Neurological disorders, stroke and traumatic brain injury in particular, are the most frequent cause of permanent disability in adulthood. Modern management of these disorders relies mainly on acute and intensive care on one hand, and on early and later phase rehabilitation on the other hand. During the last decade, the outcome of these disorders has substantially improved due to specialized treatment strategies in both acute and post-acute care.
Early neuro-rehabilitation (phase B)
During the early phase of rehabilitation (the so-called "phase B” of the rehabilitation phase model covering phases A - D), various techniques with scientifically proven efficacy are applied for different neurological deficits. Several of these techniques have been tested and found effective in large randomized controlled trials.
Primary aim is the improvement of disorders of consciousness by enhancing a patient's disturbed vigilance, as this constitutes an important prerequisite for the patient's ability to participate in rehabilitation.
Early verticalization is one of the mainstays to enhance vestibular input and to enable efficient afferent stimulation. Pharmacological stimulants constitute another important therapeutic pillar. Large multicenter trials revealed an increasing number of ever more severely affected patients entering early neuro-rehabilitation. This has resulted in a category of intermediate care patients in early neuro-rehabilitation, necessitating specialized treatment strategies. These include early verticalization, in particular dynamic verticalization implementing the use of robotic devices, early focused swallowing therapy aiming at early decannulation, and continuing dysphagia treatment thereafter. These (and other) measures serve to reduce the risk for poor outcome and to enhance the patients' quality of life substantially.
Evaluation and treatment of neurogenic dysphagia are of utmost interest in the early phase of neuro-rehabilitation, carried out in an interdisciplinary team approach among medical doctors, voice and swallowing therapists, and specialized neuro-rehabilitation nurses.
Later neuro-rehabilitation (phase C)
Later phases of neuro-rehabilitation depend much on the severity and complexity of a patient's functional disabilities. Mainly, these neurological deficits consist of motor disorders, attention deficits, speech and vocalization disorders, and neuropsychological symptoms such as apraxia and neglect. Duration and intensity of neuro-rehabilitative treatment serves as a predictor for the amount of a patient's functional improvement, with intensity of therapy correlating with improvement.