The numbers are overwhelming.
One in six of the world’s population suffers from a neurological disorder.
Parkinson’s disease affects nearly 1 million Americans, and almost 800,000 people in the United States suffer a stroke every year.
But having a neurological injury or disorder does not mean life is over. The road to recovery following an injury or disease, such as stroke, Parkinson’s disease or multiple sclerosis, involves a multi-disciplinary team comprised of doctors, specialists, nurses, therapists, family members and many others. One of the steps to get your life back is outpatient neurological rehabilitation.
| Donna McMahan
St. Joseph’s/Candler offers neurological rehab throughout the entire spectrum of care. This includes rehabilitation from acute care to inpatient to skilled nursing to home health to outpatient.
Neurological rehab focuses on the brain more than the body, says Donna McMahan, St. Joseph’s/Candler physical therapist, who is a graduate of the neuro rehab residency program at Brooks Rehabilitation Hospital (Jacksonville, Fla.).
While the program may have some of the practices and principles of general physical therapy, neuro rehab delves deeper into each injury or disease to design a plan of care that optimizes more normal movement patterns and mobility.
“We must retrain the brain,” McMahan says.
A neurological physical therapist is a physical therapist who specializes in the evaluation and treatment of individuals with movement disorders due to disease or injury to the nervous system. The nervous system is anything that involves the brain, spinal cord, or peripheral nerves. Changes within this system may affect strength, balance, sensation, and cognition. Neurological rehab helps to restore or improve mobility required to achieve the highest level of independence and community reintegration, McMahan says.
Neurological physical therapy has a different role depending on the disease or injury. For example, the plan of care for those individuals with Parkinson’s disease emphasizes recovery of mobility, strength and balance; however, there is also a requirement for education on compensation techniques and caregiver education, as this is a progressive disorder.
This differs from recovery intervention following a stroke, as early intervention is focused on recovery of strength and mobility to returning to the highest level of independence and normalcy as possible.
“The biggest thing for neuro rehab is figuring out which part of the brain or spinal cord is affected,” McMahan says. “What is that part of the brain or spine responsible for, and how are we going to work to improve that area as well as remap around the injury to get the individual to the highest level of functional mobility and independence.”
Who would benefit from neuro rehab?
Neuro rehab is designed for people with diseases, trauma, or disorders related to the central nervous system. The majority of patients that McMahan works with are recovering from a stroke or have Parkinson’s disease. Other common movement disorders treated are multiple sclerosis, spinal cord injury, brain injury, vestibular disorders, history of idiopathic falls, and balance impairments.
Following an acute injury, such as a stroke, it is important for patients to understand outpatient physical therapy is an essential next step following inpatient or skilled nursing rehabilitation.
Following catastrophic injuries – a severe injury to the spine, spinal cord or brain – patients should know that the recovery process is ongoing and significant gains can be made up to two years, with the greatest degree of recovery occurring in the first six months. This is why early intervention is a must, McMahan says.
No two cases are the same, says McMahan, but a skilled neurologic physical therapist can help determine the prognosis of regaining mobility as well as how to educate and develop the most appropriate compensations to prevent secondary injuries should the patient reach a plateau.
“Just because you were discharged from a skilled nursing facility or hospital does not mean you are done with the rehabilitation process. It just means you are ready and healthy enough to go to outpatient therapy,” McMahan says. “I love inpatient rehab and skilled nursing because it teaches patients that they can be independent, gets them back home, and shows them that they have recovery potential. Outpatient therapy is where you can find ‘yourself’ again and learn your ‘new normal.’ This is also the time that we work together to help you return to your hobbies or help you become a part of adaptive sports and recreation. Outpatient is where we can really achieve those personal goals.”
Neuro rehab is not just about the patient. McMahan also works with caregivers. With these types of injuries, it is not only life changing for the patient, but their loved ones as well. She feels it’s important they are educated on the recovery process, as well as ensuring they are safe while caring for a loved one. She also listens to the families’ needs, concerns, and fears and determines if and what help may be needed, as well as education on support groups and community programs.
