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The transdisciplinary assessment approach and the specific
therapeutic interventions provided by the different specialties
in our center were described above. Services that clients
might receive, based on diagnostic categories, are as follows:
Acute Onset Brain Injury/Neurobehavioral
Syndromes:
Traumatic brain injury is representative
of those neurological disorders which present with acute onset
in a previously healthy person. Other diagnoses that fit into
this category include ruptured aneurysms, cerebrovascular
accidents, anoxic injuries, carbon monoxide poisoning, and
chemical poisoning. Symptoms following acute onset
neurobehavioral syndromes can range from mild to severe and
can involve cognitive, personality, affective, sleep, sensory,
motor, and pain sequelae. Depending on the severity of the
injury, services may involve as little as supportive counseling
services and perhaps occupational therapy to aid the person
with compensatory strategies to help with ADL’s (activities
of daily living) to situations where a person receives a variety
of therapies in our integrated program including neurology,
neuropsychology, psychological services, occupational therapy,
speech-language therapy, and physical therapy in a day treatment
program. Neuropsychological testing is indicated to evaluate
the severity of impairments and to develop an integrated treatment
program. Neurobehavioral follow-up is included throughout
the treatment program.
Chronic Neurological
Syndromes with Acute Exacerbations:
Multiple sclerosis and epilepsy/epilepsy surgery are disorders
that may have been diagnosed for years before a client needs
services from CNS. Multiple sclerosis is a condition where
things may go smoothly for years, and then a client has an
acute exacerbation which results in a number of sensory, motor,
cognitive, and fatigue problems that significantly reduce
independence. Word-finding, fluency, and swallowing problems
may occur. Spasticity, bowel, or bladder control issues could
become prominent. From a medicine perspective, MS is often
considered to be a chronic disorder, but a better conceptualization
of MS would be that we have a patient whose health leading
up to the exacerbation was compromised, and now she or he
has experienced a sudden worsening of symptoms. Thus, we basically
have an acute onset of neurological symptoms in a
patient whose neurological status was already somewhat compromised;
it is not simply “more of the same” on a continuum.
It is in these situations that clients will often be referred
to our center to address a new neurological problem that is
compromising their ability to function in their independent
activities of daily living.
The same phenomenon is seen in rare cases of epilepsy where
a person whose functioning was adequate has an exacerbation
of seizures, leaving him or her with compromised cognitive
functioning. We especially see this in individuals who have
epilepsy surgery (removal of the scar tissue in the brain
from which the seizure is generated). Such individuals typically
have significant attention and memory problems. In these scenarios,
the appropriate therapy regimen will of course depend on the
nature of the symptoms and the severity of the symptoms. Neuropsychological
testing is indicated to clarify the nature and severity of
cognitive difficulties. Counseling, within a neuropsychological
framework, is essential for the client to adapt to their limitations
and to resolve grief, loss, and depression issues. Occupational
therapy may be indicated to improve independence in functional
ADLs. Physical therapy may be needed to address neuromuscular
problems and gait. Speech-language therapy may be needed to
address problems with communication and swallowing.
Neurodegenerative Disorders:
Certainly, for some disorders, the prognosis is clearly one
of continued brain and neurobehavioral deterioration. Examples
of such disorders include Alzheimer’s Disease
and similar dementias, Parkinson’s Disease, other movement
disorders (Progressive Supranuclear Palsy, Striatonigral Degeneration,
Cerebellar Disease, Huntington’s Disease. We
certainly can not reverse the course of these disorders with
therapy, but neuropsychological testing can help us determine
issues of safety and competence. Occupational therapy can
help the client (and family members) develop strategies and
techniques for compensation, especially for safety and to
promote independence. Speech-language therapy can address
communication strategies and swallowing. Physical therapy
can address safety issues and assistive devices related to
transfers and mobility. Counseling, within a neuropsychological
framework, can help the patient and family members deal with
losses, life changes, and changes in roles and responsibilities.
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