What is Neuro-rehabilitation?
Neuro-rehabilitation centres around the scientific principle of Neuro-plasticity – the ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function and connections. By conducting a comprehensive neurological examination, using advanced diagnostic technology and applying modern clinical neuroscience, we are able to identify areas within the nervous system that are either damaged, over/under-functioning, or poorly-integrated. We then tailor specific, individualised neuro-rehabilitation programs designed to create neuroplastic adaptation in these areas and those they communicate with to improve and restore nervous system function, and, by extension, patient health.
In short, we test different regions of your nervous system in different ways and see if a pattern of dysfunction arises that we can implicate to one or even a few different regions. Then we create a rehabilitation program targeted at those regions to improve how they function.
We know through scientific study that neuro-plasticity requires several key elements:
1. Repetition - Think of it just like any skill acquisition (such as riding a bike, playing an instrument, or driving a car)- it requires many hundreds of repetitions to generate or alter lasting connections between neurons, which is the basis of neuro-plasticity.
2. Use It or Lose It - Again, think of it like a skill - if you don't keep practicing it, you'll become "rusty" and the neuronal connections that you've worked hard to create/change will deteriorate. This doesn't mean that you'll have to do 'rehab exercises' for the rest of your life, but rather, that you will need to integrate these new connections into your every-day life. The good news is that it's much easier to re-acquire the same skill if you do happen to lose it.
3. Use it and Improve It - Quite simply - the more you drive a neuronal connection, the stronger and more efficient that connection becomes. Think of it as a wild bit of land full of vegetation you're trying to cross. To start with, you have to cut a pathway through it, hacking at branches and trampling grass underneath your feet. The more you use the same pathway, the more that pathway becomes clearer and well defined- the grass becomes a dirt road, the branches stay clear. Eventually that dirt road becomes cobbled streets, then it becomes a road, and even a freeway if you use it enough!
4. Specificity - The more specific the exercise to a person's particular deficit, the more effective the rehabilitation will be. Consider a golfer doing a generic gym strengthening program vs. a program specifically designed to target the movements and muscles required most for golf, as well as those movements and/or muscles that that particular golfer is most deficient - yes, he or she will experience benefits from both programs, but much more likely to improve more with the specific program.
5. Intensity - This is, to me, the most difficult one to get right. The rehabilitation program needs to be difficult and intense enough to really challenge the person, but not so much that it exceeds the person's ability to do it. It's a balancing act- not intense enough, and you get meagre results, if any. Too intense and it can lead to frustration, giving up, or worst, significant symptom aggravation. Again to take the gym analogy - If you have torn your hamstring and are doing a rehabilitation program for it, it's OK to feel a little sore afterwards. But if it's too much, then a re-aggravation of the injury can occur, causing a setback in progress.
6. Salience - Another important one for me to teach my patients - Patients have to understand why and believe that the exercises they have been given are relevant to their specific issue and how they will be beneficial. Another term for this might be 'buy in' - the patient is on board with what the practitioner is trying to achieve with the exercise(s).
7. Transference - Simply, how doing one thing can assist in performing another thing. Sometimes completing one bit of rehab will enable the patient to complete another exercise more effectively, or that doing one exercise might make completing an every-day task more manageable. For example, doing some gluteal warm-up exercise before a run might potentially make running more effective or less painful.
8. Interference - The opposite of Transference. Sometimes doing one thing might have a detrimental effect on a patient's ability to do another. Usually this is in the form of maladaptive behaviours. Again, think of someone working on improving their golf technique, but then they go to a driving range with friends and try to hit the ball as hard as they can without any thought to technique.
9. Spatial summation - I incorporate this one a lot with my rehabilitation programs - quite simply, targeting a specific part of the brain in multiple ways at the same time leads to a much greater stimulation of that region and better plasticity.