Outpatient rehabilitation of chronic neurologic conditions

Lauren Talman MD (

Dr. Talman of Boston Medical Center has no relevant financial relationships to disclose.

)
Stephanie Bissonnette DO (

Dr. Bissonnette of Boston University Medical Center has no relevant financial relationships to disclose.

)
James G Greene MD PhD, editor. (Dr. Greene of Emory University School of Medicine has no relevant financial relationships to disclose.)
Originally released February 27, 2019; expires February 27, 2022

Overview

Management of chronic neurologic diseases requires a multidisciplinary approach. In order for a patient to achieve maximal function, a treatment plan that includes more than just medication should be considered. Outpatient neurorehabilitation services, including physical therapy, occupational therapy, and speech therapy, are an important adjunct to medication treatment of chronic neurologic disease. The ultimate goal of this combined approach is to allow a patient to maintain functional independence.

Key points

 

• Chronic neurologic diseases should be treated with a multidisciplinary approach.

 

• Clinicians should have a low threshold to refer patients with chronic neurologic disease for neurorehabilitation services.

 

• Physical therapy, occupational therapy, and speech therapy have roles at time of diagnosis of chronic neurologic disease as well as throughout the course of the disease.

Historical note and terminology

In the United States, physical therapy and occupational therapy emerged as medical professions in 1917 in order to provide rehabilitation to wounded soldiers returning from war (Linker 2016). Physical therapists employed massage and stretching techniques whereas occupational therapists ran crafting workshops focused on knitting, chair caning, woodworking, printing, or rug making (Pettigrew et al 2017). Initially conceived by Congress as a way to decrease the financial burden of the veteran welfare program, rehabilitation medicine was later recognized as an integral component of the healthcare system and has since been utilized by all medical specialties (Linker 2016).

Language deficits have been described since as early as the late 19th century when poststroke lesional effects on language were identified by Wernicke and Broca (Tippett et al 2014). As the neurobiology of recovery and learning has become increasingly understood, treatment of language deficits has developed into speech language pathology as we know it today (Tippett et al 2014).

Physical therapy, occupational therapy, and speech therapy services all have an important role not only in the inpatient hospital setting but also in dedicated acute rehabilitation hospitals, outpatient clinics, and patients homes. Neurorehabilitation in particular has become a field unto its own with dedicated training and rehabilitation centers around the country.

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