Integrative and facilitatory processes in premotor pathology and their application in training

The role of the neurologist in rehabilitation goes beyond diagnosing the patient's disease and related functional disorders. This task, like dynamic diagnosis or the longitudinal evaluation of disease course and of the effects of treatments administered, can be carried out through consultations. In reality, the neurologist's direct intervention is required and should be oriented in three complementary directions. The role of the neurologist should be: 1) to define therapeutic interventions, both integrative and facilitatory training of the still preserved functions; 2) to identify patients in whom effective intervention is possible; 3) to make provision for methods and instruments designed, in both the exploratory and the therapeutic stages, to maintain the efficiency of, and to improve, the task-independent central functions. Motor pathology, whether of central origin secondary to pyramidal system damage, or of peripheral origin due to motor unit damage, falls within the field of task-specific executive processes. In the first instance, in which it is the first motor neuron that is affected, the most feasible intervention, in both an extensive and an intensive sense, is positional feedback and electrical stimulation (PFST) to prevent disuse of the short-range integrative and facilitatory functions, at the level of the praxic engram centres. In the second instance, in which it is the second motor neuron that is affected, the intervention is based mainly on classic physiokinesitherapy, in its various forms. The sector of interest to this symposium is that of premotor pathology, and its three main systems: initiation of movement, impairment of which gives rise to akinetic and dyskinetic syndromes; coordination of movement with inhibition of the antagonist muscles, impairment of which gives rise to primary ataxic syndromes: and spatial and temporal programming, impairment of which leads to various forms of apraxia. Furthermore, these three systems are associated, even at a preliminary level, with a structural resource and with two general mechanisms: mnesic memory stores and their coding and decoding function, impairment of which gives rise to phrenasthenic and dementia syndromes; vigilance mechanisms, impairment of which leads to confusional states; and purposeful attention mechanisms, whose impairment leads to dissociative mental states. Having identified the patients in whom integrative and facilitatory functions should be investigated, it remains to define the anatomical-functional substrate of these functions.