Progressing Therapeutic Intervention in Patients with Neuromuscular Disorders

Abstract

As patients with neuromuscular disorders improve, therapists continually and intentionally advance the level of difficulty of therapeutic interventions (exercises and activities). Optimal patient performance, related to ongoing intentional progression, could result in optimal functional outcomes. This paper describes a conceptual framework with parameters that can be used to adjust or progress interventions. The parameters of progression are grouped into 3 categories and include those related to: (1) motor learning: variability in practice, practicing components of movement, task attention, feedback, environmental progression; (2) characteristics of the movement or task: amplitude, velocity, amount of work, endurance, regional; as well as (3) others: developmental sequence, supportive device, assistance given.The parameters overlap in clinical application. Students and novice therapists in particularly may find the framework useful in helping them organize therapy, while experienced therapists may gain ideas to optimally challenge patients to perform at higher functional levels.

Physical Therapy Management for Conversion Disorder: Case Series

“…The importance of designing interventions with progressive levels of challenge has been advocated for patients with neuromuscular disorders. 36,37 The step progression incorporated the principles of motor learning to include providing less physical support, less verbal cueing, and more intrinsic feedback as the patient mastered skills. 36 The patients did not progress to the next level of the treatment sequence until they demonstrated mastery of the previous level.…”

Applying Motor-Control Theory to Physical Therapy Practice: A Case Report

“…5 This taxonomy identifies as least challenging those stability tasks that do not require upper-extremity manipulation and that are performed in a stationary, non-variable environment. Tasks in the taxonomy steadily increase in difficulty with the addition of mobility requirements, the addition of a manipulation component, or increased variability in the environment.…”

“…When analyzing the environment in which movement tasks occur, physical therapists must also consider whether the task takes place in a stationary or in a moving environment. 5 In a stationary environment, the regulatory conditions involve a fixed terrain and non-moving objects, and the environment influences only the spatial parameters of the movement. When activities occur in a moving environment, where objects, other people, or the supporting surface are in motion, movements must conform to both spatial and temporal parameters of the environment.…”

“…1 When analyzing movement tasks, physical therapists must also consider biomechanical factors such as the specific muscle groups and muscle actions involved in an activity; the range of motion (ROM) required for the movement; and the coordination, power, and speed demands of the task. 1,4 Environmental attributes also contribute to the execution of movement tasks. 1 Environmental constraints can be divided into regulatory and non-regulatory conditions.…”

“…When activities occur in a moving environment, where objects, other people, or the supporting surface are in motion, movements must conform to both spatial and temporal parameters of the environment. 1,5 According to Shumway-Cook and Woollacott, 1 individual constraints to movement may be divided into three categories: action, perception, and cognition. Constraints related to action involve the motor system and include primary impairments, such as muscle tone and muscle strength, and secondary impairments, such as ROM deficits.…”