Neurological rehabilitation

Overview of Treatment

Neurorehabilitation therapy is a multidisciplinary medical approach aimed at patients with damage to the brain or peripheral nervous system. It utilizes integrated strategies to assist in restoring motor, cognitive, and daily functional abilities. This therapy primarily targets neurological impairments caused by strokes, spinal cord injuries, traumatic brain injuries, and similar conditions. Through systematic training and technological aids, it promotes neural plasticity and improves quality of life. The core goal is to enhance patients' autonomous mobility and reduce long-term care needs.

The treatment process typically includes physical therapy, occupational therapy, and speech therapy, with plans tailored according to the extent and stage of injury. Personalized assessments and phased goal setting can effectively delay disease progression and maximize recovery potential.

Types and Mechanisms of Treatment

The main treatment categories are divided into physical interventions and cognitive training:

• Physical therapy: includes electrical stimulation, mirror therapy, and balance training to promote neuromuscular coordination
• Occupational therapy: involves practicing daily living skills to help patients regain basic movements such as dressing and eating
• Cognitive training: uses computerized cognitive stimulation or memory games to improve attention and executive functions

This methods leverage neural plasticity mechanisms to stimulate the re-establishment of connections in undamaged neural pathways.

Advanced techniques such as transcranial magnetic stimulation (TMS) and robotic-assisted arm training can precisely stimulate specific brain regions to promote neural regeneration and compensation. Therapists adjust stimulation parameters and training intensity dynamically based on brain imaging and functional assessment results.

Indications

Suitable for functional impairments caused by cerebrovascular accidents, spinal cord injuries, cerebral palsy, multiple sclerosis, or Parkinson’s disease. It can also effectively accelerate recovery in patients post-surgery, such as after brain or spinal surgery. It is applicable for secondary muscle atrophy or joint stiffness caused by prolonged inactivity.

Target populations include:

• Post-stroke sequelae (motor deficits, speech impairments)
• Cognitive dysfunction after traumatic brain injury
• Limb weakness due to peripheral nerve injury

These should be evaluated jointly by neurologists and therapists to develop individualized plans.

Usage and Dosage

Frequency typically starts with 1-2 sessions daily, each lasting 30-60 minutes, with acute phase treatments lasting 3-6 weeks. Chronic phase treatments are maintained at 2-3 sessions per week. Intensity is adjusted based on patient tolerance, such as gradually increasing electrical stimulation from 1mA.

Training content is phased:

• Acute phase: passive movements to maintain joint range of motion
• Subacute phase: adding active-assisted training
• Chronic phase: emphasizing functional activities and community adaptation training

It should be combined with medication and post-surgical care within a multidisciplinary team approach.

Benefits and Advantages

Main benefits include:

• Improvement in limb function (Fugl-Meyer assessment scores increase by an average of 30-50%)
• Reduction of complications related to long-term bed rest
• Enhanced ability to perform activities of daily living (ADL scores improve by over 70%)

Its non-invasive nature makes it suitable for patients of all ages.

Compared to drugs or surgery, this therapy offers:

• No drug side effects
• Objective quantification of progress through assessment systems
• Patient engagement and subjective participation in treatment

It is suitable as an adjunct to other therapies.

Risks and Side Effects

Possible local reactions include:

• Joint overuse leading to sprains (incidence approximately 12%)
• Skin redness or swelling from electrical stimulation (can be avoided by adjusting electrode placement)
• Overfatigue leading to adverse psychological responses

These side effects are usually controllable under therapist supervision.

Serious risks include: Improper training may exacerbate spinal compression symptoms, and certain spinal cord injury patients may experience autonomic dysreflexia. Strict adherence to treatment plans and avoiding self-increasing training intensity are essential.

Precautions and Contraindications

Contraindications include:

• Uncontrolled intracranial hypertension
• Open wounds at the treatment site
• Severe cognitive impairment preventing cooperation

Patients with pacemakers or electronic implants should avoid electrical stimulation therapy.

Special precautions include:

• The first three months post-stroke are the golden period for intervention
• Diabetic patients should monitor blood glucose fluctuations closely during training
• Hypertensive patients should start treatment after blood pressure is controlled

Neuro assessments and cardiopulmonary evaluations are required before treatment.

Interactions with Other Treatments

When combined with antispasticity medications, dosage adjustments are necessary to prevent excessive muscle relaxation. Patients receiving botulinum toxin injections should start training two weeks post-injection for optimal results. When combined with surgical treatments, training should commence 2-4 weeks post-operation to avoid affecting wound healing.

When used with traditional Chinese acupuncture, attention should be paid to the cumulative effects of stimulation sites. When using neurotrophic factor drugs, timing with physical therapy should be coordinated to avoid antagonistic effects.

Effectiveness and Evidence

Systematic reviews show that stroke patients undergoing rehabilitation for over three months experience an average increase of 40 points in the Barthel Index (out of 100), with significant improvements in daily independence. Functional MRI indicates that continuous training can promote new neural connections in the frontal lobe and cerebellum.

For spinal cord injury patients, combining robotic-assisted surgery results in FIM scores that are 25% higher than those with single treatments. Clinical guidelines recommend at least six weeks of regular therapy to observe significant neural compensation effects.

Alternatives

When traditional rehabilitation is not feasible, consider:

• Home-based tele-rehabilitation systems: virtual reality simulations for training environments
• Pharmacological treatments: neuroprotective agents like edaravone to slow injury progression
• Surgical options: such as spinal cord stimulators to improve motor control

Selection should be based on the disease stage.

Alternative selection criteria include:

• Severe joint stiffness: arthroscopic release surgery
• Severe aphasia: computer-assisted communication systems
• Severe spasticity: botulinum toxin injections first

Decisions should be made by a multidisciplinary team after evaluation.

 

Frequently Asked Questions

What preparations are needed before undergoing neurorehabilitation therapy?

Patients are advised to undergo a detailed physical assessment, including tests of neurological function, muscle strength, and daily activity capabilities. Discuss past medical history and current symptoms with the therapist, and modify the living environment to ensure safety during treatment, such as removing obstacles or installing anti-slip devices.

How should I respond if muscle pain or fatigue occurs during treatment?

Temporary discomfort may occur due to neural or muscular adaptation. Patients should promptly inform the therapist to adjust training intensity and use ice packs or gentle stretching to relieve discomfort. Do not self-medicate with painkillers; follow the medical team's instructions.

How can diet support neurorehabilitation to enhance outcomes?

A balanced diet is crucial for nerve repair. Increase intake of omega-3 fatty acids (e.g., deep-sea fish), vitamin B complex (e.g., whole grains), and antioxidants (e.g., blueberries). Avoid excessive processed foods and refined sugars, and maintain adequate hydration to support nerve signal transmission.

After treatment concludes, how can I prevent symptom recurrence or deterioration?

Continued self-maintenance exercises such as daily balance training or hand function practice are recommended. Regular follow-up every 3-6 months and participation in physical therapy sessions can help. Maintain a healthy lifestyle by avoiding prolonged sitting and engaging in regular exercise.

How does treatment strategy vary across different age groups?

Children benefit from gamified training to increase engagement and focus on critical periods of neural development. Elderly patients require enhanced balance training and fall prevention, with instructions tailored to cognitive status. Adolescents may need specialized programs for sports injuries or limb coordination, emphasizing functional recovery and daily living skills.