Interventions and Clinical Management of Neurologic Conditions
Core concepts
Know evidence-based interventions: task-specific gait and balance training, constraint-induced movement therapy, body-weight-supported treadmill training, virtual reality, dual-task training, vestibular rehabilitation (adaptation, habituation, substitution), respiratory management, positioning, and spasticity management (stretching, serial casting, botulinum toxin, intrathecal baclofen). Understand transfer training, wheelchair prescription, orthotic selection, and fall prevention. Recognize disease-specific management: Parkinson disease (cueing, amplitude-based training), MS (energy conservation, fatigue management), ALS (function preservation, respiratory support), and spinal cord injury (pressure relief, autonomic dysreflexia recognition).
Traps
Questions often present a popular intervention in the wrong context (e.g., CIMT in a patient without active wrist extension). Distinguish compensation from recovery and know when each is appropriate. Autonomic dysreflexia is a medical emergency-recognize the trigger and refer. Do not confuse vestibular habituation with adaptation.
Rule of thumb
Match intervention to impairment and goal: use task-specific practice for activity limitations, impairment-focused techniques as adjuncts, and compensatory strategies when recovery is not expected. Safety screening precedes every intervention.
Worked example
A patient with T6 SCI develops sudden severe headache, hypertension, and bradycardia during a session. Recognize autonomic dysreflexia, remove the noxious stimulus (e.g., tight clothing, full bladder), position upright, and escalate to medical staff.