What is the fourth layer from the bottom in the bottom-up rehab pyramid?

• A. Neuromotor control / proprioception
• B. Function / performance
• C. Range of motion / flexibility
• D. Strength and endurance

Answer: (A)

In a bottom-up rehab pyramid, you build from basic capacities up to more refined motor control. The sequence typically runs from range of motion / flexibility at the base, then strength and endurance, then function / performance, with neuromotor control / proprioception as the final, top layer. The reason this top layer fits there is that neuromotor control focuses on coordination, balance, proprioceptive awareness, and motor learning—skills that refine movement once basic movement capacity and functional tasks are already in place. Without adequate ROM and strength, or without functional task practice, neuromotor control can’t be fully developed; but once the other layers are established, targeting neuromotor control helps optimize how the body moves safely and efficiently during real tasks.