NEUROLOGIC DISORDERS

Clinical Information: Assessment & Treatment: Neurologic Disorders

Stroke:
Stroke is the number one cause of adult disability in the US, costing more than $40 billion a year (NIH, July
99;

Head Injury:
1 million Americans are treated and released from hospital emergency departments for TBI each year
(National Center for Injury Prevention and Control/CDC, www.cdc.gov)

The majority of serious head injury patients complain of dizziness for up to five years following injury and
many are disabled by this symptom Complaints of dizziness and unsteadiness are frequent problems in
accidental and job related mild head injuries Multiple Sclerosis:
250,000 Individuals suffer from Multiple Sclerosis

Parkinson's Disease:
There are 20 new cases per 100,000 population per year and one million cases in the US alone

The Problem
Acquired and degenerative neurological disorders are frequently associated with varying combinations and
degrees of impaired motor, sensory, and central coordination functions, as well as postural control problems.
Patients with these disorders also present with co-morbidities and secondary impairments which further
complicate diagnosis and treatment planning while dramatically impacting the patient's ability to perform
daily life, vocational, and leisure activities. Because of these complexities, selecting the best medical
management approach and predicting treatment outcome for chronic neurological disorders is a difficult
task, and as a result, the cost of treatment is high.

The growing consensus among health care professionals is that the medical management model, where
multi-disciplinary teams representing a variety of medical disciplines focus on minimizing disabling
symptoms and maximizing functional capabilities, is the most effective approach to treat complex, chronic
disorders. As such, the medical management model differs from the traditional acute intervention practice
model in which a disease process is localized and targeted for specialized treatment. While acute
intervention has successfully reduced life-threatening diseases, it has proven less effective in treating
chronic disorders involving constellations of interacting factors.

The acute intervention and the chronic medical management models also differ in the types of patient
information required. Whereas a localizing diagnosis drives treatment decisions under acute intervention,
specific knowledge of the underlying pathology(s) and associated functional impairments is essential for
effective treatment planning within the medical management model. This point is illustrated by the
significant differences in impairments frequently seen among patients with similar pathologies as well as the
differences in how individual patients respond to the same treatment programs.

The Opportunity
The Parkinson's patient responding poorly to traditional drug regimens provides an example of the
complementary value of functional impairment information in effective medical management. The clinical
literature describes the four defining features of Parkinsonism as tremor, bradykinesia, rigidity, and postural
control deficits (Movement Disorders: Neurologic Principles and Practice). While L-Dopa based drugs
improve tremor, bradykinesia, and/or rigidity, they can also reduce postural stability and increase falls. As a
consequence, the overall functional benefit of drug therapy may be substantially reduced when
improvements in ambulation are constrained by decreases in postural stability.

Treatment choices for the difficult to manage Parkinson's patient are expanding, creating a medical
management challenge to determine the most effective treatment combination for the individual patient. For
example, controlled clinical trials have demonstrated that physical therapy can significantly improve
UPDRS scores and ADL's in some Parkinson's patients (Physical Therapy and Parkinson's Disease: a
Controlled Clinical Trial, 1994), while pallidotomy surgery can improve the function of other severely
disabled Parkinson's patients (Changes in Postural Control After Pallidotomy, 1998).

A recent cost-effectiveness study has demonstrated that the impairment information provided by
NeuroCom® systems are of significant value in selecting among multiple treatment options in complex,
chronic vestibular balance disorders (Baylor School of Public Health cost-effectiveness study,
Laryngoscope, Apr 99). In the area of Parkinson's disease management, the results of several ongoing
studies point to similar conclusions; namely, that the information provided by NeuroCom® technology is
useful in selecting between patients likely to benefit from pallidotomy surgery and/or physical therapy (in-
progress studies and submitted manuscripts).

Neurological Applications
There is growing evidence of the efficacy of NeuroCom® Systems in a wide range of movement and
dizziness disorders that include:

 Stroke
 Multiple Sclerosis
 Huntington's Disease
 NPH (Normal Pressure Hydrocephalus)
 TBI
o Mild Head Injury/Concussion
o Whiplash/MVA
 Neuropathy
o Diabetic
o Polyneuropathy
 Geriatric
o Dysequilibrium of aging
 Pediatric
o Developmental delay
o Learning disabilities
 Panic attacks and agoraphobia
 Effects of alcohol
Impairments and Functional Limitations Assessed by NeuroCom®
Systems
Impairment information is useful in treatment planning, because it documents the impact of a disease or
injury on the individual elements of function that collectively enable the patient to perform activities of
daily living. Functional limitation assessments, on the other hand, measure the patient's ability to perform
activities of daily living and are useful in quantifying changes and documenting outcome. The following
chart shows impairment and functional limitation assessments available on NeuroCom® systems which are
applicable to patients with movement disorders.

Impairment Application
Assessment
Sensory Organization Ability to effectively use visual, vestibular, and somatosensory inputs for
Test (SOT) balance under a variety of sensory conditions.
Motor Control Test Speed and effectiveness of the automatic reactions, the patient's first line of
(MCT) defense against external disturbances.
Adaptation Test Ability to suppress functionally inappropriate automatic reactions.
(ADT) 
Limits of Stability Test
Patient's ability to voluntarily control COG position over the base of support,
(LOS) a fundamental component of sit to stand, reaching, and gait activities.
Weight Bearing/Squat Ability to bear weight equally on both legs under conditions of increasing
functional demand.
Rhythmic Weight Shift Ability to coordinate the speed and amplitude of voluntary movements.

Functional Application
Limitation
Assessment
Sit To Stand Ability to discriminate critical components necessary to perform functional
Walk and Tandem tasks, such as rising from a seated to a standing position, walking, ascending and
Walk descending stairs.
Quick Turn
Step Up & Step
Down