TOWARD PEACEFUL COEXISTENCE OF ADAPTIVE CENTRAL STRATEGIES AND MEDICAL PROFESSIONALS

We start with a number of philosophical and theoretical issues related to motor control, proceed through a spectrum of problems related to t he role of adaptive changes in the central nervous system (CNS) in res ponse to a primary disorder, and end with tentative practical recommen dations. We consider the hierarchical and dynamic approaches to motor control not as incompatible alternatives but as ways of approaching tw o equally important issues, those of control and coordination. Profess ionals working in the area of physical therapy and rehabilitation shou ld make use of the adaptive abilities of the CNS, identify goals, prov ide tools, and allow the CNS to develop optimal strategies. Therapists should intervene if they suspect that the CNS settles down in a local rather than a global optimum because of such factors as pain or the l ack of a long-term predictive ability. Adaptive changes within the CNS may be important not only in pathologies but also in cases of special ized training, normal growth, and normal ageing.