Neuromuscular Re-Education (NMRE) Treatments for Occupational Therapy

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Addressing Neuromuscular Re-Education (NMRE) is pivotal in occupational therapy practice, and contrary to common belief, it isn’t exclusive to patients with neurological diagnoses. Instead, NMRE serves as a fundamental code utilized by occupational therapy practitioners (OTPs) across various neurological-based models or frames of reference within their scope of practice. Whether employing neuromotor, neurobehavioral, neurocognitive, dual-tasking, neuromuscular, or Neurodevelopmental approaches, NMRE remains a cornerstone for promoting, restoring, or maintaining balance, coordination, kinesthetic sense, posture, and proprioception for sitting and standing activities.

Imagine a child with developmental delays struggling to maintain balance while sitting at a desk in school. By implementing NMRE interventions, occupational therapists can help the child improve core strength, coordination, and postural control, enabling them to sit upright and engage in learning activities more comfortably and effectively.

Similarly, consider an adult recovering from a lower limb injury who experiences difficulty maintaining balance while standing during household chores. Through NMRE techniques, occupational therapists can target specific muscle groups, enhance proprioceptive feedback, and improve overall stability, empowering the individual to perform daily tasks with increased confidence and safety.

Whether it’s a senior citizen aiming to prevent falls by improving balance and coordination or a stroke survivor working to regain functional independence in activities of daily living, NMRE interventions play a vital role in facilitating optimal occupational performance across the lifespan.

By addressing Neuromuscular Re-Education, occupational therapy practitioners equip individuals with the skills and abilities necessary to navigate their daily routines with greater ease, confidence, and independence. Through tailored interventions and evidence-based approaches, NMRE fosters improved balance, coordination, posture, and proprioception, ultimately enhancing the overall quality of life for clients across diverse populations and settings.

General:

Neuromuscular Re-education (NMRE) – 97112

This code does not require your patient to have a neurological-based diagnosis (this is a common mis-fact). Instead NMRE is a common code used by OTPs when applying one of the ten to twenty neurological-based models of practices or frames of reference they have within their scope whether that is neuromotor, neurobehavioral, neurocognitive, dual tasking, neuromuscular, Neurodevelopmental, etc. NMRE can apply to individuals across the lifespan when implementing interventions designed to promote, restore, or maintain balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities.

Assessments to use in Evaluation and Progress Notes:

• BERG Balance Assessment
• Timed Up and Go
• 5 Times Sit to Stand
• 10ft Tandem Line
• Modified Falls Efficacy Scale
• ABC Balance Scale

How should you approach Neuromuscular Re-Education Training in Occupational Therapy? 

Explanation: An occupational therapy practitioner has a secret sauce to rehabilitation. What separates us from everyone else is that we use activity analysis for repair and we work in continuums! We are holistic practitioners who work in both the social and medical models which means we understand that there is a sequence that must be used for maximum recovery. What is the treatment continuum for balance in occupational therapy? How should you format your plan of care or treatment plans to help someone improve their balance for maximum occupational therapy performance? Well, first of all – be prepared for 6-12 weeks of work! Balance takes a long time to correct!!! An occupational therapy practitioner is required to improve the balance so much that the balance system is effective across any context his/her patient may find themselves. So, what’s the balance continuum of occupational therapy treatments?

1. Postural Alignment Assessment and Gait Assessment
2. Address muscle mal-alignments, imbalances, and generalized weakness
3. Static sitting – supported (postural endurance and body mechanics)
4. Static sitting – unsupported (postural endurance and body mechanics)
5. Dynamic sitting activities / exercises — progress to multi-modal dynamic sitting activities
6. Static standing
7. Transitional movement efficiency and stability
8. Dynamic standing activities requiring unilateral upper extremity involvement, one hand support
9. Dynamic standing activities requiring bilateral upper extremity involvement
10. Dynamic standing activities requiring extensive weight shift beyond base of support
11. Dynamic standing activities requiring bilateral upper extremity involvement with reach outside or beyond base of support
12. Gait Training

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