Balance and Coordination Training for Brain Disorders

Neuromuscular coordination is the process in the activation of muscle contraction patterns with appropriate forces and sequences coupled with simultaneous inhibition of other muscles to carry out desired activity. Through coordination training, engram can be developed as automatic preprogrammed multi-muscular patterns in extrapyramidal system by repetitive training millions of time, whereas control is the ability to voluntarily activate a single muscle in pyramidal system with conscious awareness. The development of coordination depends on voluntary repetition of precise performance with simple components until engram is formed. Balance training begins with therapeutic standing using a tilt table and a prone stander. Thereafter, patients with stable static posture proceed to dynamic balance training and progressive gait training using parallel bars and gait aids such as walker or cane. Balance training as a comprehensive early rehabilitation program can effectively improve balance performance. As a therapeutic modality for balance and coordination, neurologic music therapy for sensorimotor training consists of rhythmic auditory stimulation (RAS), patterned sensory enhancement, and therapeutic instrumental music performance (TIMP). RAS has been shown to increase the effect of gait training by stimulating reticulospinal tract in extrapyramidal system as the underlying mechanism. TIMP using keyboard playing has been introduced as therapeutic modality to enhance sequential and programmed coordination with precise execution and independent movement of individual fingers. Therefore, clinical application of neurologic music therapy might be considered to improve balance and coordination in patients with neurological diseases. (Brain & NeuroRehabilitation 2013; 6: 68-72)