The Course is proposing an update on the concepts of “central” vs. “peripheral” motor impairments, and highlights the role of sensory systems (proprioceptive, vestibular, and visual) from the standpoint of their impact on voluntary movement and balance. Peripheral neuropathies (which can be motor, sensory or both) are not dealt with exclusively yet, they are considered as examples of nervous diseases leading to motor impairments through the disruption of the sensory-motor concert. Issues such as pain and vegetative disorders are not covered. Some useful hints for bedside and instrumental detection of sensory-motor impairments, coming for physiatric experience, are provided. Some related, emerging concepts in Rehabilitation Medicine are illustrated.
Part A -Voluntary movement
- The legacy of the Belle Epoque: disentagling central (control) from peripheral (execution) impairment.
- Synopsis of central vs.peripheral motor signs.
PART 2 – Sensation in sensory-motor interaction
- Posture & balance, strength, skill
- Update on Anticipatory Postural Actions (APAs): the Big Brother behind will and reflexes.
- The need for on-line sensory upgrade.
- APA’s impairments behind weakness and ataxia
- Sensory redundancy, sensory conflicts.
- The dominant role of spindle-based proprioception. Muscle spindles are muscle.
PART 3- Clinical hints
- Somatoform deficits revealed by absent APA’s
- Sensory deficits unmasked by movements: beyond finger-nose and heel-knee manoeuvres.
- Some simple, bedside diagnostic “tricks”
- Sensory impairment and gait
- Assigning weight to sensory systems: The Sensory Organisation Test (Equitest™ balance platform)
Part 4 – Peripheral neuropathies and rehabilitation: some hints
- Rehabilitation goals: intrinsic recovery
- The “learned non-use” and the “forced-use” principles: from the deafferentation Sherrington’s model to a generalised application across sensory systems and body sides.
- Sensory substitution: biofeedback
- Sensory conflicts: mirror training, muscle vibration…and other.
- Rehabilitation goal: adaptive recovery
The last ditch defense: orthotics and prosthetics in peripheral neuropathies
tel.+ 39 040 368 343