Here we assess and treat the client’s ability to activate specific muscles selectively in order to know more about their ability to perform specific movements and functions.
The presence of spasticity and low muscle tone affects the client’s ability to activate muscles in isolation. Think about the challenge of lifting their toes when they step or opening their hand. The difficulty in lifting their toes is two fold: the spastic muscles of the calf are almost always on and short, while the muscle on the front of the lower leg and lengthened and weak. I discuss how we use alignment to address muscle length, we can also use some of the sensory strategies discussed under awareness to see if the client is able to relax or activate their specific plantar or dorsiflexors in isolation.
Once a child is 3-4 years old they can use EMG Biofeedback to learn to activate a muscle. With EMG Biofeedback we place an electrode on the skin over a muscle and our biofeedback machine can pick up the electrical signal that generates when the muscle is active or decreases when the muscle relaxes. The client can see the signal on the machine or we can set it to sound so they can hear a tone when the muscle is active. Children love this – it is like a computer game!! They often learn to activate their muscles in a matter of minutes. Once they know how to activate a muscle with EMG biofeedback, we teach them how to activate it during function.
These are just a couple of examples of how we assess and teach muscle activation. There are many more ways!
Once we have addressed activation we can move on to step 4.