Neurorehabilitation: Recent Developments

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The face of robot-assisted neurorehabilitation has progressively transformed over the last few years. While traditional neurorehabilitation procedures treating the most common neurological conditions such as stroke, spinal cord injury, Parkinson's disease, spasticity, severe brain injury and cognitive disorders may have limited effectiveness, new technologies have reportedly significantly improved the effectiveness of rehabilitation strategies for theses ailments. Robot-assisted training may be supplemented with new and emerging technologies to further increase the improvement of function for patients including the application of virtual and augmented reality and non-invasive brain stimulation (NIBS) or a form of functional electrostimulation. When paired with robot-assisted technologies these tools enhance both the intensity and quality of neurorehabilitation by manipulating brain excitability and plasticity. Other new technologies can further help recover the wellbeing and increase the quality of life of patients during and after rehabilitation therapy including various forms of assistive technology and domotics.

Novel applications of advanced technologies for neurorehabilitation have a beneficial effect on reliable measurements plasticity. The functional MRI, high-density EEG and near infrared spectroscopy are rapidly confirming outcome measures. The creation of translational and back-translational models ensures the formation of a solid neurobiological evaluating current approaches to disorders. New approaches during the acute phase of neurological ailments, most crucially research on the most appropriate timing of the intervention, play an important role in further optimizing neurorehabilitation.

Neurological rehabilitation programs dealing with diseases, injury, or disorders of the nervous system can be performed on an inpatient or outpatient basis, and at times a combination of both. In addition to the neurologist (or neurosurgeon), orthopedist (orthopedic surgeon), physical or occupational therapist and other rehabilitation specialists, a number of skilled professionals can be included in the neurological rehabilitation team; psychologists/psychiatrists, physiatrist and internists, other specialty doctors, registered dietitians, speech and language therapists, audiologists, social workers and case managers, as well as recreational therapists among others.

Complementary activities that may be used in combination with robotic neurorehabilitation therapies include:

• Nutrition counselling
• Stress, anxiety, and depression management
• Assistance with and enabling of daily activities (eating, dressing, bathing, essential housekeeping skills etc.)
• Speech therapy to help assist speaking, reading, and writing including constraint-induced language therapy and other methods to stimulate speech and motor output.

• Activities that enhance movement, gait and balance coordination including:
  • Prism adaptation therapy
  • Therapies using virtual feedback and implicitly integrating 3D motor and perceptual function
  • Constraint-induced movement therapy
  • Other intensive, experience-dependent learning
• Transcranial magnetic stimulation inducing a permissive brain state (improving motor and cognitive recovery in addition to being beneficial for treatments of depression).
• Transcranial direct current stimulation (promoting better rehabilitation outcomes mood and motor and cognitive functions).

Neuro Rehabilitation Disorders:

• Vascular system disorders such as ischemic heart disease, hemorrhagic strokes, and subdural hematoma
• Infections, such as meningitis, encephalitis, polio, and brain abscesses
• Structural or neuromuscular disorders, such as Bell palsy, cervical spondylosis, carpal tunnel syndrome, brain or spinal cord tumors, peripheral neuropathy, muscular dystrophy, myasthenia gravis, and Guillain-Barré syndrome
• Degenerative disorders, such as Parkinson disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS), Alzheimer disease, and Huntington chorea
• Functional disorders, such as headache, seizure disorder, dizziness, and neuralgia
• Trauma, such as brain and spinal cord injury

 
While evidence-based medicine was, to a degree, somewhat difficult to apply in the field of neurorehabilitation, there is a renewed interest in data-driven systematic reviews and meta-analyses, and a recent increase in participation and interest in consensus conferences. Furthermore, new randomized controlled trials exploring and evaluating combined drug and physiotherapy treatments are emerging, lending more visibility in the field of neurorehabilitation in general, while improving function and reducing symptoms for the individual patient.