https://cbphysiotherapy.in/blog/neurological-physiotherapy-in-the-wake-of-global-pandemic-covid-19 

NEUROLOGICAL PHYSIOTHERAPY IN THE WAKE OF GLOBAL PANDEMIC (COVID 19)

•  

This article reviews the basic principles that underlie the subspecialty of neurological rehabilitation. Neurological rehabilitation is in many ways different from the other branches of physical rehabilitation. Neurological Physiotherapy is able to kick-start the message pathways that your brain is struggling to use, to make new pathways through repetitive actions and exercises. Many of the patients who undergo Neurological Physiotherapy can improve symptoms such as, difficulties with loss of balance, loss of hand and arm, or leg and foot function, walking, spasticity and pain. 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.

IMPAIRMENT DISABILITY AND HANIDCAP

These are key concepts that form the basic principles of neurological rehabilitation. The concepts were developed by the World Health Organization in 1980 and are concerned that it is worthwhile discussing the older terms in the first instance.

Impairment is just a descriptive term. It implies nothing about consequence. Examples are a right hemiparesis, left sided sensory loss, or a homonymous hemianopia. However, a right hemiparesis can obviously be relatively mild and lead to virtually no functional consequence, or can be severe and lead to a complete inability to walk. The functional consequence of impairment is the disability.  However, neurological rehabilitation goes beyond the impairment and looks at the functional consequence and tries to minimize the impact of the disability on the individual.

Thus, neurological rehabilitation mainly deals with disability. However, the concept of handicap is equally important. Handicap is the description of the social context of the disability. A person with a right hemiparesis, for example, may have a relatively mild weakness but even a limited weakness may have profound social consequences for some people. 

How it works?

By focusing on all aspects of a person's functional independence and well-being, Neuro-rehabilitation offers a series of therapies from the medications, physiotherapy, and speech and swallow therapy, psychological therapies, occupational therapies, teaching or re-training patients on mobility skills, communication processes, and other aspects of that person's daily routine. Neuro-rehabilitation also provides focuses on nutrition, psychological, and creative parts of a person's recovery.

Many neuro-rehabilitation programs, whether offered by hospitals or at private, specialized clinics, have a wide variety of specialists in many different fields to provide the most well rounded treatment of patients. These treatments, over a period of time, and often over the lifetime of a person, allow that individual and that person's family to live the most normal, independent life possible.

Neurological rehabilitation post Covid Era

The coronavirus 2019 (COVID-19) pandemic has potential to disproportionately and severely affect patients with neuromuscular disorders. In a short period of time, it has already caused reorganization of neuromuscular clinical care delivery and education, which will likely have lasting effects on the field. The  potential neuromuscular complications of COVID-19,  assessment and mitigation of COVID-19-related risk for patients with pre-existing neuromuscular disease,  guidance for management of neuro rehabilitation  therapies, practical guidance regarding neuromuscular care delivery, telemedicine, and education, and  effect on neuromuscular research.

In this rapid Review, we consider which neurological manifestations might be expected for COVID-19, given what is known about related coronaviruses and respiratory viruses more broadly.

Neurological physiotherapists are vital to the rehabilitation efforts in the acute phase of Covid 19. Neurological rehabilitation needs may be specific to the consequence of Covid 19 for most of the people suffering from different impairments and disabilities. Neurological physiotherapy in times  played a vital role in maintaining and restoring functional ability for those with disabilities and frail older people and didn’t compromised to the rehabilitation needs of people with pre-existing co-morbidities.  Neuro-rehabilitation services were adopted and evolved with changing practise environment as lock downs and public restrictions were imposed since the outbreak of Covid 19. Some reports are also highlighting some prominent neurological consequences of Covid 19 such as Guillain–Barré syndrome (GBS), stroke encephalitis, motor peripheral neuropathy and demyelinating lesions. It is imperative that a thorough neurological assessment is carried out during the rehabilitation of people post Covid 19.

 How CB Physiotherapy plays a role.

COVID-19 placed significant demands on healthcare resources and on healthcare professionals of CB Physiotherapy as it did on health care system throughout the world.  CB Physiotherapy being one of the prominent physiotherapy chains being operational at the times of Covid adopted to best practices to minimize the morbidity related to Covid 19 for patients with neurological disorders. With enhanced and amplified effort CB Physiotherapy played a vital role in mitigating the risk related to neurological disorders pertaining in the times of Covid.

During the current COVID-19 pandemic, physiotherapists at CB Physiotherapy for Neuro-rehabilitation were vigilant for neuromuscular complications that may be directly or indirectly related to coronavirus infection. CB Physiotherapy also planned to adjust their clinical practices to prevent the spread of COVID-19 and to care for patients with NMDs and the complications they experience during this time. Considering the effects of the pandemic are expected to persist for longer than several weeks, CB Physiotherapy adapted to advanced neuromuscular educational training and tele rehabilitation programs. Neuro- rehabilitation was consulted, and practitioners have to know that this may encounter in the acute setting. Given that there is limited data on neurological symptoms, health care providers at CB physio benefit from accurate and real-life data to better treat their patients.

 Latest Developments

The face of Neurorehabilitation has progressively changed in recent years. Traditional Neurorehabilitation procedures may have limited efficacy in most patients with common neurological diseases, such as stroke, Parkinson's disease, spinal cord injury, severe brain injury, spasticity, and cognitive disorders. New technologies have been reported to enhance the effectiveness of rehabilitation strategies in these conditions. They include robotic-assisted training, virtual reality, functional electro stimulation, non-invasive brain stimulation (NIBS) to enhance the intensity and quality of Neurorehabilitation, and to manipulate brain excitability and plasticity, as well as innovative approaches such as assistive technology and demotics.

The exploration of the effects of Neurorehabilitation technologies and NIBS on plasticity through the use of advanced technologies (i.e., functional MRI, near infrared spectroscopy, high-density EEG, etc.) may represent a surrogate outcome measure in the near future. On the other hand, translational and back-translational models are important to offer robust neurobiological grounds to current rehabilitative approaches to neurological disorders.

 Conclusion

A number of Neuro-Physiotherapy approaches emerged in various places around the world throughout the 20th century, each with their own rationale and strategies that could be used to encourage recovery of movement and function in patients with Central Nervous System (CNS) injury or disease Technology and innovation in the area of neuro-rehabilitation is expanding rapidly. It is difficult to predict the next chapter for Neurological Physiotherapy. Clinical and neuro-scientific research is expanding rapidly, and advances in technology such as tele-rehabilitation, motion analysis, robotics and functional electrical stimulation will no doubt influence our practice in coming years. As such in the times of global contagion like Covid 19 followed by global lockdown , Neurological rehabilitation process have countlessly evolved in its delivery process with advance practice in neuro physiotherapy covering various aspects of this discipline that include motor relearning exercise prescription and treatment approaches.