NeuroRehabilitation

• What new technical treatment options are there?

  In addition to the established forms of therapy, such as physiotherapy, occupational therapy, speech therapy, massage therapy and psychology, there are several new technologies available:

• Transcranial electrostimulation: This refers to the stimulation of the central nervous system by externally applied electric fields. How does this work? Barely perceptible electric currents are passed through the skin by means of electrodes attached to the front and back of the head and support the cerebral metabolism.

• As a matter of principle, electrotherapy can be used to improve muscle function, to alleviate pain or to improve perfusion. Muscle stimulation also stimulates sensors that in turn activate the function of the central nervous system.

• Functional electrical stimulation: This refers to the stimulation of the muscles at a precisely tuned time to support complex movements.How does this work? With the help of attached electrodes, the control of a paralyzed nerve is stimulated with slight electrical impulses – the muscle thus moves again. The timing of the stimulation is controlled by motion sensors.

Neurofeedback: If various neural pathways (information pathways) have been completely and irreversibly destroyed, a “bypass” is used to transfer the information either from the brain to the periphery or from the periphery to the brain.  

• How does this work? Brain-computer interfaces are based on the realization that even imagining a behavior already causes measurable changes in the electrical activity of the brain. For example, imagining moving a hand activates the corresponding motor cortex area. During therapy, both the computer and the human being learn which changes in brain activity are associated with specific ideas, and thus the movements become more and more accurate.

• Another further possibility is a “brain-computer interface” (BCI): This “brain-computer interface” is a special device that allows communication between the brain and a computer without activating the peripheral nervous system. Here the electrical activity of the central nervous system is registered (via EEG or implanted electrodes) and converted, by a computer, into movement. This can be achieved, for example, by electrical stimulation of the patient’s own muscles, but alternatively also via external motors e.g. driving a wheelchair or moving prostheses.

• How does this work? EEG electrodes are applied to the patient’s head. With the help of EEG measurement, cerebral activity is visualized. Via a screen, the patient is given an audiovisual feedback that feeds back changes in cerebral activity. By selecting the electrode positions and the software, the therapeutic effect is controlled.

• Neurofeedback is a specialized form of biofeedback (EEG biofeedback). Here activities of the periphery (e.g. muscle activity) are registered, optically and / or acoustically displayed, and thus passed via the eye or ear into the central nervous system.
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• Who is in charge of the neurological rehab?

  Neurological rehabilitation requires a transdisciplinary team. This comprises not just physicians and social workers, but also e.g. bioengineers and computer scientists. During its work, the team has to take into account the changes occurring over the course of the disease process.

  Modern rehabilitation should follow a “3T” approach. This means Treatment – Technology – Translationality (development). Treatment and technology must be interconnected; developments should take place in parallel.

  Unfortunately, modern technologies in neurological rehabilitation are no panacea. However, they open the possibility of individual and thus personalized rehabilitation. Each neurological disorder must be considered as an individual, patient-related process in order to enable the patient to get the best possible therapy.

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While a patient will still have a primary care medical team, the rehabilitation team provides additional treatments and therapies. The rehabilitation team consists of highly skilled professionals dedicated to each patient’s needs. The most appropriate treatment plan for each patient is developed after an evaluation. Neurological rehabilitation may include some of the following team members:

• • Physiatrists are doctors who specialize in physical medicine and rehabilitation.
  • Neuropsychologists see patients for cognitive and/or behavioral issues related to brain injury, stroke or other illnesses. They also work with patients who need help getting used to changes in their levels of ability. They may recommend cognitive therapy, stress reduction techniques or other treatments.
  • Physical therapists help and treat patients with a disease or injury contributing to pain or to loss of strength, range of motion, balance or coordination. Their goal is to restore and maintain a person’s ability to move and do physical tasks.
  • Occupational therapists assess how well patients can do daily tasks such as eating, dressing, toileting and bathing. Their goal is to help patients do as much on their own. Occupational therapists can perform vision assessments as ordered by the physician.
  • Speech-language pathologists treat patients who have problems with speech and thinking skills. These problems are common among those who have had a stroke, brain injury or other changes to the nervous system. Speech-language pathologists also work with patients who have difficulty swallowing.
  • Therapeutic Recreation Specialists help patients pursue leisure interests or develop new ones. They provide resources for support and for community involvement that a patient can continue with when they leave the inpatient rehabilitation unit.

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Although pulmonary medicine only began to evolve as a medical specialty in the 1950s, William Welch and William Osler founded the ‘parent’ organization of the American Thoracic Society, the National Association.