Neuromuscular Reeducation

Neuromuscular Reeducation
BlueCross BlueShield of Tennessee Medical Policy Manual

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.

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.

Neuromuscular reeducation does not meet the following technology evaluation criteria:

The scientific evidence does not permit conclusions concerning the effect of the technology on health outcomes.

It is unknown if the technology improves net health outcomes.

It is unknown if the technology is as beneficial as any established alternatives.

It is unknown if improvement is attainable inside or outside investigational settings.

SOURCES

American Chiropractic Association (ACA) Council on Chiropractic Physiological Therapeutics and Rehabilitation. Physiotherapy and rehabilitation guidelines for the chiropractic profession. Retrieved February 7, 2006 from http://www.chiro.org/LINKS/GUIDELINES/REHABILITATION.shtml.

Beazell, J. R., & Magrum, E. M. (2003). Rehabilitation of head and neck injuries in the athlete. Clinic in Sports Medicine, 22, 523-557.

BlueCross BlueShield of Tennessee network physicians. January 2001.

Buchanan, P. A., & Ulrich, B. D. (2001). The Feldenkrais Method: A dynamic approach to changing motor behavior. Research Quarterly for Exercise and Sport, 72 (4), 315-323. Abstract retrieved February 6, 2006 from PubMed database.

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. Abstract retrieved April 17, 2007 from PubMed database.

Complete Guide to Medicare Coverage Issues [Computer software]. (2006, November). Coverage of outpatient rehabilitation therapy services (physical therapy, occupational therapy, and speech-language pathology services) under medical insurance. (Section 220, pp. 4-213 - 4-225). St. Anthony Publishing.

Complete Guide to Medicare Coverage Issues [Computer software]. (2006, November). Practice of physical therapy, occupational therapy, and speech-language pathology. (Section 230, pp. 4-225 - 4-232). St. Anthony Publishing.

Complete Guide to Medicare Coverage Issues [Computer software]. (2006, November). Chiropractic services-general. (Section 240, pp. 4-232 - 4-235). St. Anthony Publishing.

Diels, H. (1997). Neuromuscular retraining for facial paralysis. Otolaryngologic Clinics of North America, 30 (5), 727-743.

Diracoglu, D., Aydin, R., Baskent, A., & Celik, A. (2005). Effects of kinesthesia and balance exercises in knee osteoarthritis. Journal of Clinical Rheumatology, 11 (6), 303-310. Abstract retrieved April 17, 2007 from PubMed database.

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. Abstract retrieved April 17, 2007 from PubMed database.

International FELDENKRAIS? Federation. (1998, October). Standards of practice of the Feldenkrais method?. Retrieved October 23, 2002 from http://www.feldenkrais.com/standards/index.html.

Johnson, S. K., Frederick, J., Kaufman, M., & Mountjoy, B. A. (1999). A controlled investigation of bodywork in multiple sclerosis. Journal of Alternative and Complementary Medicine, 5 (3), 237-243.

Langhammer, B., & Stanghelle, J.K. (2000). Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: A randomized controlled study. Clinical Rehabilitation, 14 (4), 361-369.

Laskowski, E. R., Newcomer-Aney, K., Smith, J. (1997). Refining rehabilitation with proprioception training: Expediting return to play. The Physician and Sportsmedicine, 25 (10). Retrieved October 23, 2002 from http://www.physsportsmed.com/issues/1997/10oct/laskow.htm.

Lennon, S., Baxter, D., Ashburn, A. (2001). Physiotherapy based on the Bobath concept in stroke rehabilitation: a survey within the UK. Disability and Rehabilitation, 23 (6), 254-262.

Maher, C. G. (2004). Effective physical treatment for chronic low back pain. Orthopedic Clinics of North America, 35 (1), 57-64. Abstract retrieved 2/6/06 from MDConsult database.

Malmgren-Olsson, E. B., & Branholm, I. B. (2002). A comparison between three physiotherapy approaches with regard to health-related factors in patients with non-specific musculoskeletal disorders. Disability and Rehabilitation, 24 (6), 308-317. Abstract retrieved February 6, 2006 from PubMed database.

Mehling, W. E., DiBlasi, Z., & Hecht, F. (2005). Bias control in trials of bodywork: A review of methodological issues. Journal of Alternative and Complementary Medicine, 11 (2), 333-342. Abstract retrieved February 6, 2006 from PubMed database.

National Center for Complementary and Alternative Medicine. National Institutes of Health. (2004, October). Manipulative and body-based practices: An overview. Retrieved February 7, 2006 from http://nccam.nih.gov/health/backgrounds/manipulative.htm.

Platz, T., Eickhof, C., vanKaick, S., Engel, U., Pinkowski, C., Kalok, S., et al. (2005). Impairment-oriented training or Bobath therapy for severe arm paresis after stroke: A single-blind, multicentre randomized controlled trial. Clinical Rehabilitation, 19 (7), 714-724. Abstract retrieved February 6, 2006 from PubMed database.

The Bobath Centre. The Bobath approach. Retrieved October 23, 2002 from http://www.bobath.org.uk/.

Van Vliet, P. M., Lincoln, N. B., & Foxall, A. (2005). Comparison of Bobath based and movement science based treatment for stroke: A randomized controlled trial. Journal of Neurology, Neurosurgery, and Psychiatry, 76 (4), 465-466. Abstract retrieved February 6, 2006 from PubMed database.

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. Abstract retrieved April 17, 2007 from PubMed database.

Work Loss Data Institute. (2006, January). Low back-lumbar & thoracic (acute & chronic). Summary retrieved February 8, 2006 from National Guideline Clearinghouse.

EFFECTIVE DATE
9/9/2007

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.

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