NEUROLOGIC DISORDERS
The Problem
Acquired and degenerative neurological disorders are frequently associated with varying combinations and degrees of impaired motor, sensory, and central coordination functions, as well as postural control problems. Patients with these disorders also present with co-morbidities and secondary impairments which further complicate diagnosis and treatment planning while dramatically impacting the patient's ability to perform daily life, vocational, and leisure activities. Because of these complexities, selecting the best medical management approach and predicting treatment outcome for chronic neurological disorders is a difficult task, and as a result, the cost of treatment is high.
The growing consensus among health care professionals is that the medical management model, where multi-disciplinary teams representing a variety of medical disciplines focus on minimizing disabling symptoms and maximizing functional capabilities, is the most effective approach to treat complex, chronic disorders. As such, the medical management model differs from the traditional acute intervention practice model in which a disease process is localized and targeted for specialized treatment. While acute intervention has successfully reduced life-threatening diseases, it has proven less effective in treating chronic disorders involving constellations of interacting factors.
The acute intervention and the chronic medical management models also differ in the types of patient information required. Whereas a localizing diagnosis drives treatment decisions under acute intervention, specific knowledge of the underlying pathology(s) and associated functional impairments is essential for effective treatment planning within the medical management model (Sandy LG, Gibson R. Managed care and chronic care: challenges and opportunities. Managed Care Quarterly 4: 5 - 11, 1996; Stewart MG, Chen AY, Wyatt JR, Favrot S, Beinart S, Coker NJ, Jenkins HA. Cost-effectiveness of the diagnostic evaluation of vertigo. The Laryngoscope 109: 600 - 605, 1999). This point is illustrated by the significant differences in impairments frequently seen among patients with similar pathologies as well as the differences in how individual patients respond to the same treatment programs.
The Opportunity
The Parkinson's patient responding poorly to traditional drug regimens provides an example of the complementary value of functional impairment information in effective medical management. The clinical literature describes the four defining features of Parkinsonism as tremor, bradykinesia, rigidity, and postural control deficits (Movement Disorders: Neurologic Principles and Practice). While L-Dopa based drugs improve tremor, bradykinesia, and/or rigidity, they can also reduce postural stability and increase falls. As a consequence, the overall functional benefit of drug therapy may be substantially reduced when improvements in ambulation are constrained by decreases in postural stability.
Treatment choices for the difficult to manage Parkinson's patient are expanding, creating a medical management challenge to determine the most effective treatment combination for the individual patient. For example, controlled clinical trials have demonstrated that physical therapy can significantly improve UPDRS scores and ADL's in some Parkinson's patients (Physical Therapy and Parkinson's Disease: a Controlled Clinical Trial, 1994), while pallidotomy surgery can improve the function of other severely disabled Parkinson's patients (Changes in Postural Control After Pallidotomy, 1998).
A recent cost-effectiveness study has demonstrated that the impairment information provided by NeuroCom® systems are of significant value in selecting among multiple treatment options in complex, chronic vestibular balance disorders (Baylor School of Public Health cost-effectiveness study, Laryngoscope, Apr 99). In the area of Parkinson's disease management, the results of several ongoing studies point to similar conclusions; namely, that the information provided by NeuroCom® technology is useful in selecting between patients likely to benefit from pallidotomy surgery and/or physical therapy (in-progress studies and submitted manuscripts).
Neurological Applications
There is growing evidence of the efficacy
of NeuroCom® Systems in a wide range of movement and dizziness
disorders that include:
- Stroke
- Multiple
Sclerosis
- Huntington's
Disease
- NPH
(Normal Pressure Hydrocephalus)
- TBI
- Mild Head Injury/Concussion
- Whiplash/MVA
- Neuropathy
- Geriatric
- Pediatric
- Developmental delay
- Learning disabilities
- Panic
attacks and agoraphobia
- Effects
of alcohol
Impairments and Functional Limitations Assessed by NeuroCom® Systems
Impairment information is useful in treatment planning,
because it documents the impact of a disease or injury on
the individual elements of function that collectively enable
the patient to perform activities of daily living. Functional limitation assessments, on the other hand,
measure the patient's ability to perform activities of daily
living and are useful in quantifying changes and documenting
outcome. The following chart shows impairment and functional
limitation assessments available on NeuroCom® systems which
are applicable to patients with movement disorders.
| Impairment Assessment
|
Application |
|
Sensory
Organization Test (SOT)
|
Ability
to effectively use visual, vestibular, and
somatosensory inputs for balance under a
variety of sensory conditions.
|
|
Motor
Control Test (MCT)
|
Speed
and effectiveness of the automatic reactions,
the patient's first line of defense against
external disturbances.
|
|
Adaptation
Test (ADT)
|
Ability
to suppress functionally inappropriate
automatic reactions.
|
| Limits
of Stability Test (LOS)
|
Patient's
ability to voluntarily control COG position
over the base of support, a fundamental
component of sit to stand, reaching, and gait
activities.
|
| Weight
Bearing/Squat
|
Ability
to bear weight equally on both legs under
conditions of increasing functional demand.
|
| Rhythmic
Weight Shift
|
Ability
to coordinate the speed and amplitude of
voluntary movements.
|
| Functional Limitation Assessment |
Application |
Sit To Stand
Walk and Tandem Walk
Quick Turn
Step Up & Step Down
|
Ability
to discriminate critical components necessary to
perform functional tasks, such as rising from a
seated to a standing position, walking, ascending
and descending stairs.
|