Additional Info on Neuromuscular Chapter

Hi Everyone,

I’ve not been able to post for a while.It’s just that there was a lot of stuff to take care of….sorry about that.

I would like to give some additional info on the NeuroMuscular PT chapter & Exercise Therapy chapter.

As mentioned in other posts,I got it from books & websites.

Diencephalon:

THALAMUS:It censors & modulates neural activity into & out of cerebral cortex.3rd ventricle lies between both thalami.

Brainstem:

PONS:It has two centers which modify the respiratory rhythm & rate established by medullary centers.They are,

a)Pneumotaxic Center(PC) in upper pons inhibits inspiration & overinflation of lungs.It limits the bursts of action potentials in the phrenic nerve decreasing tidal volume & regulating the resp.rate.Absence of PC results in increase of depth of respiration & decrease in respiratory rate(apneustic breathing)

b)Apneustic Center in lower pons which activates & prolongs inspiration by stimulating dorsal respiratory center in medulla.It controls the intensity of breathing & provides inspiratory drive unless inhibited by pneumotaxic center.

MEDULLA OBLONGATA:Contains two neuron groups namely Dorsal Respiratory Group(DRG) & Ventral Respiratory Group(VRG)

DRG is stimulated via apneustic center.It’s responsible for generation of inspiration & the rhythm .When it stops firing(inspiratory muscles relax) expiration occurs.

VRG contains both inspiratory & expiratory neurons.It is active mainly when more ventilatory effort is required (ex:exercise).

Ascending Tracts:

Spino-olivary Tracts :Neurons from SpinalCord carry proprioceptive information from muscles & tendons and cutaneous impulses to the olivary nucleus.Contributes to movement coordination(balance).

Spino-Thalamic Tracts: Fibers of Spinothalamic tract give collaterals to RAS(Reticular Activating System).

Neuro-Examination:

Barthel Index:This test measures the degree of assistance reqd by an individual on 10 items of mobility & self-care ADL.Levels of measurement are limited to Complete Independence(10)/Needing Assistance(5).Max.score is 100.

Functional Indepencence Measure:It is measures the severity of disability for an inpatient rehab setting.It rates 18 ADL on a 7 point scale ranging from complete independence(7) to total dependence(1).The max total score is 126.

EMG(Electromyography):Insertional activity is the spontaneous burst of potentials caused by insertion of electrode into the muscle.It’s also seen while repositioning electrodes.It’s < in fibrotic muscles but > in denervated muscles/inflammation.When muscle is at rest,there should be electrical silence.

Fibrillation potential is seen at rest.It’s not visible through skin.Spontaneous depolarization of a single muscle fiber causes it.

Fasciculations are visible through the skin.They are spontaneous potentials seen with irritation or degeneration of Antr.Horn Cell,Nerve root compression etc.There’s asynchronous contraction of the whole motor unit.They could also be seen in normal individuals.

EXERCISE THERAPY

I also wanted to talk to you about Swiss Ball exercises.The Swiss ball is a good piece of fitness equipment which can used to strengthen various muscle groups.The firmer the ball,the harder it is for the patient to exercise.It also promotes balance training while strengthening muscles.

Rolling the ball antrly=>Back Extensors Contract & Abdominals Stretch

Rolling the ball postrly=>Back Extensors Stretch & Abdominals Contract

Cardiovascular Endurance Training:HR max formula is not suitable for all ages.Elderly Sedentary patients have twice the rate of VO2max decline

Plyometric training: Isotonic exs that combine speed,strength & func.activities.Appropriate for later phases of rehab in young adults/athletes.The eccentric contraction (loads & stretches the muscle) is followed by concentric contraction(shortens the muscle).Ex:Jumping off and on a platform.Jumping off is eccentric and Jumping on is concentric.This activity stimulates proprioceptors and improves the Neuro.Muscular System.

Prior to plyomteric training,patient should’ve adequate strength and endurance.These exs should be preceded by proper warm-up.They should be performed as quickly as possible.

That’s all I have for this post.

See you all soon!!!

REFERENCES:

1)Wikipedia

2)PHYSICAL REHABILITATION by Sullivan and Schmitz(Fourth/Fifth Edition)

3)”Joint Structure and Function” by Cynthia Norkin