Neuromuscular Skeletal Plasticity Moving on from Traditional Physiotherapy Concepts

Purpose : N.A.P.(Neuromuscular Skeletal Plasticity) an integrative neuro-orthopedic concept to facilitate motor strategies in daily life. The primary thesis is, that treatment of body functions and structural impairments should be integrated within goal-oriented activities. The purpose of this article is to demonstrate that the functional activity itself, determines the structure. Material and Methods : A case report of a dentist with brachial plexus lesion after a motor vehicle accident is presented. The necessity for training body functions within relevant tasks is undermined by references which emphasize the importance of training realistic activities to enhance long-term changes in neural representation. Results : The treatment methods presented in this case show significant effects for the patient's ability to participate in his profession within less than a year's time after his motor vehicle accident. Conclusions : Current evidence supports the treatment methods of this concept. The inability to flex his elbow and supinate his forearm placed a considerable doubt to his ability to ever be able to participate in his profession again. Structural reorganization is possible and depends on functional demands, which need to be trained task-specifically. Single case reports may serve as the basis for further randomized controlled studies to support the efficacy of the treatment methods within the N.A.P. concept.