Principles of Nerve and Muscle Rehabilitation
Medical rehabilitation, in general, aims at improving function, activity, and participation of the patients rather than curing the disease. A widely accepted model of rehabilitation is provided by the International Classification of Functioning, Disabilit
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Principles of Nerve and Muscle Rehabilitation T. Paternostro-Sluga and M. Quittan
3.1
Principles
Medical rehabilitation, in general, aims at improving function, activity, and participation of the patients rather than curing the disease. A widely accepted model of rehabilitation is provided by the International Classification of Functioning, Disability and Health (ICF) by the World Health Organization. Accordingly, the principle of rehabilitation of neuromuscular disorders is to improve function, which may be impaired due to motor, sensory, and autonomic dysfunction, pain, as well as tendon, muscle, and joint contractures. The interventions depend on the clinical picture, the course of disease, and, furthermore, the activity and participation as demanded by the patients. Therefore, rehabilitation always aims at enabling the patient to lead a selfdetermined and independent life as good as possible. The knowledge of underlying pathology and the course of disease are very important to design a proper rehabilitation program for the patient. In regard to motor symptoms, muscle weakness, muscle wasting, muscle cramps, impaired coordination and proprioception, fatigue, gait disturbances, impaired upper limb function and fine motor skill, and impaired body posture may be present. Sensory symptoms may be plus or minus symptoms, may result in severe pain syndromes, may result in severely impaired sensation, may result in trophic disturbances as the protective function of sensation is lost, and together with autonomic dysfunction may result in impaired wound healing. Autonomic dysfunction affects all systems innervated by the autonomic system; clinical orthostatic hypotension, heart rate abnormalities, bladder and bowel disturbances, sexual dysfunction, papillary abnormalities, as well as skin changes can be seen in neuromuscular disorders. Tendon, muscle, and joint contractures are serious problems in neuromuscular diseases, and despite regular stretching and range of motion (ROM), exercises sometimes cannot be prevented. Once the ability is lost to actively stand up, E.L. Feldman et al., Atlas of Neuromuscular Diseases, DOI 10.1007/978-3-7091-1605-0_3, © Springer-Verlag Wien 2014
contractures of the ankle joint and shortening of the Achilles tendon develop easily. Contracture of the shoulder may be anticipated in shoulder girdle weakness. The central representation of peripheral nerve and muscle function as central motor pattern has to be addressed in rehabilitation strategies. Neural plasticity helps to improve function even if the physiologically responsible structure of the peripheral nervous system is impaired. Neural plasticity may occur on all levels of the nervous system, the peripheral axon, the spinal cord, and the brain. Treatment goals on the level of impairment are improving motor function, improving sensory function, decreasing pain, improving autonomic function, and activating neural plasticity. Additionally, in rehabilitation of peripheral nerve lesions, the need for surgery has to be recognized and planne
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