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 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 byNeuroCom®, a division of Natus® 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).
There is growing evidence of the efficacy of NeuroCom Systems in a wide range of movement and dizziness disorders that include:
- Multiple Sclerosis
- Huntington’s Disease
- NPH (Normal Pressure Hydrocephalus)
- Mild Head Injury/Concussion
- Dysequilibrium of aging
- 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.
|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 andTandem Walk
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.|