Neurological rehabilitation is the medical specialty that deals with the functional recovery of subjects suffering from diseases of the nervous system. Following the indications of the World Health Organization (WHO), we can define the rehabilitation of people with disabilities as the process aimed at achieving and then maintaining the best possible functional levels in the physical, sensorial, intellectual, psychological and social fields.
- Rehabilitation provides disabled people with the necessary tools to achieve independence and decision-making autonomy (self-determination). In the case of neurological rehabilitation, this process is aimed at people with disabilities secondary to injury to the nervous system.
Always following the indications of the WHO, for neurological rehabilitation means that process which, through a comprehensive and multidisciplinary approach, is aimed at improving functions, reducing symptoms and increasing the sense of well-being, within one’s own specific social, of subjects with neurological problems and their families.
The New Options
It is a relatively new branch of rehabilitation medicine that is experiencing very rapid growth and results unimagined up until a few years ago. The main lines of development must be identified on the one hand in the improvement and qualification of the intervention on the social and environmental aspects associated with disability, and on the other in the improvement of the knowledge of the neurobiological mechanisms underlying the functional recovery.
The First Aspect
The first of these aspects is specific to rehabilitative intervention and distinguishes rehabilitative medicine from other medical specializations. The key element is the centrality of the disabled person. In the traditional medical approach, the patient is the object of the intervention. In neurological rehabilitation, the disabled subject, on the other hand, is the first actor in his own rehabilitation process. The different professionals, not only of medical education, must help the patient in this process, providing the skills and tools necessary to overcome the limits imposed by the loss of function. This path must also address all the environmental and social aspects that can reduce the participatory capacity of the disabled person.
The Ongoing Process
In the still ongoing process of defining the rehabilitation intervention, the WHO plays an important role in stimulating and guiding. The first definition of the concepts of damage ( impairment ), disability and handicap dates back to 1980. Over the years, the emphasis has shifted from the determination of disability to the assessment of residual abilities and, later, to the importance of environmental conditions in determining the functional state of the subject. This path led to the transition from a vision of disability as an eminently medical problem to its recognition as a social condition. This approach is at the base of the 2001 edition of the international classification of disabilities elaborated under the direction of the WHO (International classification of functioning, disability and health).
The New Process
In the same years in which there was a downsizing of the medical vision of rehabilitation, from basic research was born an impulse in the opposite direction, in favor of neurological rehabilitation as a medical discipline capable of curing damage (Taub, Uswatte, Elbert 2002 ). The large amount of data supporting the reorganization and regeneration capacities of the nervous system, as well as the demonstration that these phenomena are able to induce a functional recovery are bringing back the emphasis on care and no longer, or not only, on the aspects of integration social. In this essay we will analyze the impact that the knowledge of the 21st century they are having on clinical practice in Neuro rehabilitation.