BlueCross BlueShield of Tennessee Medical Policy Manual

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 REMINDERS

• Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.

• 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.

Braddock, E., Greenlee, J., Hammer, R., Johnson, S., Martello, M., O’Connell, M., et al. (2009) Manual medicine guidelines for musculoskeletal injuries. Sonora,CA: Academy for Chiropractic Education. Retrieved November 13, 2012 from http://www.guideline.gov.

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)

Cahaba Government Benefit Administrators®, LLC. (2011). Local coverage determination for medicine: Physical therapy – outpatient (L30009). Retrieved April 4, 2012 from http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=30009&ContrId=217&ver=44&ContrVer=1&CoverageSelection=Both&ArticleType=All&PolicyType=Final&s=Tennessee&KeyWord=physical+therapy&KeyWordLookUp=Title&KeyWordLookUp=Title&KeyWordLookUp=Title&KeyWordSearchType=And&KeyWordSearchType=And&KeyWordSearchType=And&from2=search.asp&bc=gAAAABAAAAAA&.

Complete Guide to Medicare Coverage Issues [Computer software]. (2012, July). Coverage of outpatient rehabilitation therapy services (physical therapy, occupational therapy, and speech-language pathology services) under medical insurance. (Section 220, pp. 4-221 - 4-222). The Ingenix.

Kollen, B., Lennon, S., Lyons, B., Wheatley-Smith, L., Scheper, M., Buurke, J., et al. (2009). The effectiveness of the Bobath concept in stroke rehabilitation: what is the evidence? Stroke, 40 (4), e 89 - 97. (Level 2 Evidence)

Mehling, W., Wrubel, J., Daubenmier, J., Price, C., Kerr, C., Silow, T., et al. (2011). Body awareness: a phenomenological inquiry into the common ground of mind- body therapies. Philosophy, Ethics, and Humanities in Medicine, 6 (6), 1-12.(Level 5 Evidence)

ORIGINAL EFFECTIVE DATE:  7/1/2001

MOST RECENT REVIEW DATE:  12/13/2012  

ID_BT

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.