The human nervous system is a fascinating system that includes all of the neural and support cells located within the central nervous system (CNS) and the neural axons that enter or exit the brain and spinal cord. This complex system has a built-in innate organization that simplifies the control of movement. Redundancy exists at most levels within the system to allow a safety net when there is damage of neural structures. The capacity for neural plasticity can assist with recovery from injury or disease, with the most recovery occurring based on how the individual uses the system. Evidence in the fields of neuroscience, psychology, education, and sports has contributed to our current knowledge of how movement is controlled by the interaction of the neuromuscular system with the other systems and within the constraints of the task environment. Physical therapists need a functional knowledge of these neuroscience essentials to apply clinical reasoning skills to the examination, evaluation, and intervention of children with neuromuscular disorders.
This chapter will first discuss the evolution of neurorehabilitation practices in relationship to the theoretical underpinning of movement control. Following the American Physical Therapy Association, Guide to Physical Therapist Practice (APTA, 2001) (hereafter referred to as the Guide), examination and evaluation strategies for the neuromuscular system will be described using the structure and nomenclature of the International Classification of Functioning, Disability and Health (ICF) (World Health Organization [WHO], 2001). The clinical management of common pediatric neuromuscular disorders related to the Physical Therapy Practice Patterns 5B (Impaired Neuromotor Development) and 5C (Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System) will then be presented, followed by a discussion about prognosis and recovery as it relates to neuroplasticity in children.
Theoretical Background of Movement Control
Rehabilitation practices develop in parallel with scientific theories. From new knowledge in basic sciences emerge new theories or new viewpoints about how the brain controls movement and the relative influence of, and organization among, the different systems involved. A theory of motor control provides clinicians with a set of assumptions about how movement is controlled. These assumptions are then translated into clinical applications. Theories of motor control are used as the conceptual framework for hypothesis-oriented clinical practice. The application of specific theories to practice will influence a therapist's clinical decision-making process through the sets of assumptions underlying the hypotheses formulated from the examination findings and through the prioritizing of problems to be addressed.
With this brief introduction to motor control theories, it is hoped that how physical therapy practice has been shaped in the past and how acceptance of one or more of these theories would lead the therapist to different examinations and interventions can begin to be understood. This is important for a beginning understanding of the nature of problems in some children with neuromuscular deficits and to comprehend current research ...