What is neuro-rehab?

Depending on the type of neurorehabilitation provision, nurses from more than one discipline may be employed. E.g. Registered General Nurse (RGN), Registered Nurse Learning Disability (RNLD) or Registered Mental Health Nurse (RMN). Registered nurses work with trained support workers who provide day to day care and facilitate rehabilitation goals.

Due to the complexities of the central nervous system, people with neurological conditions can experience a variety of problems such as muscle stiffness or spasm (spasticity), muscle weakness, tremor, changes in sensation and difficulties with balance. The physiotherapist is able to assess and treat these impairments with the aim of restoring movement and function such as being able to sit or stand unsupported, walking and using the arms.

The role of an OT is to maximise independence in all areas of life. This includes activities of daily living (ADLs) such as washing, dressing and eating, rest and sleep, education, work, play, leisure, and social participation. The OT assesses and treats physical, cognitive, visual and perceptual skills to enable the individual to engage safely in activities that are meaningful and realistic for them.

Speech and language therapists assess and treat problems with speech, language, swallowing and eating as a consequence of a neurological condition. This may also include provision of communication aids where speech and language is severely impaired. Speech and Language Therapists may also treat individuals who have had a tracheostomy tube inserted enabling them to wean from the tube and breathe independently.

Neuropsychologists are concerned with the relationship between the brain and behaviour. They assess and treat people who experience difficulties with memory, concentration, planning, language, reasoning, and other aspects of learning and understanding as a result of a neurological condition. They work closely with the team to establish routines and programmes that support changes in behaviour, including the implementation of compensatory strategies.

A clinical psychologist differs from a neuropsychologist, because they primarily focus on emotions and behaviours. For example, a clinical psychologist can help to look at reasons for emotional distress and offer support to either the individual themselves, their family, carers, or the rehabilitation team.

The two disciplines therefore complement each other with their difference in focus on behaviour and many services will include both within their neurorehabilitation team. Although it is also very common to see Clinical Psychologists with Neuro experience working within a Neurorehabilitation team as there is often a shortage of qualified Neuropsychologists within the UK – these individuals will usually receive their clinical supervision from Neuropsychologists.

Diet is an important part of rehabilitation and the dietitian will ensure that dietary needs are met to promote good health and recovery. In addition the dietitian works closely with the speech and language therapist where the patient has difficulty swallowing or eating which requires diet texture to be modified. This also includes provision of non oral feeding when swallowing is too impaired to allow normal eating and drinking.

Therapy assistants may be assigned to one particular discipline or may be generic in their role. The role of the assistant is varied but may include session preparation, assisting in sessions when more than one staff member is needed, running group sessions guided by the therapist, completing therapist defined treatment plans and various administrative tasks.

NMT is often included in neurorehabilitation programmes and is seen as a valuable adjunct to the more established rehabilitation therapies. NMT is based upon neuroscience research which suggests that music is a hard wired language and aims to improve thinking, sensation and physical difficulties through the use of music.

Art therapy can provide both physical and psychological benefits. Not only does it provide a means of expression, especially for those whose verbal language skills are impaired, but also an opportunity to improve social skills and physical abilities through manipulating art materials and working within a group setting.

Hydrotherapy is an additional treatment used by physiotherapists where exercises and treatment techniques are undertaken in warm water. This helps to relieve pain, relax and strengthen muscles, increase circulation, and subsequently improve function. Due to the supportive nature of water, hydrotherapy also allows those with limited movement to maximise their mobility.

Orthotic devices are applied externally to a joint or a limb in order to support and correct abnormalities and improve function. Devices include splints, inner soles or specialist shoes and can be ready made or bespoke. Some orthoses are provided by the occupational or physio therapist but for more specialised devices a referral is made to an orthotist.

As it is not always necessary for people requiring Neurorehabilitation to be an inpatient in a service there are many ways in which people can receive this specialist treatment whilst remaining at home and attending appointments either at home or by going into a hospital or other centre.

The same professionals listed for an inpatient setting will work with individuals to maximise a person’s quality of life and address any barriers to recovery. The team and/or individual clinicians involved in treatment are likely not be of a medical focus but those focussing on functional and cognitive recovery.