The assessment of motor recovery: A new look at an old problem

After nervous system damage, functional recovery usually occurs. It is of great clinical importance to follow the course of recovery and, when possible, predict the extent. This measurement and prediction of recovery is one of the main challenges facing clinicians today. The majority of assessment procedures currently employed, however, are impairment-oriented; that is, these procedures are oriented primarily at the disease or organ level. Until now, few procedures have been available that focus at the disability or behavioural level. This lack of disability-oriented assessment procedures hinders the development and evaluation of rehabilitation programmes, as impairment-oriented assessment scores have little relevance for the prediction of daily functioning. In this paper, a preliminary task-set is presented that may function as an impetus for the development of novel disability-oriented assessment procedures in neurological rehabilitation. Motor behaviour is not assessed in vacuo, rather as the end result of a continuous interaction between motor, sensory and cognitive processes. With this task set, it is possible to evaluate the changing influence of sensory and cognitive factors on the quality of motor performance over time. These changes, it is argued, are a crucial component of functional recovery.