Abstract
The paper overviews physiologic efficiencies to provide justification for moving away from a medical model of rehabilitation using a binary conceptualization of impairment and moving towards a linear model of optimization and human efficiencies. While the clinical and neuropathological evaluation of neurological compromise has traditionally concentrated upon the focal distribution of brain disease, ignored have been the changes in the complex connections linking brain areas crucial for cognition and optimized human performance. The paper reviews the nature of nervous system plasticity, from a systems standpoint using language development and bilingualism as well as music and the brain as examples of optimized network functioning.
Highlights
We possess as neurological adults, a high degree of localization of function, with over 150 years since Broca, we still subscribe to the notion consistent with the model that dysfunction or damage to specific regions of the brain and nervous system should result in specific damage and deficits in the behavior and function of individuals
That is not enough to explain the capacity for plasticity, regeneration, spontaneous recovery, and optimization in neurological terms and certainly not in its translation in clinical rehabilitation
Among the difficulties we face in the application of rehabilitation science in practice is less the need to understand how the nervous system functions, but rather how it recovers from dysfunction, how can we effectively evaluate function, dysfunction and recovery, and a how to provide a rational basis for making economic decisions about in which method or methodology to invest
Summary
We possess as neurological adults, a high degree of localization of function, with over 150 years since Broca, we still subscribe to the notion consistent with the model that dysfunction or damage to specific regions of the brain and nervous system should result in specific damage and deficits in the behavior and function of individuals. We can see retained function in some areas and dysfunction in others that would normally be combined in the neurologically intact adult, such as in alexia without agraphia and with a color-naming deficit In such a case, an individual could not read, but could write, but could not read what he or she had written (for a further description, see [1,2]). The function of early development is training to be able to integrate what should normally be independent reflex-based processes into meaningful systems with those systems being less reliant on specific brain regions for their control and more so on the networks that are created to optimize the processes for effective performance
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