Chapter 15: General Approaches to Neurological Rehabilitation

Chapter Objectives

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

1. Discuss the evolution of neurorehabilitation models.

2. Compare and contrast the underlying principles of the neurorehabilitation models.

3. Define key terminology associated with the various neurorehabilitation models.

4. Design a therapy intervention session for a patient with neurological dysfunction, integrating the varied neurorehabilitation concepts.

5. Discuss the current evidence to support the efficacy of therapeutic interventions used in neurological rehabilitation.

6. Identify areas requiring further research on the efficacy of therapeutic interventions used in neurological rehabilitation.

Introduction

The emphasis of rehabilitation must focus on improving function to allow for a return to participation in activities of daily living (ADL), work, and leisure. In determining which of the various intervention options is best for a given patient, the therapist must work closely with the patient, family, and caregivers to identify their goals and needs. This, along with the examination results, will aid in narrowing the focus of treatment and the selection of specific exercises and activities. Some intervention approaches are more applicable to certain patient diagnoses. For example, neurodevelopmental treatment (NDT) was initially developed as an approach for children with cerebral palsy (CP) and was later extrapolated to adults with hemiplegia. Other approaches, such as proprioceptive neuromuscular facilitation (PNF), can be used with a diverse patient population with varied diagnoses. Most therapists choose to combine treatment approaches for an eclectic mix designed to meet the goals of each patient.

Therapists attempt to incorporate current research evidence into their decision-making process to determine interventions that optimize patient outcomes. The level of evidence and how it is determined varies greatly for each of the rehabilitation approaches discussed in this chapter. For example, constraint-induced movement therapy (CIMT) and locomotor training (LT) with unweighting systems use protocols that are being driven directly by experimental results. This differs from PNF and NDT approaches, which were developed from therapist observations of patients during treatment sessions, followed by research testing to verify the effectiveness of the approach. Confounding factors of the research include the quality of the study methodology, differing patient characteristics and exclusionary criteria, and the use of varied outcome measurement tools. These disparities challenge the therapist when attempting to compare treatment approaches and identify the best intervention approach for a given patient. Thus, after a critical analysis of the evidence, the patient’s success is, in part, dependent on the art of therapy.

This chapter will serve as an introduction and provide a description of the treatment approaches that may be used in the care of patients with neurological dysfunction. Past and present applications and examples of integrating the models in the clinic setting will be described. Examples of clinical application for each model will be discussed. A case study at the end of the chapter will highlight the integration of the approaches for patient intervention. Discussion as to the efficacy, advantages, and disadvantages ...