Historical Perspectives and Intervention Principles

Question 1

Remediation versus Compensation

Answer 1

• A neurological rehab program is designed to meet the needs of the individual based on the specific problem or disease
• Treatment should encompass attempts at restoration of lost function at the same time as teaching compensatory strategies

Question 2

What is the goal for neurological rehabilitation?

Answer 2

Goal is improved function through both remediation and compensation techniques

Question 3

Neurological Injuries

Answer 3

Stroke
TBI

Question 4

Neurological Diseases

Answer 4

Parkinson’s Disease
Multiple Sclerosis

Question 5

ICF (Health Condition - Neuronal): Recovery

Answer 5

Restoring function in neural tissue that was initially lost after injury.

(May be seen as reactivation in brain areas previously inactivated by the circulatory event, not expected in area of primary lesion)

Question 6

ICF (Health Condition - Neuronal): Compensation

Answer 6

Neural tissue acquires a function that it did not have prior to injury.

(May be seen as activation in alternative brain areas not normally observed in non-disabled individuals)

Question 7

ICF (Body Functions/Structure - Performance): Recovery

Answer 7

Restoring the ability to perform a movement in the same manner as it was performed before injury.

Question 8

ICF (Body Functions/Structure - Performance): Compensation

Answer 8

Performing an old movement in a new manner.

(May be seen as the appearance of alternative movement patterns during the accomplishment of a task; additional or different degrees of freedom, changes in muscle activation patterns, delays in timing between movements of adjacent joints, etc.)

Question 9

ICF (Activity - Functional): Recovery

Answer 9

Successful task accomplishment using limbs or end effectors typically used by non-disabled individuals.

Question 10

ICF (Activity - Functional): Compensation

Answer 10

Successful task accomplishment using alternate limbs or end effectors.

(Ex: opening a bag of chips using 1 hand and mouth instead of 2 hands)

Question 11

Remediation/Recovery

Answer 11

Restoring lost function
- Therapy capitalizes on the spontaneous recovery process

Question 12

Compensatory Approach

Answer 12

Learning how to develop “work arounds” for a functional task. Patient is taught to change the environment or change their approach.

Question 13

Example of cases where compensatory strategies are the priority

Answer 13

Any case where restoration is not an achievable option based on their condition.

1. 40 y.o. women with non-operable GBM in R occipital lobe. Compression of optic nerve compromised 90% of her vision in the L eye.
2. 50 y.o. male suffered T12 ASI A SCI after MVA (complete SCI’s rarely jump to a C or D)

Question 14

Combined Remediation and Compensation

Answer 14

Combined process of restoring and learning adaptive techniques for improved functioning.

Compensation needed initially and progress to restoration (as condition improves)

(Ex: 30 y.o. male dx with Guillain-Barré syndrome presents with significant weakness and tingling throughout B LE)