We do many daily tasks that involve the coordination of sense organs, muscles and mental focus. Our nervous system controls these bodily functions. However, when one faces neurological conditions such as a spinal cord injury or stroke, the nervous system gets affected, leading to impaired nerve functions.
Even after treatment, these issues may not get resolved completely. Instead, they may cause various motor disabilities and cognitive and sensory deficits and further restrict a person’s movement and functioning. Such disabilities could also lead to stigmas and limit the person’s social participation.
In addition, affected persons could also find it challenging to independently perform their daily routine activities such as eating, dressing, walking or speaking.
Loss of bodily functions was earlier thought to be an irreversible condition. However, that belief has changed now, thanks to neurorehabilitation.
Neurorehabilitation is a customised treatment method catering to individual needs and challenges. Different health experts are part of a team, which helps achieve the desired outcome for the person.
Palak Dengla, chief physiotherapist at Aster RV Hospital, Bengaluru, says neurorehabilitation is highly effective in helping people get back to their life. “We had a case of a Bengaluru-based accountant who met with an accident while riding a bike. She had a spinal cord injury in the neck region [and was paralysed] in all four limbs. She was unable to move or control her neck and had lost bladder and bowel control,” she says in an interaction with Happiest Health.
Remarkable progress
Dengla says the sessions began after two weeks of medical treatment. “[The person] was subjected to physiotherapy and occupational therapy twice a day. Beginning with some flicker of movements in her feet and hands, she had some hand movements and could turn in bed with assistance after four months,” Dengla says.
After seven months, her situation improved further into assisted sitting and some trunk control. In a little over a year, she could walk with the help of a walker and do her daily tasks such as grooming, eating and bathing, all thanks to neurorehabilitation, she adds.
Targeted methods can help people get back on their feet partially or wholly and improve their quality of life. “In this [method] an [affected] person is trained in different comprehensive methods to get them back to their functional activities as much as possible – [as they were] before the neural injury,” says Dengla.
She cautions that while the therapy improves their functions and quality of life, the damaged organs may not perform as well as before.
Retraining the brain
Neurorehabilitation techniques train the brain regions to regain their lost functionality. “Neurorehabilitation can be used in many neurological disorders such as stroke, Parkinson’s disease, traumatic brain injury, spinal cord injury, multiple sclerosis, muscular dystrophy, cerebral palsy, Down syndrome, hydrocephalus and slipped disc,” says Dr Priyank Vasavada, consultant neurosurgeon, Shree Giriraj Hospital, Rajkot, Gujarat.
Dr Vasavada explains that neurorehabilitation includes physical, social and mental exercises. Various physical exercises and techniques help strengthen muscles and endurance when arms or legs become weak, helping the individuals be independent to the best possible extent.
Neural injury has a tremendous impact on mental health also. Its sudden onset does not give a person time to adjust mentally, affecting their morale. Sometimes, they also face behavioural changes like irritability, rigidity and anger due to the long-term effects of the condition. Thus, psychological rehabilitation is also done to provide strength and mental coping mechanisms to deal with injury, elaborates Dr Vasavada.
“One also faces social challenges, as they may be unable to go to the toilet due to weak muscles. Their gait is also impaired, and they need to use diapers or wear catheters all the time. Dealing with these issues while maintaining a person’s dignity is also part of neurorehabilitation,” he adds.
All about neuroplasticity
Dengla says, “Neurorehabilitation works on the principle of neuroplasticity, a process involving structural and functional changes in the nervous system in response to internal and external stimuli. It [neuroplasticity] is present both in the brain and peripheral nerves.”
It enables the brain to compensate for damaged areas by rerouting neuronal pathways, in the process creating new connections and triggering nearby regions to perform the disrupted function.
Certain motor learning practices in neurorehabilitation involve repetitive practice and biofeedback to train the person’s brain to relearn the lost actions. Repetitive movements create new neural pathways. “We work on this principle to make a person functional and improve the person’s quality of life,” adds Dengla.
Different methods
Dengla outlines a few techniques that are part of neurorehabilitation:
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Physiotherapy:
- Involves muscle strengthening exercises to improve the affected person’s endurance, balance and movement.
- Individuals are given walking aids, prostheses or supporting braces if necessary.
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Occupational therapy:
- It focuses on fine motor skills such as buttoning the shirt, brushing or writing where neuro-muscular coordination is involved.
- Cognitive training to improve memory, attention and problem-solving capabilities.
- An occupational therapist can suggest modifications in the workplace, such as grab bars at a certain height, based on the person’s profession.
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Speech and swallowing therapy:
- These are done to improve impaired speech and swallowing of food. Specific exercises are taught to a person to produce certain sounds and improve the fluency of speech. Exercises are taught to strengthen the coordination of swallowing muscles and body position for problem-free swallowing.
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CIMT or constraint-induced movement therapy:
- The affected side of the body is stimulated by restraining the unaffected side. For example, if a person’s right hand is affected due to a stroke, the therapist restrains the left hand, thereby inducing a natural default mode of force in the right hand to work.
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Aquatic therapy:
- Therapists make use of the buoyancy of water to train the affected persons when their muscles are under reduced stress in water. Exercises are done in water in a controlled manner to improve muscle coordination, muscle strength and balance.
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Virtual reality:
- It is used to develop hand-eye coordination and improve balance with the help of video games and simulation with head-mounted displays.
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Robotics-assisted devices:
- Nowadays, robotic devices such as the Lokomat — a robotic walking treadmill – are used to assist persons whose lower limbs are impaired. Over time, this strategy it reinvigorates the muscle-nerve coordination and promotes improved mobility.
Nowadays smart wearable devices are available to track the person’s daily progress in the range of motion and muscle strength.
Many people are also able to resume their previous occupations. Dengla says advancements in therapeutic techniques could be useful where recovery has been incomplete.
To know more about neurorehabilitation, ask an expert.
