The Principles of Neurogym Training

The following are the 10 major principles of the NeuroGym® methodology and practice:

1. The NeuroGym® methodology targets the following four domains:  
   • Sensory Motor control and Coordination 
   • Strength
   • Balance
   • Mobility
     Other parameters of motor ability, such as endurance and range of motion, are addressed within the training routines that are employed addressing the above four domains. 

1. The most effective way to improve control and coordination affected by neurologic decline is by providing intensive and speed sensitive active training. Various forms of biofeedback (BF) techniques, including electromyographic BF and virtual reality, can provide the high level of intensity and speed sensitivity required to be effective. 
2. The most effective way to improve strength is to provide progressive resistance training tailored to the individual’s needs (e.g., hip, knee, shoulder, etc.). Strength is essential to function. Elastic resistance and light bar bells, though they may be necessary tools at the earliest stages of activation, cannot provide the same benefit as machines that are designed to progressively increase resistance to the targeted joints.
3. Improving balance is a complex process that requires increased strength and motor control. Again, dedicated technologies that provide intense, speed sensitive balance training for specifically targeted impairments are most effective at improving static and dynamic stability.  
4. The enabling of movement that is otherwise not available to the recovering individual is key to the NeuroGym® rehab system. The plastic changes necessary to recover lost movement cannot take place without a partially successful active attempt. Technologies such as Body Weight Support (BWS) are especially effective at enabling safe and productive training. 
5. The underlying assumption in the NeuroGym® rehabilitation approach is that, since changes in the CNS (central nervous system) are associated with attempted and with (at least) partially successful movements, the active component of the training is the most crucial component; in the case of limited or no mobility, the NeuroGym® methodology and associated technology enables mobility that is otherwise not available due to paralysis or weakness. 
6. Still associated with the principle of plasticity, NeuroGym® strives to develop building blocks of movement that, when available to the CNS, can and should be incorporated into the successful movement. For example, a stronger capability to dorsi-flex the ankle presents the brain with the potential to ‘construct’ a more effective motion of stepping while re-learning that action. The brain is capable of ‘scanning’ the available resources and implementing those resources into the newly formed movement. 
7. The therapist can encourage the process of the patient’s brain implementing the required building blocks into functional movement by manipulating the training environment such that movement can be enabled. Some of the technologies associated with NeuroGym® provide such enabling environments, but other options, such as water or elastic surfaces (e.g., trampoline) may be employed to help enable the desired movement.  
8. For optimal motor control or balance training, NeuroGym® training focuses on the activation of synergies, rather than that of isolated movements. Using multi-channel biofeedback, for example, the desired synergy can be determined and practiced. Such practice increases the strength and automaticity of the desired motion/synergy. 
9. For optimal results, the motor control and balance aspects of the training require intensive practice (3 times a week is the minimally recommended intensity, but daily training is more effective). Instructions and guidance alone cannot replace active, intense repetition of even partially completed movements.