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Neuro Rehabilitation

What is Neuro-Rehabilitation-1

  • Need based medical care of a person needing rehabilitation services
  • Consists of Clinical Assessment and its evaluation, if required supplemented by CT-SPECT Fusion Scan of brain or equivalent, to delineate areas of brain dysfunction requiring management and repair.
  • Instruct Therapists on neural damages identified, so that they may choose specific need based neuro-rehabilitation strategies accordingly.
  • Makes medical diagnoses of complications for taking care of, e.g. malnutrition, micronutrient deficiencies, epilepsy, deformities, hypothyroidism, diabetes, etc.

What is Neuro-Rehabilitation – 2

  • Where needed, advise electro diagnostic approach
  • In selected cases, based on clinical assessment and investigations, have detailed discussion of all pros and cons of modern and/or experimental interventional therapies like HBOT, Biomedical approach,
  • surgical correction of deformities and spasticity, and Regenerative Medical Therapies
  • Make it clear to the attendants and patient that a variable degree of disability WILL persist, but, with proper holistic Neuro-Rehabilitation and need based medical interventions, quality of life may be enhanced significantly in most but not all cases.

What are the requirements of Neuro-Rehab?

  • Team Approach
  • Familiarity and regular use of established scales for measurement of disabilities
  • Regular follow up for years if needed
  • Awareness that holistic Neuro-Rehab is the foundation of all management strategies
  • The patient’s physical, functional, emotional, and psychosocial well-being must always be considered in totality for effective treatment.

What major functions does the Group Leader do?

  • Detailed medical history taking: why/how the mishap occurred, followed by Biomedical, Genetic and/or Health tests as per individual case needs
  • Discuss with group members to decide the final management, orthotic aids, further tests, etc.
  • In patient is not responding to any approved and established therapy, and is only being given palliative tonics, etc., only then consider using Experimental Therapies if they fit Helsinki Protocol Para 35 guides. – Here, approach must be as in a clinical trial, with all its safeguards, detailed record keeping, full information to patient or guardian. A 2 year follow up is recommended.

Cases handled by Physical Therapists

Musculoskeletal care:– Different forms of arthritis: Osteo-, Rheumatoid, Traumatic, Ankylosing, Fibromyositis, Low Back Pain, etc.Sports injuries:- Examples: Achilles Tendonitis, Iliotibial Band Syndrome, Turf Toe, Medial & Lateral Epicondylitis, Tenosynovitis, Rotator Cuff Pathology, Acromioclavicular Separation, Biceps Tendonitis, Stress Fractures, Concussion, etc.

Cases seen by Neuro-rehabilitation therapists

Neurorehabilitation:– Cerebral palsy, Traumatic Bain Injury, Autism Spectrum, Stroke, Spinal Cord Injury, Muscular Dystrophy, Parkinsonism, Multiple Sclerosis, Motor Nuron Disorders, etcPain medicine:- Different Neuralgias, Chronic Fibro-myossitis, Cancer Pain Management, Regional Pain Syndrome, Back Pain, Degenerative Arthritis, Carpal Tunnel Syndrome, Tennis Elbow, etc.

Cases seen by Special Educators

  • Cerebral Palsy
  • Autism Spectrum Disorder:-Aspergers, Autism, PDD, PDD-NOS, Rett, TBI-induced autistic features, Mental Impairment (Fragile-X, Tuberous Sclerosis, Down, etc)
  • Post traumatic cognitive impairment, eg. After accident, war injuries,
  • Brain damage with cognitive impairment after stroke, cardio-respiratory failure and other forms of Hypoxic Ischemic Encephalopathy (HIE)

Cases seen by Psychologist

  • All forms of impairment of-Cognition, especially its regression for no cause-Psycho-social behaviour, -Communication skills- Attention deficit Hyperactivity
  • Bizarre behavior as in Autism Spectrum, Depression, criminal tendencies, Schizophrenia,
  • Mental Impairment

Cases seen by Speech Therapists

  • Contrary to popular opinion, a Speech Therapists’ work is not limited to speech only.
  • He provides all necessary Physical and Special Education Therapies to functions related to the area from throat to nose.
  • Sucking
  • Swallowing
  • Blowing
  • Chewing
  • Phonation
  • Soft palate control
  • Hard palate control
  • Breathing control
  • Communication, language and speech development

Role of Dietician and Other Medical Specialists

  • Dietician-Balanced, hypo-allergenic need based diet avoiding foods that are prohibited in a particular situation / disease.
  • Vascular Surgeon-Specific target organ based administration of a drug
  • Geneticist
  • Diagnosis of obscure genetic disorders by tests
  • Orthopedician Surgical correction of deformities and spasticity

Role of Other Medical Specialists – 2

  • Neurologist / Neurosurgeon
  • Brain pathology management by surgery or medication especially in cases Hydrocephalus, brain trauma, tumors and abscesses, epilepsy, etc-Pediatrician
  • Manage pediatric complications in childhood disprders
  • Internal Medicine Specialist (Physician)
  • Group Leader, who can consolidate everyone’s opinion, and then lay down the ultimate holistic approach to be followed in a particular case and be the main handler.

Specialized Experimental Therapies

HBOT: Hyperbaric Oxygen Therapy has stood the test of time over 3 decades and is now recognized and approved therapy for well over a dozen indications by US FDA & its European counterparts.

Cerebral Palsy in children: likely to be officially approved soon

Autism: reports of many small trials encouraging but more data needed from large scale long follow up trials for its final official approval.

Stem Cell Therapy: Adult Human Stromal Stem Cells are recommended to be in Clinical Trial Phase as of early 2014.-Autologous stem cells somewhat closer to approval. Good for acquired pathologies, but prolonged relief in genetic disorders questionable as the very stem cells used are defective, coming from the patient only.

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