What can you expect during rehab sessions?
Neuro rehab is based on what disease or injury the person has, McMahan says. Each plan of care is unique and individualized to the patient.
Stroke and Parkinson’s patients, for example, can expect high repetition, high intensity sessions. The most common goal McMahan hears is, “I want to walk independently.” To achieve that goal, patients will be guided through a rigorous and task-specific program such as treadmill training. These patients should expect to be up and moving the entire session, which typically last 45 minutes to an hour, and working at personal capacity.
Multiple sclerosis patients, on the other hand, often experience MS fatigue and cannot handle high intensity or lots of repetition. McMahan will have patients with MS fill out a fatigue questionnaire, and do a series of exercises to gage their fatigue levels. MS fatigue can improve over time with rehab if started with the appropriate exercise dosing. This is why it is important to find a neurologic physical therapist because there is wide spectrum of movement disorders and each are unique, McMahan says.
No matter the diagnosis, each patient should expect to be given a home exercise program.
“I tell people, just like the doctor prescribes medicine, I am prescribing a specific exercise dose, and it is important that you remain compliant with the prescription,” McMahan says.
Patients participating in a neuro rehab program can expect a variety of treatment techniques that will help individuals move better, restore functional mobility, prevent disability, slow disease progression, and facilitate or maintain good health. For example, treadmill training is a very task-specific and goal-oriented activity.
“Just because you are unable to walk at this time doesn’t mean I am not going to get you on a treadmill,” McMahan says. “You are in a harness and you are safe, but if you want to walk again, you actually have to walk.”
Body Weight Support Treadmill Training allows for a safe, efficient, and effective option to improve walking mechanics, speed, and balance, McMahan says. Patients are fitted in a harness that is placed over a treadmill. With the LiteGait unweighting system, a percentage of body weight is removed from the patient to allow for a more normalized stepping pattern as well as to allow the patient to take more steps. Repetition is key.
This open harness system also allows for manual assistance for lower extremity advancement and placement to optimize and achieve the most normal gait pattern so that the cortical reorganization that occurs after an injury to the nervous system relearns and establishes the most optimal movement pattern and sequence, McMahan says. After walking on the treadmill with the best form achievable, the patient is better able to walk overground more efficiently and with less assistance.
Treadmill training not only improves gait but also balance, coordination, core strength, upright tolerance and posture. As you improve, weight is reduced to simulate daily ambulation and improve lower extremity strength and endurance.
How is the brain retrained through neurologic rehab?
The adult brain is plastic, meaning that it is capable of change and cortical remapping, McMahan says. Movement patterns, language, and skills are all housed in the brain. Following an injury, these skills and patterns are disrupted, and in some cases even erased. However, through neuroplasticity the brain is able to adapt, remap, and relearn these patterns, McMahan says. It takes a lot of hard work and repetition, but learning to walk again is synonymous to trying to learn a new language as an adult, says McMahan.
It is also important to understand that plasticity and recovery are affected by age, disease, extent of injury, and comorbidities. The amount of recovery is different for everyone, and unfortunately results are not guaranteed, McMahan says.
However, through creative thinking, problem solving, hard work, and employment of evidenced-based practice, the patient and loved ones will be taught how to manage their health condition, maintain optimal function, slow declines, and achieve the long-term health benefits and overall life-satisfaction and quality of life.
“I don’t want people to think just because something traumatic happened to them or they received a disease diagnosis that life is over,” McMahan says. “Your entire medical team – doctors, nurses, etc. – have worked hard to save or improve your quality of life. However, physical therapy is where you truly get your life back through improving your independence and functional mobility. Recovery takes a long time, but there’s a lot of recovery to be made. Exercise is the only intervention that provides a neuroprotective effect. You just have to want it and be willing to earn it.”
If you think neuro rehab would be beneficial to you, talk to your primary care doctor or specialist. A physician’s referral is required for outpatient rehab.
If you have more questions about outpatient rehab, contact any of our seven locations.