Neuromuscular Reeducation
DESCRIPTION
Neuromuscular reeducation is a therapeutic technique that is used to improve balance, coordination, posture, kinesthetic sense and proprioception. There is no precise description of what neuromuscular reeducation entails. Treatment may include balance exercises such as one-legged standing and the progressive use of a wobble board. Tandem exercises along with a postural challenge may be utilized to evaluate stability. The individual receiving treatment is encouraged to feel the correct position of joints and to perceive the direction of movement of the body extremities.
The Feldenkrais Method® is described as a learning process that focuses on the connection of the mind to the body. This method uses relaxation, massage of pressure points and movement therapy to achieve rehabilitation.
The Bobath approach teaches the caregiver positioning techniques that assist in the change of abnormal postures and movements interfering with functional skills. The Bobath approach is used mainly for individuals with cerebral palsy. Other areas of neuromuscular reeducation involve constraint-induced movement therapy for limbs. This technique involves restraint of a non-involved limb and extensive movement practice with the involved limb.
POLICY
Neuromuscular reeducation for the treatment of conditions/diseases, including, but not limited to, neurological (central or peripheral), orthopedic, muscular or those having a combination in origin, is considered investigational.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Well-designed, well-conducted studies to evaluate the clinical importance of neuromuscular reeducation are lacking. Evidence to show that neuromuscular reeducation improves or restores long-term physical function following disease, injury, or loss of body part is not available.
SOURCES
American Chiropractic Association (ACA) Council on Chiropractic Physiological Therapeutics and Rehabilitation. Physiotherapy and rehabilitation guidelines for the chiropractic profession. Retrieved March 10, 2010 from http://www.chiro.org/LINKS/GUIDELINES/REHABILITATION.shtml.
BlueCross BlueShield of Tennessee network physicians. January 2001.
Buchanan, P. (2010). A preliminary survey of the practice patterns of United States guild Certified Feldenkrais Practitioners (CM).BCM Complementary and Alternative Medicine, 10 (1), 12 (Epub. ahead of print). (Level 5 Evidence)
Charles, J. R., Wolf, F. L., Schneider, J. A., & Gordon, A. M. (2006). Efficacy of a child-friendly form of constraint-induced movement therapy in hemiplegic cerebral palsy: A randomized control trial. Developmental Medicine and Child Neurology, 48 (8), 635 - 642. (Level 2 Evidence)
Complete Guide to Medicare Coverage Issues [Computer software]. (2009, November). Coverage of outpatient rehabilitation therapy services (physical therapy, occupational therapy, and speech-language pathology services) under medical insurance. (Section 220, pp. 4-234 – 4-251). The Ingenix Complete Guide to Medicare Coverage Issues.
Complete Guide to Medicare Coverage Issues [Computer software]. (2009, November). Practice of physical therapy, occupational therapy, and speech-language pathology. (Section 230, pp. 4-251 - 4-260). The Ingenix Complete Guide to Medicare Coverage Issues.
Complete Guide to Medicare Coverage Issues [Computer software]. (2009, November). Chiropractic services-general. (Section 240, pp. 4-260 - 4-263). The Ingenix Complete Guide to Medicare Coverage Issues.
Gordon, A., Connelly, A., Neville, B., Vargha-Khadem, F., Jessop, N., Murphy, T., et al. (2007). Modified constraint-induced movement therapy after childhood stroke. Developmental Medicine and Child Neurology, 49 (1), 23 - 27. (Level 5 Evidence)
Kollen, B., Lennon, S., Lyons, B., Wheatley-Smith, L., Scheper, M., Buurke, J., et al. (2009). The effectiveness of the Bobath concept in strike rehabilitation: what is the evidence? Stroke, 40 (4), e 89 - 97. (Level 2 Evidence)
National Guideline Clearinghouse. Work Loss Data Institute. (2008, June). Low back-lumbar & thoracic (acute & chronic). Retrieved April 15, 2010 from. http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=12674&string=%22Low+back+lumbar%22+and+%22thoracic+acute%22+and+chronic.
Wolf, S. L., Winstein, C. J., Miller, J. P., Taub, E., Uswatte, G., Morris, D., et al. (2006). Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA, 296 (17), 2095 - 2104. (Level 2 Evidence)
ORIGINAL EFFECTIVE DATE: 7/1/2001
MOST RECENT REVIEW DATE: 4/8/2010
ID_BT
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