PURPOSE: This study compares a new protocol, the Cortico-subcortical
Relay approach, in rehabilitation with the traditional concepts.
The Cortico-subcortical Relay study identifies the neurological
lesion but with a focus on pathway damage. Therapy involves deploying
substitution pathways. Pathways are critically analysed to determine
if their stimulation or inhibition is beneficial. Integrating the
right pathway with proper stimulation methods is the key.
RELEVANCE: The Cortico-subcortical approach is specific to
the individual patient in contrast to the general approach in traditional
therapy. It is more correctly the designer approach in therapeutics.
The difference in outcomes is highly significant both in the degree
of recovery and the quickness of response. Although greater expertise
is necessary to employ this approach, there are sufficient reasons
to change from the older approach the new Cortico-subcortical concept
globally.
DESCRIPTION: Cases are both neurological and orthopedic.
Orthopedic appliances used cater to the stimulus approach rather
than the conventional supportive aim alone. Thus it is a more neuro-orthopedic
angle with dynamic orthoses. It has been analysed from the neuro-anatomical
perspective with future rehabilitation methodology in mind. Various
cases are presented to support the above theory.
OBSERVATIONS: The immediate response and the quick and effective
results indicate that the affected pathway has been targeted correctly
and the bypass or parallel pathway found is effective in bringing
about functional recovery. CONCLUSIONS: Thus the
cortico-subcortical relay theory proves its efficacy in rehabilitation
mangement by showing that no two patients are identical, even with
similar lesions and therefore use of identical therapeutic techniques
is outdated and ineffective. Thus a tailor-made approach is more
suitable to bring about the desired results.The use of neuroanatomical
pathways repeatedly in mangement the author owes to Alf Brodal.
This above study and clinical application of the same is the future
horizon, India in the World. A number of short-term and year long
courses in this direction have already proved the efficacy and popularity
in India and abroad and thus the place if India in the scientific
world.
A book on this subject titled CSR Circle-a designor approach
in musculoskeletal dysfunction based on Cortico-subcortical
relay studies a neuroanatomical approach by Dr. Nandu Chhabria,
P.T., Honorary Director Rehab Sciences, Sir H.N. Hospital and Research
Centre, Mumbai India, paves a way for quality care a step ahead..
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