Neurological rehabilitation and management of spasticity

The WHO model of functioning, disability and health describes consequences of illness or trauma on four levels: pathology (the underlying disease), impairment (the symptoms and signs), activity or disability (activities of daily living), and participation or handicap (the patient’s social roles). Neurological rehabilitation is provided by a multidisciplinary team, whereby all team members work towards common goals. The goal-setting process needs to involve the patient, and the family if appropriate. Therapies can follow one of two basic principles: practice of an impaired function or using compensatory techniques. By using the latter, patients with neurological illnesses can improve their activity and participation even if their impairment does not recover. Research evidence shows that neurological rehabilitation is effective and efficient. Rehabilitation reduces mortality, morbidity and dependence on care. There is evidence of a dose–response relationship between therapeutic input and outcome: the more therapy, the better the result. The available data suggest that the most important elements of effective rehabilitation are not specific techniques, but good organization, such as co-ordination of services, expertise of the team, and education of the patients and their families. This article gives an overview of rehabilitation techniques for motor deficits and neuropsychological symptoms.