This book provides a comprehensive introduction to the basic concepts of neurology, specific neurological conditions, and the related physical therapy treatment approaches used in rehabilitation. It brings together contributions from an experienced, multidisciplinary team of clinicians in the field of neurological rehabilitation, ensuring the reader will come away with practical knowledge of work being done in the field. Well-researched, fully referenced, and clinically up to date, this text is a good introduction for students as well as a helpful reference for practicing physical therapists. This research-based text includes extensive scientific references and case histories, covering a wide array of important topics. Thorough definitions of neurological conditions provide a strong base for all future learning. Information on the etiology, prevalence, incidence, and epidemiology of these conditions prepares the reader for future practice. Coverage of anatomy and physiology, diagnostic and clinical signs, and assessment and outcome of each condition offers the most expansive coverage available. Material on medical and physical management, as well as multidisciplinary team work, gives the reader a practical explanation of how to deal with a variety of real-life situations. Content on relationships with patients provides the reader with a method of setting goals for their patients and themselves. Background information on physiology and physical therapy presents a clear link between the two areas.
The central tenet of this innovative collection is that identity can be regarded as a performance, achieved through and in dialogue with others. The authors show that where neuro-degenerative disease restricts movement, communication and thought processes and impairs the sense of self, music therapy is an effective intervention in neurological rehabilitation, successfully restoring the performance of identity within which clients can recognise themselves. It can also aid rehabilitation of clients affected by dementia, traumatic brain injury, and multiple sclerosis, among other neuro-generative diseases. Music Therapy and Neurological Rehabilitation is an authoritative and comprehensive text that will be of interest to practising music therapists, students and academics in the field.
Neurological Rehabilitation is the latest volume in the definitive Handbook of Clinical Neurology series. It is the first time that this increasing important subject has been included in the series and this reflects the growing interest and quality of scientific data on topics around neural recovery and the practical applications of new research. The volume will appeal to clinicians from both neurological and rehabilitation backgrounds and contains topics of interest to all members of the multidisciplinary clinical team as well as the neuroscience community. The volume is divided into five key sections. The first is a summary of current research on neural repair, recovery and plasticity. The authors have kept the topics readable for a non-scientific audience and focused on the aspects of basic neuroscience that should be most relevant to clinical practice. The next section covers the basic principles of neurorehabilitation, including excellent chapters on learning and skill acquisition, outcome measurement and functional neuroimaging. The key clinical section comes next and includes updates and reviews on the management of the main neurological disabling physical problems, such as spasticity, pain, sexual functioning and dysphagia. Cognitive, emotional and behavioural problems are just as important and are covered in the next section, with excellent chapters, for example, on memory and management of executive dysfunction. The final part draws the sections on symptom management together by discussing the individual diseases that are most commonly seen in neurorehabilitation and providing an overview of the management of the disability associated with those disorders. The volume is a definitive review of current neurorehabilitation practice and will be valuable to a wide range of clinicians and scientists working in this rapidly developing field. A volume in the Handbook of Clinical Neurology series, which has an unparalleled reputation as the world's most comprehensive source of information in neurology International list of contributors including the leading workers in the field Describes the advances which have occurred in clinical neurology and the neurosciences, their impact on the understanding of neurological disorders and on patient care
The clinical trial is essential to testing efficacy and effectiveness of therapeutic interventions. Neurorehabilitation presents unique challenges in the execution of clinical trials due to the complexity of both human interface with complex interventions and clinical/research staff interaction. Attention to key elements, recruitment, retention, treatment fidelity, and control intervention selection, contributes to successful conduct of a trial. Alternatives to the randomized controlled trial and outcome measure selection are important considerations contributing to the merit of the trial. While clinical trial outcomes contribute to the scientific evidence, their true value and impact comes in the next step, translation to clinical practice and the improvement of patient outcomes and qualify of life. Translation of evidence into practice may best be achieved via partnerships of scientists, clinicians, and administrators resulting in a dynamic interface between science and practice, the laboratory, and the clinic.
Janet Carr and Roberta Shepherd head up a new team of eminent authors for the second edition of this definitive text on neurological physiotherapy. In the first edition, the authors described a model of neurological rehabilitation for individuals with motor dysfunction based on scientific research in the areas of neuromuscular control, biomechanics, motor skill learning, and the link between cognition and action, together with developments in pathology and adaptation. The new edition continues to advance this model while identifying and incorporating the many advances that have occurred in the last decade in the understanding and treatment of adults with neurological conditions, whether caused by accident or disease. Among these advances is the knowledge that the brain retains a plastic potential to reorganize, even in old and/or lesioned brains, and that neural plasticity can be influenced by task-related mental and physical practice in a stimulating environment. There is also an increasing body of knowledge related to the musculoskeletal system’s adaptability and the need to prevent length and stiffness- related changes in muscle contractility, together with loss of aerobic fitness and endurance. There is an expanding body of clinical research that appears to support the model provided here. The training guidelines outlined in Neurological Rehabilitation are based on biomechanical constructs and motor relearning research, applied to enhance brain reorganization and muscle contractility, and encourage functional recovery of the patient. It connects science and clinical practice enabling students and practitioners to develop their knowledge and use new clinical methods based on modern scientific understanding. All chapters have been revised, some with the collaboration of five specialists who are engaged in high level scientific research and clinical practice Biomechanical models are presented to provide a framework for action-specific training and exercise to improve performance Clinical guidelines are science- and evidence-based Emphasis is on new approaches to the delivery of neurological rehabilitation that increase the time spent in mental and physical activity, and the intensity of practice and exercise Up-to-date referencing
In the past 20 years there have been many changes in the way that neurological rehabilitation is delivered worldwide. This is in part a reflection of improved acute medical therapies and intensive care and also related to the development of a more holistic approach to recovery, embracing the principles of the WHO International Classification of Functioning as a model for rehabilitation. Traditionally, rehabilitation services have tended to develop piecemeal according to local resources and need. By definition such services should be driven by a patient-centered approach and thus there is wide variety in service provision nationally and internationally. This chapter describes the background to current service set-ups and provision, exploring models of rehabilitation delivery and common presentations in neurological rehabilitation. Relevant legislation and guidance documents are reviewed. The text provides an overview of different aspects of rehabilitation services including acute and inpatient provision, outpatient services, community-based rehabilitation, residential facilities, and vocational services.
