Historical Perspectives and Intervention Principles Flashcards
Remediation (Recovery) vs. Compensation: goals and treatment
Goal is improved function – movement, QoL, independence
Treatment should encompass attempts at restoration of lost function/skills AND/OR teaching of compensatory strategies = Maximize skills while learning new ways of performing tasks/activities
A neurological rehabilitation program is designed to:
meet the needs of the individual based on their specific movement dysfunction, injury/disease considerations, and personal goals
Neurologic Injuries (e.g., Stroke, TBI) Remediation (Recovery)
aims to restore lost function by promoting neuroplasticity—the brain’s ability to reorganize and form new connections
early intervention in the rehabilitation process focuses heavily on recovery
intensive therapies (e.g., physical, occupational, speech therapy) target the damaged areas of the brain or spinal cord to regain motor, cognitive, and sensory functions
exercises may aim to improve strength, coordination, balance, speech, and cognition.
Neurologic Injuries (e.g., Stroke, TBI) Remediation (Recovery) examples
Post-stroke physical therapy to restore limb function through task-specific repetition and motor learning.
Cognitive therapy to help patients recover memory or problem-solving skills after a TBI.
Neurologic injuries are often:
acute and non-progressive
meaning the brain or nervous system can recover to some degree if the right interventions are applied early
While some damage may be permanent, there is often potential for improvement, especially in the first few months post-injury
Neurologic Injuries (e.g., Stroke, TBI) Compensation
When full recovery is not possible, compensatory strategies are introduced to help individuals adapt to residual deficits
may involve teaching patients to use their unaffected limbs, modify tasks, or incorporate assistive devices to maintain independence and functionality
If certain functions cannot be fully recovered, compensation allows the individual to return to daily life and activities as independently as possible
Neurologic Injuries (e.g., Stroke, TBI) Compensation examples
Using a cane or brace to assist with walking if full recovery of gait is not achievable.
Adapting daily tasks like using one hand for dressing or grooming if the other hand is permanently weakened or paralyzed.
Neurodegenerative Diseases (e.g., Parkinson’s Disease, Multiple Sclerosis)
Remediation (Recovery):
remediation can be used in the early stages of neurodegenerative diseases to maintain or restore function, its effectiveness is often limited as the disease progresses
exercises may slow the rate of decline but do not reverse damage
focuses on maintaining motor function, flexibility, and coordination through specific exercises, medication management, and lifestyle changes
goal is to maximize current abilities for as long as possible
Neurodegenerative diseases are:
progressive, meaning function gradually declines over time
Therefore, while recovery of lost abilities is not usually possible, remediation efforts may aim to delay functional decline.
Neurodegenerative Diseases (e.g., Parkinson’s Disease, Multiple Sclerosis)
Remediation (Recovery) examples:
Exercise programs to maintain muscle strength and motor control in early Parkinson’s disease.
Balance and gait training in early multiple sclerosis to address motor symptoms before they worsen.
Neurodegenerative Diseases (e.g., Parkinson’s Disease, Multiple Sclerosis)
Compensation:
increasingly important as neurodegenerative diseases progress and the loss of function becomes more permanent - helps patients adapt to their changing abilities and maintain independence
Adaptive devices, environmental modifications, and compensatory techniques help individuals manage daily tasks despite the progression of their condition
often teach compensatory strategies early to prepare for future declines
neurodegenerative diseases are chronic and progressive, compensation is essential for maintaining quality of life = emphasis is on finding long-term solutions to manage day-to-day activities as the disease advances
Neurodegenerative Diseases (e.g., Parkinson’s Disease, Multiple Sclerosis)
Compensation examples
Use of mobility aids (e.g., walkers, wheelchairs) as walking becomes more difficult in advanced Parkinson’s disease.
Energy conservation techniques for individuals with MS who experience fatigue, helping them prioritize tasks and use energy efficiently.
Voice amplifiers or communication devices in later stages of Parkinson’s disease when speech becomes impaired.
Neurologic Injuries (Stroke, TBI): summary
Remediation: Focuses on restoring lost function and capitalizing on the brain’s capacity for neuroplasticity. Significant gains are often made in the early stages of recovery, particularly within the first few months post-injury.
Compensation: Used when recovery is incomplete or plateaued. Adaptive strategies and devices help individuals cope with permanent deficits.
Neurodegenerative Diseases (PD, MS): summary
Remediation: Aims to maintain function and slow functional decline in the early stages. True recovery is typically limited due to the progressive nature of these diseases.
Compensation: Becomes the primary approach as the disease progresses, helping individuals adapt to worsening symptoms and maintain independence despite declining function.
___ is more central to recovery following neurologic injuries, whereas ___ becomes the dominant strategy in managing the progressive loss of function in neurodegenerative diseases.
remediation
compensation
ICF - health condition (neuronal) motor recovery
restoring function in neural tissue that was initially lost after injury
may be seen as reactivation in brain areas previously inactivated by the circulatory even
although this is not expected to occur in the area of the primary brain lesion, it may occur in areas
ICF - body functions/structure (performance) motor recovery
restoring the ability to perform a movement in the same manner as it was performed before injury
this may occur through the reappearance of premorbid movement patterns during task accomplishment (voluntary joint range of motion, temporal and spatial interjoint coordination)
ICF - activity (functional) motor recovery
successful task accomplishment using limbs or end effectors typically used by nondisabled individuals
ICF - health condition (neuronal) motor compensation
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 nondisabled individuals
ICF - body functions/structure (performance) motor compensation
performing an old movement in a new manner
may be seen as the appearance of alternative movement patterns (recruitment of additional or different degrees of freedom, changes in muscle activation patterns such as increased agonist/antagonist coactivation, delays in timing between movements of adjacent joints) during the accomplishment of a task
ICF - activity (functional) motor compensation
successful task accomplishment using alternate limbs or end effectors
for example, opening a package of chips using 1 hand and the mouth instead of 2 hands
Remediation/Restoration
focuses on returning a function or ability to its previous state, often by addressing the underlying cause of the impairment
aims to recover lost skills or improve the functional capacity of affected areas
primary aim is to restore the individual’s original capabilities or to achieve a level of function as close as possible to what was present before the impairment
Compensation
adapting to the impairment by using alternative strategies, techniques, or assistive devices
focuses on enabling the individual to perform tasks and maintain independence despite functional limitations
aim is to manage and mitigate the impact of the impairment by finding ways to achieve tasks or activities despite the functional loss
58-year-old female with left hemiplegia following a recent stroke, the focus was on restoring strength and mobility through both in-patient and out-patient rehabilitation:
UE:
- HEP focused on open-chain strengthening exercises
- Task-specific movement patterns to regain functional use
LE:
- Closed-chain strengthening exercises, including weight-bearing activities
- Gait training to improve walking ability
- Balance training to address both static and dynamic stability