Chapter 14: Concepts and Principles of Neurological Rehabilitation

Chapter Objectives

Upon completion of this chapter, the learner should be able to:

1. Discuss the importance of using processes of deductive and inductive reasoning in designing, implementing, testing, and validating sound strategies of neurological rehabilitation.

2. Value an integrated approach to neurological rehabilitation based on contemporary science in areas of motor control and motor learning.

3. Design intervention strategies that promote the functional competence of patients.

4. Design intervention strategies that optimally engage patients by respecting their attributes and constraints, the complexity of the tasks to be learned, and the opportunities for practice that exist.

Introduction

The main objective of neurological rehabilitation is to help patients optimize their functional competence; that is, the ability to perform daily activities in a variety of environments, under different conditions, with a minimal expenditure of physical and cognitive resources. Neurological pathology alters the human condition, causing impairments of body structures and functions that limit the ability of patients to explore solutions to the functional activities they are trying to perform. During the rehabilitation process, patients learn to identify the attributes and constraints of their movement system, plan valid movement strategies and movement patterns for accomplishing tasks, and analyze and refine their motor outcomes. Through practice, they create functional coordination modes of motor output that can be refined, diversified, retained, and transferred to meet the spatial and temporal regulatory features of the tasks and environments they encounter. However, physical ability alone is not enough. To be functionally competent, patients must be motivated and confident in their abilities, and willing to meet the challenges they encounter when performing functional tasks. Creating and implementing comprehensive and effective therapeutic intervention strategies that empower patients with neurological pathology to optimize their functional competence can be complex and elusive processes.

The purpose of this chapter is to provide an overview of important concepts and principles of neurological rehabilitation that help patients optimize their functional competence. This involves therapists integrating the concepts of movement and function, creating meaningful interfaces for learning, progressing therapeutic interventions in a valid manner, and promoting the active role of patients in their recovery. Four major principles provide the underlying structure of this evidence-based approach to neurological rehabilitation. Hypothetical patient scenarios throughout the chapter illustrate how the concepts and principles presented apply to clinical practice. An emphasis is the importance of therapists personalizing their intervention strategies to promote patient engagement and learning. The content of this chapter complements the discussion of plasticity and the basis for making clinical decisions in Chapter 1, approaches in neurological rehabilitation in Chapter 15, prevention of secondary impairments in Chapter 16, and the indications and applications of assistive technology in Chapter 17. The principles of motor behavior and motor learning discussed in this chapter will apply to all interventions discussed in the chapters of Section IV of this text and to interventions designed to improve functional abilities as ...