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What is the impact of rehabilitation?

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The worldwide renowned rehabilitation specialist from Zürich had a closer look on several studies. He inquired if rehabilitation is making a difference after central nervous damage and which factors are defining its effectiveness. This is hard to figure out because literature does not provide a gold standard für neurorehabilitation.

No improvements through increased intensity and technological assistance
It is a popular misbelief that an increase in training intensity alone provides the winning formula.
In fact, several studies suggested that a more intensive training would bring more functional recovery in arm and leg function. However, careful analysis revealed that this increase is only temporarily. On the long run, functional improvement between normal or high intensity rehabilitation is identical. Recovery is usually achieved with a maximum within the first three to four months following injury.

An outstanding finding of the paper is that the simple use of more technology is not the answer. For example, there is no benefit of robotic supplies in order to expand training time. The achieved level of recovery is not dependent on the selected type and intensity of neurorehabilitation. 

Most rehabilitation approaches target a repetitive execution of movements. For example, reach and grasp for arms/hands or stepping for legs. Focused and repetitive training plays a key role in efficacy. The underlying mechanism is to enforce functional improvement via plasticity.  As a consequence, type and application of rehabilitation have to be selected thoroughly. 

Individual potential of recovery
Recovery mostly depends on the level and on the strategic extent of the injury. This contributes to the fact that a potential for recovery is postulated individually. Moreover, age is an important factor here.  Nowadays, the individual potential of recovery after injury can be determined by clinical, electrophysiological and imaging examinations. Rehabilitation measures can be adapted accordingly.
Improvements through electrical stimulation
Elderly patients have difficulties to translate the recovery of motor deficit into function. For this group, Dietz has new, non-training approaches in mind such as epidural or deep brain stimulation. These approaches are currently tested in clinical trials. Future development has the potential to further increase the recovery potential.
This study was published in the journal Brain Communications.

Source: Dietz V. Restoration of motor function after CNS damage: is there a potential beyond spontaneous recovery? Brain Communications, Volume 3, Issue 3, 2021, fcab171, https://doi.org/10.1093/braincomms/fcab171

You can find out more on the spinal cord and the influence of its damage on the human body in our basic-information. Wings for Life Glossary gives an understanding of scientific terms.