31 - Rehabilitation outcomes in neurological and neurosurgical disease

Summary

Introduction

Rehabilitation is integral to all neurological and neurosurgical management because almost every patient has some alteration in behaviour, function or life style as part of their illness and rehabilitation is concerned with these aspects of illness. Thus almost every clinician is necessarily involved in some rehabilitation, particularly as many patients with neurological or neurosurgical disease are unfortunately left with life-long neurological loss. Specialist rehabilitation might help many of these patients to gain maximum benefit from their surgery or medicine but specialist services are often not available, in the UK at least. Therefore it becomes the responsibility of the initial clinician to be actively involved in the rehabilitation of many of their patients. This is often quite appropriate because it maintains continuity of care and expertise, and it may be essential in the absence of specialized services.

Thus this chapter is aimed primarily at the neurologist and neurosurgeon, not the rehabilitation specialist. The purpose of this chapter is to help clinicians judge the effectiveness of rehabilitation both in research literature and in local practice. It will first explain what the aims of rehabilitation are, because often these are not discussed or recognized. An understanding of the aims is essential if the outcomes from rehabilitation are to be measured. Then the chapter will discuss the processes involved because in practice rehabilitation is often monitored (audited) through measures of process. Third, the chapter discusses some of the processes, and reviews the evidence relevant to intervention where that exists. However, it must be recognized that the quantity and quality of rehabilitation research is limited.