The Geriatric Patient with Central Nervous System Dysfunction

Abstract

The clinical manifestations of central nervous system dysfunction (CNS) in geriatric patients present a serious challenge to all health care providers. As professionals knowledgeable in the neurophysiological basis of CNS dysfunction, physical and occupational therapists have a unique responsibility to upgrade the quality of rehabilitation services provided to the severely disabled elderly. Although the most well known neurophysiological approaches utilized by therapists have traditionally been applied to children with developmental disabilities, these therapeutic approaches can be effectively adapted to the geriatric patient with CNS dysfunction. In this article, Rood's sensorimotor approach, based upon neurophysiological and developmental concepts, is applied to sensorimotor problems commonly encountered by therapists in geriatric patients: poor weight bearing function, abnormal postures and movements, and flexor tightness leading to contracture. Intervention strategies are developed from the tonic/phasic differentiation of skeletal muscle and from mobility/stability concepts within Rood's four levels of sensorimotor development. This author proposes that many sensorimotor problems of geriatric patients with CNS dysfunction are the result of a poorly functioning tonic system is considered, and activities facilitatory to tonic, stabilizing functions are reviewed.