Maximizing functional recovery.

To the Editor: I read with great interest and pleasure the recent Update by Amy Bastian entitled "Mechanisms of Ataxia" Uune 1997), and I would like to pose a philosophical question and express a personal point to the author and the readers of the article. In her summary, Dr Bastian stated, "...it could be reasoned that treatments focusing on strategies to reduce the complexity of a movement by minimizing the number of moving joints or by stabilizing against the inertial effects of limb movement will improve movement." My question is: When examining a patient with ataxia during those early months of rehabilitation (a patient who does those compensations anyway, without our "help"), should we be satisfied, or should we try to utilize the patient's remaining potential to maximize the plasticity of the central nervous system? Elia Panturin makes an important point about neurorehabilitation today. It is essential to understand when efforts to restore normal function will be feasible and when the therapist should begin to teach new compensatory strategies. There rnav be some cases of cerebellar damage where restoration of' normal function is feasible. For example, there may be instances in which the extent of cerebellar damage is very small and localized to the cerebellar cortex. In these cases, clinical experience has shown that many people have the potential to regain a fairly normal pattern of movement.! On purely theoretical grounds, this recovery of function could be due to neighboring regions of the cerebellar cortex taking over the function of the damaged cortex (although this has never been experimentally demonstrated). These types of lesions, however, may not cause enough movement deficits that are consequenIt seems to me that the aim of rehabilitial enough to drive people to seek tation is to offer the patient the maxiclinical care. mum opportunity possible to return to In many cases of cerebellar damage, his or her former functions. Therefore, there are several reasons why cornpenI believe that the therapist should not sation different movement stratestart with compensations but instead gies may ie the best treatment. In should teach of movement' instances in which a large region of the have the patient practice dynamic stacerebellum is damaged, it is unclear b i l i t ~ t and add various pr0prioceptivewhether other reeions can take over the stimuli (such as approximation of " function of the damaged region. The movement). Elln Panlunn, PT S~nzor Instruct07 IBITAH (Internatzonal Bohath Instructor) School of Pltyszotherapy School of Medzczne TPI Auz~) Unzuerszty POB 10483