floor

• Timed climbing 4 stairs

Exercise training role in NMD Introduction

Patients

- Progressive weakening and loss of functional skeletal muscles

Disabilities

- Depends on the specific type of disease, pathogenesis, extent of clinical involvement, and rate of progression

Primary clinical goal

- maintaining strength, function, independence, and quality of life

Main tool

- Exercise

Exercise mechanism in maintaining strength

- Stress causes microscopic damage to the myofibers which initiates gene transcriptional and splice mechanisms

Exercise training role in NMD treatment

Exercise and neuromuscular disease

• Main question

- Whether exercise training may be helpful in individuals with neuromuscular diseases

• Postmortem muscle study of a patient with Duchenne muscular dystrophy (DMD)

- the greatest muscle degeneration occurred in muscles used during sustained physical activity

Exercise studies in NMDs

• Rarity of NMDs

• Grouping different subjects of NMDs

Exercise training role in NMD

Motor neuron diseaseALS(Amyotrophic Lateral Sclerosis)

Undelineated pathogenesis and Motor neuron deficiency in ALS

Studies of effects of exercise on mice with ALS

Randomized control trial among 25 individuals

• 3 months improvement in patient condition

• 6 months no difference

Conclusion

• Inadequate evidence from randomized controlled trials

• Potential to improve condition of individuals regarding to the type, stage, and severity of the disease

• Assessing effects of exercise