Neurological Rehabilitation

What is neurological rehabilitation?

Neurological rehabilitation is a special form of general rehabilitation or follow-up treatment. Medical rehabilitation means coordinated and occupation group comprehensive treatment to cope with the consequences of illness. Neurological rehabilitation in particular deals with patients who suffer from disorders or diseases of the peripheral or central nervous system.

In the course of neurological diseases, the affected patients can acutely or insidiously lose skills such as mobility, communication, or personal hygiene, and cognition. Since these skills are essential for independent and self-determined participation in the life, it is essential to improve and, if possible, regain these skills in order to maintain the quality of life - this is often possible with the help of neurological rehabilitation techniques.

Patients who can benefit from good neurological rehabilitation are those affected by acute incidents, such as strokes (apoplexy), slipped discs, brain hemorrhages (e.g. brain aneurysms), or craniocerebral trauma, but also by chronic diseases such as polyneuropathy, Parkinson's disease, epilepsy, multiple sclerosis, brain tumors (e.g. glioblastoma), or chronic pain.

Neurological rehabilitation is becoming increasingly important due to the further increasing number of patients and the constant progress of therapeutic procedures.

What treatments can be expected in a neurological rehabilitation?

Every therapy in the course of neurological rehabilitation, whether an outpatient or inpatient treatment, is directly adapted to the patients’ needs and limitations. Consequently, direct patient contact with exact communication of the patients' wishes and concerns and the realizable possibilities and goals from the therapists' side has the highest priority in order to establish a common therapeutic goal at an early stage. In most cases, the patient's relatives are also involved in therapy planning, in order to also realize and support the social structure around the patients in the best possible way. Targeted neurological diagnostics are carried out in order to record the patient's deficits as accurately as possible before the therapies begin.

The therapy plan usually consists of various elements of physiotherapy, occupational therapy, speech therapy, and other individual treatments. There are different and versatile therapy concepts that are currently used in neurological rehabilitation, e.g. the Bobath concept, proprioceptive neuromuscular facilitation (PNF), treadmill training, neuromuscular electrostimulation (NMES), or equipment-supported motoric rehabilitation. In addition to physiotherapy, occupational therapy, and speech therapy, there are numerous other therapeutic approaches to support the neurological patients, such as dance therapy, music therapy, art therapy, and also supporting individual health and body awareness. Psychotherapy is also a central component in rehabilitating patients since neurological diseases often mean severe limitations for the affected patients. The therapies are offered in individual settings or in groups, depending on the patients’ needs.

The central goals of neurological rehabilitation include, among others, passive and active mobilization, supporting sensory and motor skills, developing sensory perception and supporting swallowing, speaking, and writing skills.

Requirements for a stay in a neurological rehabilitation clinic

Every year, about 260,000 people in Germany suffer a stroke. About 80% of these patients have sensorimotor deficits and in about two-thirds of the patients, the motor function is disturbed in the beginning. 270,000 people suffer craniocerebral trauma and another 400,000 people develop other neurological diseases and damage to the nervous system. Beyond that, approximately 800,000 people in Germany have a severe disability or chronic disease of the nervous system. Every patient with neurological disabilities has the right to a self-determined life, maintaining earning capacity, and avoiding or reducing the need for high maintenance care.

The majority of these patients who show late effects after acute or chronic neurological diseases or those, whose functional ability in everyday life has not yet been fully regained, benefit from neurological rehabilitation.

The need and associated therapies always depend on the individual case, since each neurological disease can be differently developed in the patients and their wishes and needs always depend on their life situation (age, social environment, work, activity status, etc.).

The acute phase of neurological diseases usually takes place as inpatient treatment in clinics and after completion of the acute therapies, patients are referred to the neurological rehabilitation clinics. The patients can either start rehabilitation immediately after their inpatient stay or after a phase at home. A transition, as smooth as possible, in order to maintain and continue the best possible progress of the therapy, is especially advisable in case of acute illnesses such as strokes, cerebral hemorrhages, or herniated discs. The earlier and more consistently rehabilitation begins, the higher is the probability of success. Scientific studies have shown that the functional ability of the arm after a stroke a few weeks after the acute event is associated with the severity of the disability after six months. A therapy as early as possible can improve the long-term outcome. Most of the functionally significant recovery is usually completed three to six months after a stroke.

In general, neurological rehabilitation can be carried out in outpatient or inpatient settings. This depends on the individual situation of the patient. The early stages of rehabilitation are usually carried out in inpatient settings. If the patient's independence is well restored and the mobility of the affected patient allows it, the therapies can easily be completed in outpatient settings from home.

Phases of rehabilitation

Since 1995, a classification of rehabilitation into phases A to G has become established in medicine. The classification into phases is based on the patients’ severity of the illness and their need for care and support. Depending on their specialization, the rehabilitation clinics take care of different rehabilitation phases.

• Phase A: acute treatment of the illness in the clinic
• Phase B: early rehabilitation with intensive medical care - the patients are usually bedridden and suffer a disorder of conscious up to a stage of being unconscious
• Phase C: advanced rehabilitation – the patient is mobile and consciously takes part in various therapy units, but the patient is still under curative medical care and requires a high level of care
• Phase D: follow-up treatment – the patient can independently carry out basic tasks in the daily routine, copes with everyday life mostly on his own
• Phase E: follow-up care and job-related rehabilitation - the aim of transition from medical rehabilitation to earning capacity and sustainable assurance of rehabilitation success
• Phase F: activating long-term care - for patients with remaining impairments of ability and an unchanged high need for care, e.g. persistent vegetative state
• Phase G: assisted/attending living

Aims of neurorehabilitation

Neurorehabilitation supports the special ability of the human nervous system to reorganize itself after irreversible damage and to adapt its functions accordingly. The therapeutic applications activate and optimize the plasticity of the nervous system and the compensatory capacity of the brain.

Increasing the quality of life and independence of the affected patients is the first and foremost aim of rehabilitation. Depending on the disease, patients may not be able to regain their previous abilities, such as aid-free walking or error-free speech, despite intensive rehabilitation. However, it is usually always possible to improve these abilities in order to enable the affected patients to better participate in social and professional life.

In the context of neurological rehabilitation, multidisciplinary work is always necessary, since the success of the therapies must also reflect in the concrete work and everyday environment.

Above all, planning a preferably individual supply chain and its transition, a real orientation towards self-determination of the affected ones, and respect for the right to participate in social life represent high challenges in neurological patients. Improving therapy procedures and the development of even better networks allow the modern neurological rehabilitation clinics the realization.

Which rehabilitation clinics are specialized in neurological rehabilitation?

One of the leading clinics for neurological rehabilitation is cereneo in Switzerland, directed by our specialist Prof. Andreas R. Luft, MD.

Sources

• www.bv-neurologe.de/themen-bdn/rehabilitation-bdn (status October 16, 2019)
• www.dgnr.de (status October 16, 2019)