1. Motor control and Physiotherapy and Sports in Neuromuscular disorder(NMD)
MOEIN KADKHODAPOUR,AMIRHOSEIN HASHEMIAN,ALI ABAEIYAN
Supervisor: dr. arshi
Spring 2013

2. Table of Content Introduction of Motor control
Physiotherapy and neuromuscular disorder
Sport and neuromuscular disorder

3. 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.

4. 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

5. 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

6. 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

7. 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.

8. 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.

9. Exercises Exercises 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.

10. Objective Measures monitored in NMD clinic
Range of Movement of joints and muscle length
Timed Functional activities
Balance
Respiratory function, along with Pulmonary function testing

11. 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

12. 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

13. 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

14. 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

15. Exercise training role in NMD
Motor neuron disease
ALS(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

16. 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