Principles of Neurorehabilitation

Question 1

What are the guiding principles of neurological rehabilitation?

Answer 1

• The ICF
• Teamwork
• Person-centred care
• Prognosis
• Neural plasticity
• Systems model of motor control
• Functional movement re-education
• Skill acquisition - motor learning
• Exercise prescription
• Self-management
• Health promotion
• Mindset
• Behaviour change

Question 2

How does person-centred care lead into neurological rehabilitation?

Answer 2

• Patient + their wishes + situation take priority
• Feeds into neuroplasticity
• Everyone is individual

Question 3

How does prognosis lead into neurological rehabilitation?

Answer 3

• Based on understanding of pathology, anatomy, physiology & neuroplasticity
• Often patients with life limiting conditions (MS, PD, MND)
• Some patients may not make a ‘full recovery’/are permanently affected (stroke, brain injury, spinal cord injury)
• Often involve decisions about end of life/feeding/moral & ethical medical debates
• Based on best available evidence

Question 4

How does neural plasticity lead into neurological rehabilitation?

Answer 4

• Ability of CNS to reorganise after injury or disease
• Task specific
• Salient
• Reps (#100 reps)
• Intensity – suitably changing

Question 5

How does functional movement re-education lead into neurological rehabilitation?

Answer 5

• Basis of treatment is the ability to practice functional tasks or movement (e.g.: rolling, lying, sit to stand, walking, balance)
• Analyse + recognise normal movement patterns
• Kinematic ranges of normal movement patterns + anatomy + biomechanics
• Training of movement (instead of pure ‘exercise’)

Question 6

How does exercise prescription lead into neurological rehabilitation?

Answer 6

• Improving cardiovascular endurance, muscular fitness or flexibility
• FITT

Question 7

How does self-management lead into neurological rehabilitation?

Answer 7

Most neurological conditions have ongoing consequences – need support to manage their disease
E.g.:
- Manage own catheters
- Home exercises
- Fatigue management
- Self-efficacy
- Checking skin if poor sensation

Question 8

How does health promotion lead into neurological rehabilitation?

Answer 8

• Many people with neurological conditions don’t meet recommendations for a healthy lifestyle (for many reasons)
• Cardiovascular risk factors + secondary prevention is an important component of their long-term management
• Face additional barriers to active healthy lifestyle that may require support in overcoming
• Need to support exercise, diet, smoking cessation, mental health/wellbeing

Question 9

How does mindset lead into neurological rehabilitation?

Answer 9

• Thoughts, beliefs + expectations that influence recovery
• Adopting strategies to foster motivation, resilience + hope with service users + bring a positive mindset

+ Communication – active listening
+ Goal setting
+ Self-management
+ Praise

Question 10

How does behaviour change lead into neurological rehabilitation?

Answer 10

Facilitating behaviour change to enable individuals to live
- Health promotion
- Self-management
- Habit formation

Question 11

What are some influencing factors in neuro clinical reasoning?

Answer 11

• Individual patient (wants, needs + beliefs)
• Assessment findings
• Fluctuation + variability in clinical presentation over time
• Long-term nature of most neurological conditions
• Psychological impact of neurological disease
• Underpinning knowledge of anatomy, pathology, normal movement + physiology
• Evidence base withing field of neuroscience _ neurorehabilitation