Rehabilitation

Rehabilitation




Introduction


Neurological disease may result in chronic neurological deficit, and this accounts for a substantial burden of morbidity in the community. Some disabling diseases are particularly likely to affect young individuals, for example trauma, multiple sclerosis and cerebral palsy. The disability may be stable and long term or slowly progressive in these patients. Severe physical disability affects 420 000 people between the ages of 16 and 59 years in the UK, which is 0.75% of the total population.


Neurological rehabilitation is aimed at optimizing the level of function of the patient within his or her usual environment. This includes maximizing physical ability, preventing deterioration due to secondary disease, optimizing the patient’s environment, facilitating psychological adaptation to disability and encouraging social integration (Fig. 1). All these facets need to be assessed in providing the most appropriate support. Most of the burden of caring for the disabled falls on their families and the rehabilitation process involves training relatives and providing them with practical, emotional and psychological support.


image

Fig. 1 Reduction of handicaps by different interventions. These strategies are used concurrently rather than sequentially.



Impairment, disability and handicap


Neurological impairment, disability and handicap are key concepts in rehabilitation. Neurological impairment is a disturbance of the nervous system that results in an abnormality of function. It may occur at any level of the nervous system causing:


image intellectual or emotional impairments

image sensory or motor impairments.

Impairment causes disability if there is difficulty performing tasks that are normal for a human being. Disability causes handicap if the patient is unable to continue performing his or her normal role as a result of disability. For example, an attack of multiple sclerosis may cause leg weakness. This causes a disability if the patient can only walk short distances. If the patient is a postman, this causes a handicap, as he cannot perform his job, but if his occupation is sedentary, it may not result in the same level of handicap.



Recovery in the nervous system



Neurological recovery


Neurological regeneration may occur after damage, especially in the peripheral nerves. The type of disease is important in this regard; there is usually full recovery after classical demyelinating Guillain–Barré syndrome, but more frequently incomplete recovery after the rarer axonal variant. In the central nervous system, there is less scope for regeneration, but recovery may still occur. Two main factors contribute:


1. The initial pathological process may subside, e.g. reduction of inflammation in multiple sclerosis.

2. Plasticity effects. The central nervous system has less scope for recovery than the peripheral nervous system.


Predictors of neurological recovery


The nature of the disease and its treatment is the first important predictor. Demyelination is usually followed by more recovery than infarction, because axons are preserved. Severe brain trauma typically affects multiple sites and recovery may be slow. If there is a progressive disease, for example a tumour, then recovery will be determined by the success of treatment.

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Jun 10, 2016 | Posted by in NEUROLOGY | Comments Off on Rehabilitation

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