Justifying neurorehabilitation

Neurorehabilitation is evolvingrapidly in our changing health care environment. Neurologists provide principal care to patients with chronic nervous system impairment. Neurologic management is not limited to diagnosis and prevention. Neurologists use rehabilitation strategies to limit medical complications and enhance functional and physiologic recovery. With the advent of managed care, there is escalating pressure to document both treatment efficacy and efficiency. Fortunately, this pressure converges with our motivation to understand the scientific basis of neurorehabilitation. For divergent reasons we are moving in the right direction. MS is a prototypical illness that is managed by neurologists in both the acute and chronic setting. Although immunosuppressive therapy holds promise to slow CNS demyelination, most MS patients continue to have progressive limitation of activity. The MS complications treated in the rehabilitation setting include paralysis, spasticity, cognitive impairment, movement disorders, visual disturbances, pain, affective disorders, and autonomic dysfunction. Neurorehabilitation targets these disease manifestations to help patients maintain greater and more long-lasting independence. Inpatient rehabilitation offers a structured “package” of intensive services. MS patients are usually referred for rehabilitation after functional decline related to disease activity, trauma, surgery, or systemic illness. Inpatient rehabilitation typically follows either acute inpatient …