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Principles of neurological rehabilitation

This article reviews the basic principles that underlie the subspeciality of neurological rehabilitation. Neurological rehabilitation is in many ways different from the other branches of neurology. Rehabilitation is a process of education of the disabled person with the ultimate aim of assisting that individual to cope with family, friends, work, and leisure as independently as possible. It is a process that centrally involves the disabled person in making plans and setting goals that are important and relevant to their own particular circumstances. In other words it is a process that is not done to the disabled person but a process that is done by the disabled person themselves, but with the guidance, support, and help of a wide range of professionals. Rehabilitation has to go beyond the rather narrow confines of physical disease and needs to deal with the psychological consequences of disability as well as the social milieu in which the disabled person has to function. Thus, a key factor that differentiates rehabilitation from much of neurology is that it is not a process that can be carried out by neurologists alone, but necessarily requires an active partnership with a whole range of health and social service professionals. The key characteristics of the rehabilitation process are summarised in box 1.

These are key concepts that form the basic principles of neurological rehabilitation. The concepts were developed by the World Health Organization in 1980 (table 1). Although the terms have recently been modernised (and the new definitions are discussed below) the three original terms—impairment, disability, and handicap—are so well known and so ingrained in the philosophy of neurological rehabilitation that it is worthwhile discussing the older terms in the first instance.

View this table:

 Table 1 
Definitions of the WHO’s International Classification of Impairments, Disabilities and Handicaps



Impairment is just a descriptive term. It implies …