Neurorehabilitation

Around the middle of the 1900s, the general consensus in the neuroscience community has shifted to accept that the brain was a dynamic organ even after injury or disease, capable of reorganization and with regenerative potential.

Neurorehabilitation is broadly based on research that has shown the brain to be malleable i.e, capable of recuperating or adjusting its function post injury or due to environmental changes.This includes neural regeneration, neural repair and strengthening synaptic connections, which are all generally referred to as the ‘neuroplasticity’ of the brain. Research in neuroplasticity has increased our understanding of the neurological bases of functional deterioration or dysfunctions which are responsible for behaviourally expressed impairments that we observe in patients. Therefore, therapies based on the principle of neuroplasticity aim to deal with the fundamental neurological impairments, with comprehending the intrinsic plasticity processes present in the brain and using this knowledge to design treatments that more targeted to the ‘root’ causes.

What Kind of Therapies Are Available During Neurorehabilitation?

Neurorehabilitation includes a variety of therapies and a treatment plan is developed that is tailored to every individual patient’s needs. It requires the combined effort of doctors, nurses and a team of specialized therapists to provide a patient with neurorehabilitation.

Some of the therapies involved in a neurorehabilitation program are as follows:

• Physical therapy: Involves techniques/exercises that help boost mobility, muscle strength, gait and general aspects of body movements.

• Occupational therapy: Is concerned with providing support for daily life activities such as dressing, eating, using the bathroom amongst others. Occupational therapists also advise patients on using adaptive equipment.

• Psychological therapy/counselling: Psychological therapy or counselling is necessary for dealing with depression or stress that comes with having any illness.

• Speech and language therapy: Is helpful when a patient has difficult with articulating words, with stuttering or related issues, voice quality, processing language or expressing themselves. Vision therapy: This therapy is useful for patients with visual abnormalities such as problems with eye movement, accommodative and vergence dysfunction.

• Brain stimulation: Research involving methods such as transcranial direct current stimulation (tDCS) or transcranial magnetic stimulation (TMS) is being carried out, mostly focusing on restoring motor function.

• Neuropsychological/cognitive rehabilitation therapy: These therapies focus on improving neurocognitive functions such as attention, emotions, memory and executive functions.

• Nutrition counselling: To provide patients with dietary advice to help cope with their current conditions, or side effects that have been caused due to the medication they’re taking.

• Pain management: For helping patients manage acute or chronic pain that is a part of one/more illnesses that require neurorehabilitation.

What Should I Expect?

As mentioned earlier, neurorehabilitation is a collaborative effort and involves a large team of a range of specialists from fields such as psychology, physical therapy, social work, neurology and more. Rehabilitation deals not just with the physical aspect of the illness, but the psycho-social consequences related to it as well. It is important to keep in mind that process is done by the patient, with help from the rehabilitation team. The main aims of the rehabilitation are to reduce the disability, acquiring new skills that will help a patient to adapt and lastly adapting the environment around the patient to make it accessible.

During the course of your rehabilitation, there will be a number of measures that will assess the progress of your recovery, these can be specific to more short term outcomes and can involve short questionnaires or short physical tests. Functional magnetic resonance imaging and related neuroimaging techniques are used for assessing long time results and observing the effects of different interventions on different kinds of patients.

Here are a few things to be aware of:

• Your family and friends will play a vital role in the entire rehabilitation process.

• Establishing goals is an integral part of your neurorehabilitation procedure. Long term goals, broken down into more specific short term aims is helpful. The patients themselves play a key role in deciding their treatment plan.

• Even though most rehabilitation procedures are directed at patients with recoverable conditions, patients with steadily progressive diseases will benefit from a reduction in signs and symptoms of the illness.

• Lastly, do not lose heart whilst progressing towards your goals. There are bound to be ups and downs, as is part of any rehabilitation. Rigid goals are not the appropriate way to approach a recovery, your goals should be adjustable.

In the future, neuroplasticity-based approaches will be the treatment of choice. Advances in neuroimaging techniques as well as machine learning-based approaches will refine the current neurorehabilitation therapies, and help make better individualised plans for patients and consequently ensure the best possible recovery.