Over the last decade a dramatic change has occurred in the field of neurorehabilitation in motor recovery that is marked by three transitions: first, by movement away from intuitive and ideology-based approaches to evidence-based therapy practices; second, by a change from hands-on treatment of patients to hands-off coaching approaches by motor therapists, who incorporate knowledge about motor reorganization and motor learning; and, finally, by a transition from one-on-one treatments to group-oriented treatments. General rules (such as the need for repetition, feedback of results, shaping task difficulty) have been derived from the animal experimental and human behavioral literature and incorporated into the design of innovative treatment strategies that can be adapted to individual patients' needs. This chapter reviews the state of the art for most of the evidence-based motor therapy concepts in the rehabilitation of patients with motor deficits after stroke, traumatic brain injury, etc., and other conditions. Treatment approaches derived from neuromodulation techniques such as stimulation or blockage of peripheral nerves, noninvasive brain stimulation, and pharmacological means are addressed. Finally, a modular concept is proposed to define optimal therapeutic approaches according to the individual level and type of impairment.
Neurorehabilitation is based on the assumption that motor learning contributes to motor recovery after injury. However, little is known about how learning itself is affected by brain injury, how learning mechanisms interact with spontaneous biological recovery, and how best to incorporate learning principles into rehabilitation training protocols. Here we distinguish between two types of motor learning, adaptation and skill acquisition, and discuss how they relate to neurorehabilitation. Functional recovery can occur through resolution of impairment (reacquisition of premorbid movement patterns) and through compensation (use of alternative movements or effectors to accomplish the same goal); both these forms of recovery respond to training protocols. The emphasis in current neurorehabilitation practice is on the rapid establishment of independence in activities of daily living through compensatory strategies, rather than on the reduction of impairment. Animal models, however, show that after focal ischemic damage there is a brief, approximately 3–4-week, window of heightened plasticity, which in combination with training protocols leads to large gains in motor function. Analogously, almost all recovery from impairment in humans occurs in the first 3 months after stroke, which suggests that targeting impairment in this time-window with intense motor learning protocols could lead to gains in function that are comparable in terms of effect size to those seen in animal models.
The autonomic nervous system (ANS), through its central connections and efferent pathways, innervates every organ in the body, influences their function, and is also involved in a number of integrative systems such as those concerned with maintenance of arterial blood pressure, organ perfusion, and body temperature. Responsive functioning of the ANS is thus needed in a variety of situations; it contributes to well being, and is essential for survival. Autonomic dysfunction may occur in a number of neurological diseases and may complicate various medical disorders. This chapter will provide an outline of the scientific principles, followed by classification of autonomic disorders, an outline of the autonomic investigations, brief accounts of some of the key disorders and the pathophysiological mechanisms involved, and discussion of treatment, emphasizing the importance of non-pharmacological methods and, in particular, the role of autonomic neurorehabilitation.
Depression, anxiety, emotionalism, irritability, and apathy are common findings in the neurological rehabilitation setting and are associated with poorer outcomes. This chapter outlines the importance of detecting and attending to these disorders. The authors recommend the systematic use of self-report measures, tailored for those with cognitive or motor difficulties, in combination with interview-based assessments where suspicion of the presence of a disorder is aroused. A stepped care scheme for coordinating rehabilitation services is presented which highlights the importance of training all staff to be aware of the possibility of patients presenting with emotional disorders and the need to equip all staff with the skills to make emotional enquiries and to carry out brief interventions where indicated. Interventions should be based upon a combination of watchful waiting and optimization of clinical care followed by evidence-based brief therapies such as problem solving, motivational interviewing, and behavioral activation. Antidepressant prescribing should be reserved for the more severe cases and protocols should involve a system for reviewing and time-limiting prescriptions. This chapter aims to aid those designing services to produce simple and widely understood programs that meet the needs of this inherently heterogeneous client base.
The neurological consequences of an acquired brain injury (ABI), of traumatic or nontraumatic origin, are caused by an alteration of neuronal activity that compromises physical integrity or function of one or more areas of the brain. Impairments resulting from an ABI often affect cognitive function, as well as language, memory, attention, and information processing faculties, leading to partial or total disability that is likely to prevent people's functional and psychosocial recovery even in the long term. This situation has harmful clinical, social, and economic effects. Social costs caused by a patient's death or acquired disability are extremely high, and costs to healthcare systems rank among the top three in Europe. One of the main considerations when dealing with traumatic or nontraumatic brain injury is the complexity of the rehabilitation process. Many variables must be taken into account because of the great variety of clinical features that may occur, involving damage etiology, severity level, and health complications. Great advancements have been achieved over the past 10–15 years in the treatment of ABI, but new basic and clinical research must be encouraged and financially supported. Many challenging issues still occur when evaluating patients with ABI due to the lack of appropriate assessment measures and reliable prognostic indexes that could support clinical observation. Furthermore, researcher authors need to create a network of rehabilitation services that responds to the needs − medical, emotional, and social − of all brain-injured patients and their families, from initial hospitalization to reintegration into the community.