Innovations and Novel Trends in Neurological Rehabilitation

If brain reorganization and functional recovery from brain lesions is dependent on use and activity, then the rehabilitation environment is likely to play an important role in patient outcomes. The rehabilitation environment is made up of the physical or built environment (the physical setting), the methods used to deliver rehabilitation (type of intervention, intensity, dosage) and the staff (their knowledge, skill, attitudes, and their ability to teach).

Observational studies of rehabilitation settings provide insights into how patients spend their days, suggesting that the environment may not be sufficiently geared to facilitating physical and mental activity or social interaction, and that it may not function as a learning environment. Other studies suggest that a large percentage of the patient's day is spent in passive pursuits rather than in physical activity. The issue of how much time is spent on physical activity, including practice of motor tasks, and how this time is organized, is therefore a critical one for rehabilitation.

Focusing on intensive task-oriented training has required some changes in physical therapy practice, not only in the methods used but also in delivery. Physiotherapists are exploring different ways of organizing delivery to enable the patient to be an active learner. They are examining, for example, the effects of an interactive relationship between patient and therapist, the effects of working in a small group during circuit training, and the effects of sessions where patients work in partnership with each other.

In an attempt to increase the time spent practicing, several investigators have reported the development of technology to provide computer-aided training, for example, robot-mediated therapy (RMT). The focus has been on movements of the upper extremity that are challenging, engaging and repetitious. Significantly more improvement in upper limb function has been reported compared with NDT/Bobath therapy of equal intensity and duration. In addition, the rate of recovery when treatment was delivered with RMT was found to be greater in relation to either no treatment or treatment with sling suspension in a single case study. The generalizability of RMT and its role in motor learning are yet to be tested.