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Neurorehabilitation: Importance and Recent Advances

There is an overall lack of understanding when it comes to rehabilitation, even within the medical community unless you are a PMR (physical medicine and rehabilitation) specialist, a physiotherapist, an occupational therapist, or a speech and language pathologist. Rehabilitation should be given as much importance as acute care. There is a huge imbalance in the number of rehab specialists available for the Indian population. In the UK there are around 1100 rehabilitation beds for the entire population (around 53 million) whereas in India there are only 800 of those for 1.3 billion people. This imbalance makes it harder for patients to access rehabilitation facilities, especially neurorehabilitation. 

MedPiper Technologies and JournoMed in association with HAMSA Spine and Brain Rehab Centre, Shree Balaji Medical College and Hospital, Chennai and Kauvery Hospital, Chennai had conducted a webinar on 24th March, 2022 titled “ Advances in Rehabilitation: Rehab after Stroke, Spine and Peripheral Nerve Injuries” where the speaker, Dr. G Balamurali, explained some of the recent developments in the field of neurorehabilitation. Dr. G. Balamurali is the Head of Spine and Neurosurgery at Kauvery Hospital and Managing Director of HAMSA Spine and Brain Rehab Centre, Chennai. He is also an Adjunct Professor at Sree Balaji Medical College and Hospital, Chennai. 

Why is Rehabilitation Necessary?

Acute care involves the immediate short-term healthcare consisting of life-saving procedures where the patient is treated for the illness, disease or injury. Acute care in India is well-established, well-studied, and backed with proper medical reimbursement. Chronic care in India on the other end is not backed by enough studies and randomised controlled trials. Long-term care is just as essential as acute care as it helps trauma and disabled patients to have a better quality of life. The other big problem with chronic care is that there is no proper reimbursement. Dr. Balamurali states that the field of chronic care and rehabilitation needs more understanding and widespread awareness. 

What is Neurorehabilitation?

Neurorehabilitation constitutes for around 70% of the rehab cases. After an accident or a stroke, there is significant neuronal damage which may either cause short term or lifelong disability. Rehabilitation is about learning skills, adjusting to the new normal, and avoiding further complications. The doctors should communicate with the patients, help them maintain a positive attitude through all the despondency and be realistic about the timeframe of healing, not giving false promises. 

Strokes, Brain Injury, Spinal Cord Injury, Neurodegenerative Disorders like Parkinson’s, Alzheimers and Ataxias, Post trauma operations, and Paediatric issues like Cerebral Palsy require neurorehabilitation. 

The unique features of Neurorehab is that the patient groups are not as easy to treat due to various problems such as:

  1. Low consciousness, loss of memory and understanding
  2. Airway problems due to tracheostomy, ventilation, and oxygenation
  3. Speech and swallowing issues
  4. Nutrition via NG or PEG tubes 
  5. Bed Sores, contractures, muscle and limb wastage
  6. Lack of coordination and balance
  7. Aggressive, anxious, depressed, stressed or not motivated at all. 
  8. Emotionally and financially exhausted

Neurorehab consists of a large team of rehab physicians, trained nurses, physiotherapist, occupational therapists, speech and language pathologists, psychologists, dieticians, vocal and recreational therapists, social workers and support assistants. It even consists of a medical team of neurosurgeons, neurologists, spine surgeons, psychiatrists, urologists, physicians, anesthesiologists, and respiratory specialists. All of the specialists involved should be aligned with the common goal and plan of action. 

Recent Advances in Neurorehabilitation 

Skin Care: Regularly turning (i.e. every four hours) the patient will help reduce bedsores. Airbeds and materials that reduce pressure on the skin will also help with avoiding bedsores. 

Respiratory Outcomes: Respiratory complications are one of the major causes of death after an acute spinal cord injury. Using Silver coated endotracheal tubes can help reduce ventilator associated pneumonia. Early tracheostomy is also associated with lower rates of pneumonia and shorter periods of mechanical ventilation in trauma patients. 

Pain Management: Around 80% of patients with spinal or head injury suffer from pain, 60% of which have lifelong pain. Many specialists go for therapeutic procedures that do not involve painkillers such as DREZ lesioning, Spinal cord stimulator and Intraspinal pumps. Sometimes, deep electrical stimulation of brain structures and spinal cord also help with abating debilitating chronic pain. 

Bowel and Bladder Care: Brindley Bladder Stimulator enables controlled voiding of the urinary bladder, thus improving continence and reducing UTIs. Bowel Irrigation helps with enabling defecation and improving gut health. 

Technological Advances in Neurorehabilitation 

Virtual Reality technologies are emerging tools aid in cognitive training, mobility and coordination. Functional electrical stimulators enable muscle strengthening via electrodes placed in the limb. Robot-aided neurorehab can improve the interface between physician and therapist. Brain machine interface is a future research tool where the electrodes are connected from the brain to the software, which helps to bypass the spinal pathway (which may be non functional due to trauma or damage). This interface allows for the direct translation of thoughts to movement. 

There are other technologies with respect to transport and mobilisation that help neurorehab patients to adapt to the environment in terms of daily living. These include wheelchairs, stair climbers, and hand control systems for driving. Voice recognition software and adaptability switches can also assist the patients with moving through familiar spaces. 

“Rehabilitation is a field that has major scope to expand in the coming decades” says Dr. Balamurali. Surgeons perform procedures to help improve functionality, however putting that functionality to use is what rehabilitation encompasses. Rehab aims to provide life after trauma and it is the need of the hour in healthcare.

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