Dr. David Charles Good, Emeritus Professor of Neurology at the Milton S. Hershey Medical Center of the Penn State College of MedicineThe care of patients with neurological disorders is not complete until the patient’s functional ability in all aspects of life has been addressed. Promoting FUNCTION is the major goal of rehabilitation. This includes optimal functioning in the home, community, at work and in social settings. These important aspects of life are sometimes overlooked in traditional medicine, which is focused on the diagnosis and treatment of specific diseases. Neurorehabilitation deals with impaired function that occurs because of neurological illness and injury.
Examples of neurological conditions that often require Neurorehabilitation include stroke, brain injury, spinal cord injury, multiple sclerosis, Parkinson’s disease and other movement disorders, and neuromuscular disorders. Disorders of children are also important, including developmental disorders, cerebral palsy and neuromuscular diseases.
Rehabilitation is very “patient focused” on functional issues unique to the needs of the individual patient. A couple of examples might be useful. A rehabilitation goal for a patient with hemiparesis might be as basic as transferring from the bed to a wheelchair. The same patient might have difficulty with ambulation and a goal might be to ambulate independently to the restroom. A patient may not be able to perform tasks in the same manner as before their neurological condition, but it is important that they learn to accomplish functional tasks as well as possible within the limits of their physical impairments. This usually requires training with a rehabilitation professional (for example a physical or occupational therapist). Teaching compensatory techniques is often necessary. As much independence as possible should always be the goal, but complete independence may not be possible. In that case, training a family member or caregiver to provide assistance may be necessary. The examples above involve physical activity, but other aspects must also be addressed. These include performing basic activities of daily living (for example bathing, dressing and eating), and language and cognitive issues.
In higher income countries, a variety of trained professionals may participate in the rehabilitation program. These may include physical therapists, occupational therapists, speech/language pathologists, neuropsychologists and others, who collectively form a “rehab team.” Unfortunately, the availability of trained rehabilitation professionals and organized rehabilitation programs is often lacking, especially in low and middle income countries. Patients may not get the rehabilitation services they need. The demand for rehabilitation will grow in the future with the aging of the population, longer life expectancy, and an increased incidence of conditions that require rehabilitation, especially stroke.
The WHO 2030 report indicates that there is already a tremendous unmet need for rehabilitation services worldwide. Patients with neurological conditions are one of the most important groups lacking services. This results in family members or untrained personnel trying to provide rehabilitation. A positive development is the widespread availability of cellphones and similar technology. This allows interaction with rehabilitation professionals that would not otherwise be possible. While simple communications devices like cellphones are helpful, they cannot completely substitute for in-person training. There is a tremendous need to train more rehabilitation professionals.
In addition to traditional therapy-based rehabilitation, there are many exciting research developments which may change how Neurorehabilitation is practiced in the future. A few examples of promising new treatments include use of robots, brain stimulation , and cell transplantation.
The World Federation for Neurorehabilitation (WFNR) is an international multidisciplinary organization dedicated to promoting and improving Neurorehabilitation through education, research and advocacy. The WFNR includes 42 national societies, 37 special interest groups (SIG’s) and 3500 individual members. The SIG’s are dedicated to specific topics in Neurorehabilitation, including neuropsychological problems, speech/language disorders, and spasticity. Other SIG’s address socially important issues like driving and community organization of rehabilitation services. Special interest groups address the rehabilitation of specific neurological conditions, such as stroke, brain injury, spinal cord injury, Parkinson’s disease, multiple sclerosis, and others.
The WFNR sponsors a number of educational events including webinars on various topics and a certificate course. The Flying Faculty is a unique program in which rehabilitation experts travel to low and middle income countries to educate and train individuals in rehabilitation theory and practical techniques.
The WFNR is a dynamic organization which is celebrating its 25th anniversary in 2021. The WFNR is proud to be a partner in OneNeurology.
In summary, Neurorehabilitation promotes maximum function and independence in all aspects of life in patients with neurological illness or injury. Neurorehabilitation improves quality of life for patients and their families. Unfortunately, there is a great unmet need for rehabilitation services, which will likely grow in the future. Advocacy to obtain support from governments and social agencies is critical. Organized neurology needs to join in the efforts to promote Neurorehabilitation. Our patients deserve the maximum function and independence possible, and a good quality of life.
Dr. David Charles Good is Emeritus Professor of Neurology at the Milton S. Hershey Medical Center of the Penn State College of Medicine. He was the founding Chair of the Department of Neurology and served in that role for 12 years. Dr. Good received his MD degree from the University of Wisconsin at Madison and subsequently completed his Neurology residency and stroke fellowship at the University of Minnesota Hospitals.
Dr. Good is a thought leader in the field of Neurorehabilitation. He has served as a consultant or advisor to a number of organizations, including the National Institutes of Health, the Food and Drug Administration and the National Multiple Sclerosis Society. He has served on a number of national study sections, and has held leadership positions in a variety of organizations, including the American Society of Neurorehabilitation, the American Academy of Neurology, and the United Council for Neurologic Subspecialties. He is currently President of the World Federation for Neurorehabilitation.
Dr. Good is author or co-author of numerous journal articles, book chapters, and has edited three books. His research focuses on stroke recovery, particularly techniques to enhance motor recovery. Dr. Good is an accomplished teacher and has received a number of teaching awards. Dr. Good is frequently invited to speak nationally and internationally on topics related to Neurorehabilitation.
