Rationale for considering nervous system pathology in diagnosis
Summary of relevant clinical neuroanatomy
Relationship between neuroanatomy and clinical syndromes
Numbness, tingling, weakness, and dizziness are just a few symptoms commonly encountered in physical therapist practice that may indicate pathology of the neurological system. Resultant difficulty in mobility and function is what frequently drives an individual to seek physical therapy services. As specialists in the diagnosis and treatment of movement dysfunction, physical therapists must have the knowledge base and clinical skills to confirm that impairments are consistent with a given medical diagnosis. As Gordon and Watts discuss in Chapter 1, physical therapists must engage in the diagnostic process as part of their overall evaluation. The process must lead to a decision regarding the probable pathological or pathophysiological cause of an individual's problem, followed by a determination of whether physical therapy intervention is the most appropriate to address the pathology underlying the condition. We advocate that the use of this process should extend to physical therapists working with individuals who display symptoms and signs consistent with nervous system pathology.
Nervous System Pathology is Important to Consider in Diagnostic Reasoning
We believe it is imperative for physical therapists to be as skilled in the process of diagnosis for individuals reporting concerns of activity restrictions for reasons other than pain, as it is when diagnosing individuals reporting concerns of pain. As Landel describes in Chapter 2, it is the responsibility of the physical therapist to encourage individuals to describe what activities are limited as a result of their chief concern. Unlike individuals with pain, however, individuals with neurological diagnoses rarely report problems at the level of body structures and functions as a chief concern. Individuals are not likely to state that they are experiencing ataxia, spasticity, or problems with force production. Rather, these problems manifest as limitations specific to activity or participation in a social context, and these limitations are frequently the chief concern. Regardless of whether activity restrictions are the result of pain or impairments resulting from nervous system pathology, the physical therapist is encouraged to conduct the examination to establish causative pathology and the appropriate plan of care. Determining appropriateness for physical therapy and identifying the primary problems influencing the movement dysfunction are the primary goals of the physical therapy evaluation.
To illustrate the importance of considering nervous system pathology during the process of differential diagnosis, throughout the chapter we will use the example of a 34-year-old Caucasian female schoolteacher whose chief concern involves not being able to reach high enough to effectively write on the chalkboard. Patient interview reveals the individual has experienced this difficulty reaching for the past 3 weeks. Past medical history is unremarkable with the exception of nearsightedness for which the individual wears corrective lenses. The individual states that she has experienced intermittent problems with ...