Thursday, August 16, 2012
Should PTs Train for Compensation or Recovery?
There is much debate in clinical circles regarding whether physical therapy interventions should focus on teaching people with disability to do whatever is required to accomplish a task (compensation) versus promoting the neuroplasticity needed to activate the neuromuscular system in a way that allows the task to be accomplished as
non-disabled person would do it. In the short term, teaching
compensatory strategies is the fast, cheap way to get a person to a level of independent function. There are several drawbacks to this approach however. Among the drawbacks is that, as compensatory strategies become habits, they are difficult to unlearn as all learning, even that associated with compensatory strategies, is accompanied by neuroplasticity changes that make it more difficult to “unlearn” these strategies. Another drawback is that compensatory
approaches are less efficient in the long term as the strategies are often inflexible, such that they cannot be generalized to other tasks. As an example, a person with deficits of hand function might use a compensatory strategy of sliding a card to the edge of the table in order to pick it up, rather than using a more typical pinch grasp. The compensatory strategy, while fine for picking up a card, cannot be transferred to turning the pages of a book. On the other hand, one might argue that in the early stages after stroke or spinal cord injury, the nervous system is not ready to learn recovery-based approaches, and therefore, given the need to prepare for discharge, it is necessary to teach compensatory strategies