What is neurological rehabilitation?

10/25/2016
Neurolog. Rehazentrum Rosenhügel | Ganganalyse | credit Andreas Leo Wallner

The goal of rehabilitation in case of nervous system diseases is likewise to restore the function of the nervous system as much as possible, to optimize everyday activities, and to achieve social participation to the highest degree possible.

In modern rehabilitation approaches, this process is based on the notion of “neuroplasticity”. In physiology, plasticity means a change in the central nervous system due to information (stimuli). The brain is not “hardwired”, but changes throughout life due to experiences and impressions; new connections are formed continuously between neurons – we learn. This learning or relearning is the central object of rehabilitation, even many years after e.g. a stroke.

How does rehabilitation work?

Rehabilitation aims to restore health in the best possible manner after the onset of neurological disorders (such as multiple sclerosis, Parkinson’s disease) or after a stroke The goal is to restore the patient’s independence as much as possible. A rehabilitation team creates an individual treatment plan for each patient. After an initial examination, personal goals are defined. A rehabilitation stay usually lasts four weeks. During this time, the patient will receive at least two to three hours of therapy per day.

Phase model of neurological rehabilitation

Neurological rehabilitation consists of 7 phases: They are based on the severity of the neurological injuries and their symptoms. They are measured e.g. using the so-called Barthel Index, which measures independence in everyday life. The phase in which the patient is determines the treatment.

  • Phase A – Acute Treatment: Intensive care unit
  • Phase B – Early Rehabilitation: The patient’s consciousness is usually still severely impaired. Intensive care treatment options are still needed. Rehabilitative measures are intended to improve the state of consciousness. Inclusion criteria: Permanent ventilation is no longer required, circulation is stable, injuries have been treated, no intracranial pressure.
  • Phase C – Further Rehabilitation: The patient can already actively participate in the therapy, but still needs to be cared for with high nursing effort. The rehabilitation aims at partial mobilization.
  • Phase D – Medical Rehabilitation: Starts after completion of the early mobilization and represents medical rehabilitation in the traditional sense.
  • Phase E – Secondary Rehabilitation: This is mostly about professional, social, and domestic reintegration. The treatment results are to be maintained.
  • Phase F – Activating Rehabilitation: Activating treatment care for patients in a vegetative state.
  • Phase G – Assisted and Accompanying Living: The patient is assisted in finding his way back to an independent life – helping people to help themselves.

In which conditions is neurological rehabilitation an option?

  • Stroke
  • Cerebral hemorrhages
  • Parkinson’s and related diseases
  • Multiple sclerosis
  • Inflammatory disease of the brain and spinal cord
  • Benign tumors
  • Atypical degenerative brain diseases
  • Craniocerebral trauma
  • Disc herniations
  • Polyneuropathy and polyradiculitides (e.g. Guillain-Barré syndrome)
  • Myopathies
  • After cerebrovascular surgery

What new technical treatment options are there?

In addition to the established forms of therapy, such as physiotherapy, occupational therapy, speech therapy, massage therapy and psychology, there are several new technologies available:

  • Transcranial electrostimulation: This refers to the stimulation of the central nervous system by externally applied electric fields. How does this work? Barely perceptible electric currents are passed through the skin by means of electrodes attached to the front and back of the head and support the cerebral metabolism.
  • As a matter of principle, electrotherapy can be used to improve muscle function, to alleviate pain or to improve perfusion. Muscle stimulation also stimulates sensors that in turn activate the function of the central nervous system.
  • Functional electrical stimulation: This refers to the stimulation of the muscles at a precisely tuned time to support complex movements.How does this work? With the help of attached electrodes, the control of a paralyzed nerve is stimulated with slight electrical impulses – the muscle thus moves again. The timing of the stimulation is controlled by motion sensors.
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  • Neurofeedback: If various neural pathways (information pathways) have been completely and irreversibly destroyed, a “bypass” is used to transfer the information either from the brain to the periphery or from the periphery to the brain.    
  • How does this work? Brain-computer interfaces are based on the realization that even imagining a behavior already causes measurable changes in the electrical activity of the brain. For example, imagining moving a hand activates the corresponding motor cortex area. During therapy, both the computer and the human being learn which changes in brain activity are associated with specific ideas, and thus the movements become more and more accurate.
  • Another further possibility is a “brain-computer interface” (BCI): This “brain-computer interface” is a special device that allows communication between the brain and a computer without activating the peripheral nervous system. Here the electrical activity of the central nervous system is registered (via EEG or implanted electrodes) and converted, by a computer, into movement. This can be achieved, for example, by electrical stimulation of the patient’s own muscles, but alternatively also via external motors e.g. driving a wheelchair or moving prostheses.
  • How does this work? EEG electrodes are applied to the patient’s head. With the help of EEG measurement, cerebral activity is visualized. Via a screen, the patient is given an audiovisual feedback that feeds back changes in cerebral activity. By selecting the electrode positions and the software, the therapeutic effect is controlled.
  • Neurofeedback is a specialized form of biofeedback (EEG biofeedback). Here activities of the periphery (e.g. muscle activity) are registered, optically and / or acoustically displayed, and thus passed via the eye or ear into the central nervous system.

Who is in charge of the neurological rehab?

Neurological rehabilitation requires a transdisciplinary team. This comprises not just physicians and social workers, but also e.g. bioengineers and computer scientists. During its work, the team has to take into account the changes occurring over the course of the disease process.

Modern rehabilitation should follow a “3T” approach. This means Treatment – Technology – Translationality (development). Treatment and technology must be interconnected; developments should take place in parallel.

Unfortunately, modern technologies in neurological rehabilitation are no panacea. However, they open the possibility of individual and thus personalized rehabilitation. Each neurological disorder must be considered as an individual, patient-related process in order to enable the patient to get the best possible therapy.

Sources:

Deutsche Gesellschaft für Neurologie [German Society of Neurology]: Multiprofessionelle neurologische Rehabilitation [Multiprofessional neurological rehabilitation]; AWMF registration number: 030/122; as of: September 2012; Valid until: 31-DEC-2016

Österreichische Gesellschaft für Neurorehabilitation [Austrian Society for Neurorehabilitation]: Phaseneinteilung neurologischer Krankheitsprozesse [Staging of neurological disease processes] at http://www.neuroreha.at/phasenmodell.html Most recently retrieved on: 13-SEP-2016

Backup by Univ. Doz. Dr. Thomas Bochdansky: Was ist neurologische Rehabilitation? [What is neurological rehabilitation?]

 

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AUTHOR

Univ. Doz. Dr. Thomas Bochdansky formerly VAMED - Chief Medical Director

Richard Strauss Straße 12 1230 Wien
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