32 - The organization of neurorehabilitation services: the rehabilitation team and the economics of neurorehabilitation

Summary

The Concise Medical Dictionary (Oxford University Press, 2000 edition) defines “rehabilitation” as:

1. (in physical medicine) the treatment of an ill, injured, or disabled patient with the aim of restoring normal health and function or to prevent the disability from getting worse;

2. any means for restoring the independence of a patient after diseases or injury, including employment retraining.

With its emphasis on plasticity and repair of the nervous system, the Textbook of Neural Repair and Rehabilitation is predicated on this broad definition rather than the more restricted one assumed traditionally by physical medicine and rehabilitation; that is, “development of a person to the fullest physical, psychologic, social, vocational, avocational, and educational potential, consistent with his or her physiologic or anatomic impairment and environmental limitations (DeLisa, 1993).” Nevertheless, because rehabilitation does not presume perfect restoration of anatomical connections, implicit in the concept of rehabilitation is a holistic, comprehensive, and transdisciplinary team approach, which includes patient education in primary and secondary prevention of disease processes. Thus patients and caregivers are integral parts of the rehabilitation team.

The World Health Organization model of rehabilitation

Restoring patients' overall functioning in their social environment requires development of complex outcomes measures and the vocabulary to support them. The World Health Organization (WHO) International Classification of Functioning, Disability, and Health (ICF) provides a foundation for discussing the tenets of traditional rehabilitation and its social context (World Health Organization, 2001) but is limited as a descriptive tool for the broader view of neurorehabilitation, which incorporates plasticity and repair of the nervous system.