Neurological Rehabilitation and Holistic Medicine in Neurology
By- Dr. Shreyjit Kaur, Medical Officer, Umeed Multi-Speciality Hospital, Sangrur
Neurological rehabilitation is a complex doctor-supervised program for patients with nervous system disorders, diseases, and injuries. It aims to restore physiological function, compensate for functional alterations and minimize symptoms while enhancing the patient’s overall well-being and quality of life.
The neurologic conditions that may benefit from neurological rehabilitation include, but are not limited to:
- Vascular disorders, e.g., ischemic or hemorrhagic stroke, subdural hematoma, transient ischemic attacks, etc.
- Infections, e.g., meningitis, encephalitis, poliomyelitis, brain abscess, etc.
- Trauma, e.g., brain and spinal cord injuries.
- Structural and neuromuscular disorders, e.g., Bell’s palsy, cervical spondylosis, carpal tunnel syndrome, peripheral neuropathy, muscular dystrophy, myasthenia gravis, etc.
- Functional disorders, e.g., headaches, seizure disorders, neuralgia, etc.
- Degenerative disorders, e.g., Parkinson disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS), Alzheimer disease, Huntington chorea, etc.
Many skilled professionals form a multi-disciplinary team in neurological rehabilitation, such as a neurologist/neurosurgeon, orthopaedist/orthopaedic surgeon, internist, rehabilitation specialists, nutritionist, physiotherapist, occupational therapist, speech/language therapist, social worker, psychologist/psychiatrist, chaplain, vocational counsellor, etc. Neurological rehabilitation programs help the patient achieve the following goals:
- Performing activities of daily living (ADLs), e.g., eating, dressing, bathing, toileting, cooking, basic housekeeping, etc.
- Speech therapy to help with speaking, reading, writing, or swallowing.
- Bladder and bowel re-training.
- Activities to improve walking, mobility, muscle control, gait, balance, etc.
- Pain management.
- Nutritional counselling
- Management of anxiety, depression, post-traumatic stress disorder, sleep disorders, etc.
- Activities to improve cognitive skills, concentration, attention, memory, etc.
- Development of social and behavioural skills.
- Help with obtaining assistive devices that promote independence.
- Educational and vocational counselling.
A toolbox of newer options for neurological rehabilitation of disabling brain disorders such as stroke and traumatic brain injury is fast emerging; based on increasing awareness of the regenerative potential of the brain and dynamic brain reorganization. These are described as follows:
Constraint-induced movement therapy (CIMT).
It is a prototype example of translational neurorehabilitation for the paresis of the upper limb. In CIMT, stroke survivors wear a mitt on the unaffected hand during most of their waking hours to reinforce the use and mobility of the paretic arm and perform task-specific, repetitive movement shaping.
Weight-supported treadmill training It is intensive, experience-dependent functional movement training where the patient wears a supportive harness. Technicians are stationed with the patient on a treadmill to assist in trunk movements and balance at a minimal walking speed. Stroke survivors may greatly benefit from upright aerobic training for general health, insulin resistance, bone mass density, and psychological well-being.
Constraint-induced language therapy
It is reported that some treatment modalities may indirectly support a function, an effect known as “vicariation.” Vicariative interventions may activate a neural system that is closely interacting with the stroke-impaired network so that both neural systems are functionally active during the treatment. There are various examples of stroke survivors with acute and chronic aphasia who were made to use their left, non-paretic hand to make communicative and non-communicative gestures that eventually improved their verbal language. Prism adaptation training for spatial neglect consists of simple, brief, in-hospital rehabilitation sessions where the 20-diopter, 12.4° right-displacing wedge prism lenses are usually worn for a few short sessions of intensive motor training. Optical displacement while wearing wedge prisms induces a “virtual” mismatch between perception and action, prompting functional, automatic self-correction.
“Virtual reality” platforms that implicitly integrate 3D motor and perceptual function, allowing immersive, novel visual-motor experiences, have been used to rehabilitate hemiparesis, spatial dysfunction, memory and learning, organizational skills, and psychiatric problems such as anxiety disorders. By directly activating complex brain networks and prompting the patient to move and react, virtual reality interaction could increase treatment adherence and engagement.
Transcranial magnetic stimulation(TMS):
Some promising results are showing the benefits of repetitive TMS as an add-on therapy in several neurologic and psychiatric disorders, including stroke, tinnitus, chronic pain, posttraumatic stress disorders, etc. Also, the FDA has approved the use of rTMS in single-drug-resistant unipolar depression.
Transcranial direct current stimulation(tDCS):
There is growing evidence suggesting that tDCS may exert therapeutic effects in improving motor dysfunction, chronic pain, memory impairment, addictive craving, major depression, speech production in aphasia, and spatial neglect.
Despite the prevalence of various types of neurological disorders, unfortunately, there are only a limited number of definitive treatments that can fully cure them. Therefore, complementary and alternative medicine (CAM) plays a vital role in treating such patients and is often used to support conventional medical approaches. A few of the most typical examples are as follows:
- Acupuncture is effective in managing headaches and persistent lower-back pain.
- Chiropractic therapy is beneficial to some extent for acute lower-back pain, neck pain, and muscle-contraction headaches.
- Some herbal remedies have been reported to be beneficial for mild depression (e.g., St. John’s wort), migraines (e.g., butterbur), and mild dementia (e.g., Ginkgo biloba).
- Various diets (e.g., the ketogenic diet) have also been used in the management of epilepsy.
- Yoga has been used as an adjunctive therapy for carpal tunnel syndrome, multiple sclerosis, epilepsy, post-stroke paresis, diabetic neuropathy, etc. Hatha Yoga has been observed to show improvements in motor function such as shoulder flexibility, spinal flexibility, etc. Sudarshan Kriya (yogic breathing exercise) has been shown to enhance mood in patients with depression.
- Tui Na (Chinese massage therapy) and yoga have been shown to improve symptoms in patients with fibromyalgia.
Achieving a holistic perspective on human health allows healthcare providers to achieve an overall understanding of all the physiological, psychological, and social needs of patients. However, extensive and exhaustive research is the need of the hour to effectively study the safety and efficacy profiles of CAM therapies, including research on potential negative interactions between CAM therapies and conventional treatments, to bring forth their true value in neurology and other disciplines of medicine.
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Author – Dr. Shreyjit Kaur, Medical Officer, Umeed Multi-Speciality Hospital, Sangrur