Neurologic Rehabilitation

Neurologic rehabilitation is a dynamic process through which patients with disabilities are able to optimize physical, cognitive, emotional, and social functions. It is a patient-centered, multidisciplinary endeavor involving neurologists, physiatrists, physical therapists, occupational therapists, neuropsychologists, speech therapists, nutritionists, and nurses, in addition to the patient's caregivers. The ultimate objectives are to renew or maintain functional independence, community participation, and quality of life despite the impairments.

Neurologists often have the most knowledge and experience about the specific disease process, the treatments available, and the expected course of illness affecting the nervous system. Neurologists should play an important role in neurologic rehabilitation. The articles in this issue serve to highlight the central role a neurologist can play in the rehabilitation of patients with a range of cognitive and motor disabilities; establishing an integrated network of experienced multidisciplinary professionals is paramount.

Over the past two decades, there has been a concerted effort to provide evidence to support specific approaches to neurologic rehabilitation. There has been important progress in both the basic understanding of the recovery process, as well as the clinical care of patients suffering from a range of neurologic diseases. A particular focus of each article in this issue is to highlight current care that is based on evidence. Each article also outlines areas that are being actively investigated. Collectively, it is clear that there is now a wealth of evidence to support neurologic restorative efforts for both “static” (e.g., stroke) and progressive (e.g., amyotrophic lateral sclerosis) neurologic disorders.

Neurologic rehabilitation is also the translation of basic and clinical neuroscience research to maximize mechanisms of neural reorganization and compensation. The objective is to restore lost function; it may include multiple overlapping mechanisms such as restoration of injured areas or activation of new pathways. Compensation, in contrast, is the use of modified motor and cognitive behaviors (e.g., focusing on the unaffected arm) and/or assistive devices to improve function. Specific focus on restoration versus compensation depends on the expected disease course and the prognosis. From a clinical perspective, however, the ultimate distinction between recovery and compensation may not be important if disability is minimized and quality of life is improved. With continued research into treatments for each specific neurologic disease, as well as more general research into cell-based therapies and restorative neural engineering, we are certainly hopeful that over the next decade we can shift toward a greater focus on true neurologic recovery.