Neurorehabilitation Overview

Neurological Rehabilitation

• Rehabilitation is a process where a disabled person learns to cope with family, friends, work, and leisure independently.
• It aims to restore function and improve coping strategies, for any type of disability arising from a pathological condition.
• The process involves the disabled person, guided and supported by professionals.
• Neurorehabilitation aims to restore function in people with neurological damage.
• It uses a multidisciplinary team to apply strategies reducing disabilities, improving quality of life.
• The persons/patients are the center of the rehabilitation process.

Key Concepts of Neurorehabilitation

• Impairment: Alterations in anatomy or physiology (bodily structure or function).
• Disability: Functional consequence of impairment, leading to restrictions in functions such as walking, communicating.
• Handicap: Description of social context of disability, with restrictions in social functions (e.g., paid employment).

WHO's International Classification of Functioning, Disability and Handicaps (1980)

• Impairment: Any loss or abnormality of psychological, physiological, or anatomical structure or function.
• Disability: Any restriction or lack of activity, stemming from an impairment, to perform an activity considered normal for those of the same age, sex, and culture.
• Handicap: Disadvantage for an individual resulting from an impairment or disability, limiting fulfillment of a role that would otherwise be normal.

New Classifications (ICIDH-II)

• Impairment: The loss or abnormality of a body structure or a physiological or psychological function.
• Activity: The nature and extent of functioning at the level of the individual. Activities may be limited in nature, duration, and quality.
• Contextual factors (participation): Include features, aspects, and attributes of objects, structures, human-made organizations and service provision, physical, social, and attitudinal environments.

Medical and Social Models of Disability

• Medical Model:
  • Disability is seen as an individual condition located within the individual.
  • The problem and its solution are located in the individual.
  • Disability is a disease state deviating from the norm, requiring treatment.
  • A disabled person is viewed as inherently biologically/psychologically inferior.
  • Disability is a personal tragedy, with a victim.
• Social Model:
  • A person's impairment is not the cause of restriction of activity.
  • Society's organization restricts activities.
  • Society discriminates against disabled people.
  • Economic, attitudinal, sensory, and architectural barriers are significant.
  • Focus is on involvement of health professionals in the life of the disabled person.

International Classification of Functioning, Disability, and Health (ICF)

• ICF is a framework to describe and organize information about functioning and disability.
• It provides a standard language and conceptual basis for defining and measuring health and disability.
• The model of ICF: a hierarchical diagram with health conditions, body functions and structures, activity, participation, environmental factors, and personal factors.

Example of ICF Application

(Illustrative example using a hypothetical 23-year-old spinal cord injured person)

• Body Function & Structure: Loss of sensation below the waist, loss of lower limb movement
• Activities: Limited daily living function, self-care assistance
• Participation: Social activities, school attendance
• Environmental Factors: Barrier-free facilities, use of rehabus
• Personal Factors: Peer support, family support

Using ICF to Define Problems / Checklist

• The checklist is a practical tool to elicit and record information on functioning and disability.
• It provides a user-friendly display of relevant ICF categories for clinical purposes.
• The checklist allows simple and time-efficient identification of functioning profiles.
• Information from the checklist is suitable for case records in clinical or social work.

Rehabilitation Process (Overview)

• Rehabilitation is a dynamic process supporting people with disabilities to develop knowledge and skills, maximizing physical, psychological, and social functioning. This process can be viewed in three key areas.

Basic Approaches in Neurological Rehabilitation

• Approaches reducing disability: Managing/reducing existing impairments.
• Approaches acquiring new skills and strategies: Learning new skills to compensate or perform tasks to improve function.
• Approaches to alter the environment: Adapting the physical and social environment to improve functioning.

Important Note

• Neurological rehabilitation is a practical and logical application of basic principles in the context of a detailed understanding of a condition's natural history and associated symptoms.