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Program Development

CLINICAL DECISION-MAKING

A measurement tool is of clinical value when it provides new information and objective evidence for clinical decision-making, thereby directly impacting the treatment plan and resulting in an improved outcome.

In the assessment and treatment of balance disorders, diagnostic tests can be utilized to identify specific pathology. Clinical observational tests can confirm the presence of balance problems. Neither can quantify impairments or functional limitations - assessment data critical to effective treatment planning. This is where computerized assessment protocols designed specifically for the objective quantification of balance and mobility can have a significant impact in clinical decision-making.

The sensory, motor and central integrating systems that maintain balance control are distinct, yet highly interdependent. Technology that provides objective assessments of these individual systems can yield essential data to define the true nature of a patient's balance problem. Without this level of information, the clinical evaluation is incomplete and effective treatment planning is limited.

Most chronic balance problems can be medically stabilized, but seldom cured by surgical and/or pharmacological treatments. Once a patient's medical problems are stabilized, many of the associated functional problems can be reduced or eliminated by rehabilitation treatment. While site-of-lesion information is essential to planning medical treatments, functional information about how the individual patient utilizes sensory information and motor reactions maximizes the effectiveness of rehabilitation by targeting exercises to the patient's specific functional problems.

Clinical outcome studies have demonstrated that management models utilizing treatment strategies customized to each individual patient's impairments are cost-effective and provide better outcomes than models focusing on pathology alone.1-4

NeuroCom®, a division of Natus® Systems enable the clinician to objectively quantify and differentiate a patient's sensory and motor impairments and functional limitations. The concise data obtained in the automated test results not only improves treatment outcome, but also enhances the efficiency of care.

  • Improving Care Outcome: Treatment plans customized to the individual patient's pathology, impairments and functional limitations are more effective and result in better outcomes than generic treatment approaches. Impairment information is essential in the customized planning process because it directs the treatment of patients lacking definitive pathological diagnoses and indicates co-morbidities requiring modified or enhanced treatment plans for patients with pathological diagnoses. Finally, treatment outcomes are objectively demonstrated by documenting changes in impairments and functional limitations.
  • Improving the Efficiency of Care: During the course of treatment, impairment and functional limitation information can more quickly identify the patient who is not improving in accordance with the care plan. In these cases, the information helps define modifications or justifies changing the patient's level of care. This type of progress monitoring is a routine component of customized treatment programs.

NeuroCom Systems Automated Reports

Immediate Biofeedback & Standardized Exercise Protocols

Balance is primarily an involuntary, unconscious activity. As such, highly trained clinicians must monitor patient training activities to assure that patients understand instructions for performing balance exercises and perform the exercises correctly. In the motor learning research and clinical literature, structured exercises with immediate feedback of results have been shown to be effective tools for speeding the learning process through enhancing task understanding and performance accuracy. Furthermore, structured exercises and objective feedback provide the additional benefit of maintaining the patient's motivation and performance accuracy while reducing the level of clinician supervision.

Rehabilitation outcomes are enhanced by motivating patients to exercise as intensively as possible. Immediate feedback information can help clinicians adjust the exercise task difficulty to match the maximum capabilities of the patient. An overly difficult task results in a very low success rate, while a very high success rate indicates that the task is insufficiently challenging.

Technology can also provide standardized training protocols designed to target specific underlying impairments and functional limitations, which can speed recovery by focusing treatment in an efficient and highly effective manner. The difficulty level of the prescribed exercises can also be adjusted to the needs of the individual patient.

Standardized training coupled with immediate biofeedback of performance helps ensure patient compliance, further maximizing treatment. The addition of automated daily training and progress reports enables to the clinician to effectively adjust treatment as the patient improves.

Summary

Applications for precise objective information in clinical management are as diverse as the team and the services they provide. Objective patient data helps to determine and justify the levels and types of services appropriate for individual patients; formulate individualized treatment plans; monitor and adjust plans as necessary; and document outcomes. During rehabilitation exercises, the data can be used to focus patients on appropriate tasks, assure that the tasks are performed correctly, and maintain patient motivation.

The types of information and the complexity and format of presentation vary with the application. NeuroCom Systems provide clear documentation of objective evidence to complete the clinical picture for the individual patient and support the above applications from the initial evaluation through treatment. The clinical value of the information provided by NeuroCom Assessment Protocols has been well documented in the published literature.

The addition of technology, no matter how broad or valid its applications may be, supports rather than replaces the experience and skills of the clinician. It is not a question of either/or, but rather an integration of scientifically and clinically sound "high-tech" and "hands-on" practices that will provide the most value and result in cost-effective management strategies and improved functional outcomes.

References:

  1. Black FO, Angel CR, Pesznecker SC, Gianna C (2000). "Outcome analysis of individualized vestibular rehabilitation protocols." American J Otology 21:543-551.
  2. Calder JH, Jacobson GP (2000). "Acquired bilateral peripheral vestibular system impairment: rehabilitative options and potential outcomes." J American Academy Audiology 11:514-521.
  3. Shepard NT, Telian SA (1996). Practical Management of the Balance Disorder Patient. Singular Publishing Group, Inc., San Diego, 221pp.
  4. Rose D, Clark S (2000). "Can the control of bodily orientation be significantly improved in a group of older adults with a history of falls?" JAGS 48:275-282.