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Principles of neurological rehabilitation 

Principles of neurological rehabilitation

Chapter:
Principles of neurological rehabilitation
Author(s):

Michael Donaghy

DOI:
10.1093/med/9780198569381.003.0160
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date: 23 April 2017

Neurology has an undeserved reputation for being a speciality where diagnosis requires great intellectual effort, although from which little therapeutic intervention flows. The reader will form their own opinion about the difficulty of making diagnoses, but now neurological rehabilitation can offer all patients great help subsequently. Other chapters discuss the roles of specific medical and surgical treatments in transforming neurological patients’ lives; this chapter discusses the role of neurological rehabilitation in focusing primarily on reducing limitations on patient activities rather than by detailing the specific nature of these individual interventions.

Neurological rehabilitation can be defined as a process that aims to optimize a person’s participation in society and sense of well-being. This definition highlights several important features: rehabilitation is not a particular type of intervention; the focus is on the patient as a person; the goals relate to social functioning, as well as health or well-being; it is not a process restricted to patients who may recover, partially or completely, but applies to all patients left with long-term problems. The contrast to traditional neurology is in the broader scope, extending well away from the underlying pathology but always being fully informed by the paramount importance of the primary diagnosis.

This chapter will start by giving a fuller description of rehabilitation in terms of structure, represented by the resources needed, process, consisting of what happens, and outcome, defined by the goals. Subsequently the general evidence supporting neurological rehabilitation as a process is reviewed. It is not practicable to review the wide range of high class randomized controlled trial evidence investigating different and detailed aspects of the process. Some specific diseases and specific clinical problems are considered in Section 6.4.

Neurological rehabilitation has a sound theoretical and conceptual basis derived from the World Health Organisation’s International Classification of Functioning, the WHO ICF (Wade and Halligan 2004) and from a general problem-solving approach (Wade 2005). There is strong evidence supporting its effectiveness as a process, and reasonable evidence in support of some specific treatments. The approach of neurological rehabilitation extends the intellectual challenge of neurology; in most clinical situations the physician and the wider rehabilitation team have to make pragmatic decisions based on incomplete information concerning many important factors.

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