The Many Benefits of Neurological Rehab
Neurological rehab helps patients regain function and a sense of normalcy
ILLUSTRATION BY elizabeth ellis
We’ve seen bumper stickers that ask, “Why be normal?’’ Not to pick on the spirit of the sentiment — we’re all for celebrating individuality — but when it comes to having the physical ability to perform common, everyday tasks, most people would surely agree that normalcy is something to cherish.
Rehabilitative medicine aids those who long for a return to the routine by helping patients regain the function and independence they had before injury or illness took its toll. And although the word “rehab” might conjure images of people working to recover from orthopedic injuries such as broken legs and tennis elbows, rehabilitation can also help restore strength and wellness in patients who suffer from symptoms and impairment related to neurological damage. Individuals who undergo neurological rehabilitation have injuries and conditions far afield from your average torn rotator cuff, such as traumatic brain injury, stroke, spinal cord injury, amputation, Parkinson’s disease, and certain infections and tumors.
Neurological rehab patients often work with a multi-disciplinary team made up of experts such as a physical therapist, occupational therapist, speech therapist, recreational therapist, and a physiatrist, or a doctor who specializes in rehabilitative medicine. A social worker, psychologist, or psychiatrist might also be part of the team to help patients cope with their new circumstances, says Bruce R. Myers, MD, a physiatrist who is founder of Seacoast Area Physiatry and medical director of Portsmouth Regional Hospital’s rehabilitation department.
The team approach makes sense since many neurological cases are complex and involve cognitive as well as physical factors that require attention. Sometimes patients “have had a stroke and a fall, and they hurt their shoulder,” for example, Myers says. Most neurological injuries will create a cognitive problem, Myers says, because any time something harms the brain, there’s a potential for language, coordination, and mental processing difficulties to occur. “You can’t just treat it with a physical therapist, and you can’t just treat it with an occupational therapist,” because there are usually so many facets to the injury, Myers says.
In part because neurological injuries and conditions often affect so many different aspects of a person’s health, recovery can be long and arduous. During neurological rehab, “you’re basically trying to bombard the nervous system repetitiously to reintegrate and to rewire the brain,” Myers says. Perhaps not surprisingly, the rewiring process can occur faster in the younger population than in the older. “It takes a lot longer in the older population and it’s less complete in the older population because the brain doesn’t have that plasticity,” Myers says, referring to the brain’s ability to reassign a part of itself to take over for another part of the brain that has been damaged.
Today’s neurological patients can benefit tremendously, however, from a variety of state-of-the-art rehab techniques and equipment. A suspension system that features rails and harnesses, for example, enables patients with impaired balance to become comfortable with walking again. Wearable robotic exoskeletons helps patients to move. Other electronic units can be used to stimulate muscles, Myers says.
Electrical devices can also stimulate nerves to help with foot drop, a common problem that follows stroke, in which lifting the foot becomes difficult and causes impaired individuals to drag their foot on the ground while walking, creating the potential for a fall. Also, Parkinson’s disease patients can take advantage of a new type of walker that includes laser light to help improve their gait. “With these various rehab interventions, we can improve the quality of the walking to help prevent [patients] from falling,” says Gregory J. Zuercher, DO, a physiatrist and the medical director of the in-patient acute rehab unit at St. Joseph Hospital in Nashua. Technology offers “a different way of helping people to recover” that boosts rehab’s potential, he says.
Although ideally, rehab will help restore 100 percent of a person’s functioning, some patients will need to rely on various devices, both high- and low-tech, for the rest of their lives; when damage to the nervous system is extensive, a partial recovery might be the best a neurological patient can hope for. In those circumstances, rehab efforts focus on teaching patients how to “compensate with what they have so they can function better in the future,” says Zuercher.
Regardless of the outcome, change doesn’t come easily; neurological rehab patients typically must commit to a lot of work before they experience meaningful gains in movement and function, making patient attitude the “number-one” key to success for neurological rehab, Zuercher says. Not all patients are eager to go through the effort that rehab requires, however. “I run an in-patient rehab clinic, so usually we admit people with new disabilities or new impairments, and there’s a big adjustment period that they have to go through,” he says. Part of the rehab team’s job is to try to change that attitude and encourage patients to participate in the program. “Hopefully that will continue into the out-patient setting with out-patient therapy or any lifestyle changes that they might have to make,” Zuercher says.
Those who stick with it can reap meaningful rewards. “I’ve seen many cases where someone is so disabled they can’t even get out of bed by themselves, and by the time they leave [the rehab program] they’re walking down the hallway,” Zuercher says. In other instances, patients with a serious brain injury have begun rehab unable to speak and communicate, but “with a combination of natural recovery and our facilitation, they become able to communicate and get back into society. I’ve seen a few cases where they even get back to work and I just think, ‘Wow.’”
Indeed, rehab “makes a huge difference” in the long-term outcome for patients, Myers says. “There’s such a tremendous difference” between those who participate in rehab and those who don’t in terms of the number of complications they experience, the extent of recovery, the degree of functional improvement, and the overall ability to manage and adapt, he says. “This is not something that is innate in our ability to just cope with. You have to rely on the [therapists] to educate both the patient and the family members, the caretakers,” Myers says.
Rehab: It’s not all pulleys, treadmills, and medicine balls
Wander into any typical rehab facility and you’re likely to be surrounded by an assortment of balls, weights, and other pieces of equipment that are destined to help countless patients grow stronger and move more easily.
But for neurological patients, tending to the softer side of the rehabilitation process can be just as essential as flexing muscle. Taking advantage of support groups and non-traditional treatments such as tai chi and acupuncture is “super-important” and can greatly benefit neurological patients, says Gregory J. Zuercher, DO, a physiatrist and the medical director of the in-patient acute rehab unit at St. Joseph Hospital. Although maintaining emotional health is important for everyone, it’s especially critical for neurological patients, who often suffer from depression, Zuercher says.