A model for multisystem evaluation, interpretation, and treatment of individuals with neurologic dysfunction

We have presented a model that can be used to organize current concepts of neuroanatomy, neurophysiology, and motor control theory into a clinically relevant context. This model can be used to postulate the causal relationship among pathology, impairments, and disabilities. Knowledge of the insult often provides predictive information regarding stability of the disability, progression of the disease, and possibly recovery. Knowledge of neuropathology should guide the clinician regarding the types of impairments that are expected. Thus, by knowing the type and location of the lesion, the clinician already has a perspective regarding which evaluative tests should be emphasized and what treatment strategies will be most effective. In the absence of known pathology, knowledge of motor control theory, neuroanatomy, and neuropathology can still help the clinician make educated judgments regarding the interrelationship of the patient's impairments. In this model, we separate impairments that result directly from neuropathology and those that arise indirectly to help the clinician keep the total patient in perspective and to focus intervention. This separation emphasizes the applicability and limitations of motor control theories in the treatment of neurologically impaired individuals. Motor control theory helps to identify the relationship between direct impairments and their likely consequences; motor control theory does not address the very real issue of impairments that arise indirectly in systems such as the musculoskeletal and cardiopulmonary systems. Impairments that occur as a composite effect of multiple causes are identified as a separate category. Some of the causes of these impairments can often be addressed by physical therapy intervention, and some cannot.(ABSTRACT TRUNCATED AT 250 WORDS)