Rehabilitation principles in chronic neurological conditions in adults and children

Rehabilitation medicine focuses on enabling people to learn how to regain optimal movement, minimize disability, and enable engagement and participation in life. In both adults and children, the aim of neurological rehabilitation programs is to achieve the maximal possible functional outcome in physical, psychological, social, and vocational domains whilst maintaining health and preventing secondary complications of disability. This is often achieved through a coordinated, inter-professional team-based approach involving medical practitioners, nurses, and allied health professionals who are involved in diagnosis, patient-centered goal-setting, and treatment in both inpatient and community-based treatment programs [1–3]. The term “neurorehabilitation” refers to “… the clinical subspecialty that is devoted to the restoration and maximization of functions that have been lost due to impairments caused by an injury or disease to the nervous system” [4]. The neurosciences literature affords a growing evidence base underpinning neurorehabilitation principles. It is now known that synaptic plasticity occurs at the cellular level following brain damage and the brain can learn new ways to perform functions that have been disrupted with brain injury [5]. Functional connectivity in the brain can also be enhanced in some individuals through practice and by structuring the environment and the tasks they perform. It is argued that “adaptive learning” of this type can be facilitated in many people with neurological damage through participation in rehabilitation programs that promote positive neural changes through the processes of learning and practice. When adaptive learning is not possible, clinicians can adopt a compensatory approach. This uses intact regions of the brain to compensate for the functions that have been compromised by the brain lesion so that the person can quickly achieve return to everyday living. This chapter will explore these aspects of neurorehabilitation in adults and children with chronic neurological conditions. We shall focus this discussion on traumatic brain injury, multiple sclerosis, hereditary spastic paraplegia, and cerebral palsy.