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Table of Contents    
Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 343-345

Neuro-rehabilitation - a multidisciplinary approach

Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Web Publication7-Mar-2019

Correspondence Address:
Dr. Harsh Deora
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.253611

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How to cite this article:
Deora H. Neuro-rehabilitation - a multidisciplinary approach. Neurol India 2019;67:343-5

How to cite this URL:
Deora H. Neuro-rehabilitation - a multidisciplinary approach. Neurol India [serial online] 2019 [cited 2022 Aug 8];67:343-5. Available from: https://www.neurologyindia.com/text.asp?2019/67/1/343/253611

Author : V.C Jacob, Hema Biju, Alok Sharma

Publishers : NeuroGen, Brain and Spine Institute, Mumbai

Edition : 1st Edition

Pages : 527

”If you aren't fired with enthusiasm, you will be fired with enthusiasm”

– Vince Lombardi

Rehabilitation therapists, caretakers, physicians, non-governmental organisations and societies, who devote their lives to the rehabilitation and care of neurological injuries and diseases, will bear testament to the enthusiasm it takes to care for a paraplegic young patient with minimal hope of recovery. Day in and day out, it is a struggle for these patients to clean and to feed themselves, to get out of bed, and to live. All the while while one's life, family, and friends fade away. Thus, it is imperative that a book discussing various facets of rehabilitation for all neurological ailments and injuries has been released with a physiotherapist, occupational therapist and a neurosurgeon at the helm.

The book is divided into 5 sections, each one dealing with a specific system, with 'Spinal cord injury' being given a dedicated section and is the most well described part of the book. Right out of the gate, the emphasis is on a multidisciplinary team approach comprising of neurosurgeons, urologists, physiotherapists, occupational therapists, medical social workers, counselors, rehabilitation nurses, and other caregivers. After dealing with the relevant theory regarding the various grading systems and outcomes of spinal cord injury, focus shifts to basics regarding ambulation, occupational therapy and vocational rehabilitation for these cases. All stages of spinal injury including spinal shock and rehabilitation have been covered in detail and various complications such as pressure sores, bladder incontinence, sexual dysfunction, and psychological breakdown and its rehabilitation have been illustrated with practical measures and clinical photographs. The chapter ends with a touching monologue of an unfortunate patient with D12 vertebral body fracture with acute paraplegia who gives a first-hand account of her journey. Various lacunae of our health care system stand out with the lack of a proper spinal injury ambulance or paramedical care, difficulty in transporting the case from a peripheral hospital to Mumbai, and the rise of homeopathic care and its concept among the general population. The silver lining that shines right through, however, is the care provided to her by her doctors and physiotherapists, and the role of various charitable organizations and support groups who help her with her rehabilitation. She says, “ To have an ace senior physiotherapist to guide, advice and correctly assess my condition was a very important aspect of my rehab.” This piece underlines the fact that the buck does not stop with surgery, rather the journey just begins in the form of a life-long commitment of the surgeon and the rehabilitation personnel towards the patient.

The next section is on 'Brain and spine related disorders', starting with 'Stroke' and 'Cerebral palsy'. Here, various methods of late rehabilitation are discussed such as the Bobath Approach, which uses the neurodevelopmental model of voluntary movements being built on reflexive movements, and thus, treatment must follow the normal developmental sequence. Other approaches such as the constraint-induced movement therapy, where the able limb is tied and the patient is forced to use the weakened limb during the waking hours; and, the Brunnstorm approach, which uses primitive synergistic patterns in training to improve motor control through central facilitation, to illustrate a few, have been discussed. Exciting new developments such as functional electrical stimulation, robot-assisted therapy, and virtual reality therapy give us a glimpse of what lies in the future of this field. Occupational therapy, including the use of wheelchairs, positioning while sleeping and sexual rehabilitation are discussed at length, with the role of neuroplasticity being emphasized throughout. The chapters on 'Cerebral palsy' and 'Autism' again reiterate the need for team management and emphasize the neuro-developmental technique, as developed by Karel and Berta Bobath in 1940, which focuses on building the individual's strengths while addressing impairments such as postural control, development of hand skills, sensory integration and development of visual perceptual skills. It then switches over to activities of daily living and focuses on handwriting skills, reading and studying math, recreation, leisure and environmental control to allow for a child's maximum development. The chapter on 'Head Injury' deals with the various stages of head injury and rehabilitation, focusing more on occupational rehabilitation of the paralyzed individual. The chapter on 'Dementia' deals with various causes of the same and pharmacotherapy on offer and then plunges into the rehabilitation, which consists of reality orientation as well as memory therapy, home care strategies and occupational therapy. The chapter on 'Cerebellar ataxia' primarily deals with gait, speech control and provides practical suggestions regarding eating, drinking, and dressing, which might be very useful to these individuals. The chapter on 'Multiple sclerosis' deals primarily with the natural course of the disease and cognitive rehabilitation along with caregiver fatigue. The section tries to cover all aspects of rehabilitation of these neurological ailments, with an embellishment of illustrations and photographs, wherever they are relevant.

The next section is on 'Muscle and nerve related disorders' and starts with 'Muscular dystrophies' that are detailed initially, followed by a focus on the various aspects of management such as postural alignment, range of motion, manual muscle testing, girth measurement, respiratory status, activities of daily living, orthosis and transfers, with a very illustrative collage of pictures to supplement the theoretical steps described. The chapter on 'Motor neuron disease' deals with a lot of similar aspects of neurorehabilitation with emphasis on hand motor skills and adaptive devices such as ergonomic keyboards. The human-computer interactions have also been described for these cases. The chapter on 'Polyneuropathies' focuses on strength training, stretching exercises to prevent contractures, the re-education of sensory awareness, postural kinesiotherapy, balance training and orthosis for these ailments. Activities such as clay pressing, rolling and pinching are beautifully illustrated with photographs, aimed to improve hand strength and dexterity.

A 'Miscellaneous' section starts with 'Spasticity' with physiotherapy being described for reduction of tone, facilitation of normal movement patterns and giving a sense of normal position and normal movement. A comprehensive description of the various 'Orthosis' used according to the site of weakness with illustrative photographs, and 'Psychological rehabilitation' and 'Speech rehabilitation' methods and grading scales follow. The importance of person-centered therapy and group therapy sessions; as well as, trans-personal psychology, music therapy, and family therapy are described with special therapy modalities for children, such as play therapy and art therapy.

What follows is the most controversial section of the book focusing solely on 'Stem cells and stem cell therapy'. The basics of stem cells along with their classification is discussed with a section on transplantation of stem cells aspirated from the bone marrow of the individual either systemically (intravenous or intra-arterial) or locally (intra-thecal or by direct implantation into the spinal cord or brain) are described with clinical photographs of the procedure. Even intramuscular injection of stem cells for patients suffering from muscular dystrophy has been advised. The author is also part of the “Clinical Cell Therapy Guidelines for Neurorestoration (IANR/CANR 2017)” trial released in Feb 2018[1] and various other publications [2],[3],[4] on the same subject. While a few encouraging results have been seen in the preclinical experiments with stem cell transplantation, they are not sufficiently successful for translation into clinical practice. Further, the Food and Drug Administration (FDA) approval has not been obtained for these therapies as yet and only clinical trials have been approved. The efficacy of these therapies is currently questionable, with a review by Tandon et al.,[5] concluding, very aptly, that while there is an absence of a scientifically acceptable proof of reliable and reproducible benefit of human stem cell therapy, thousands, if not millions, of patients have been submitted to the yet “unproven” therapy. Market-driven research is being published and practiced and evidence of in-vitro differentiation of neural cells has been demonstrated.[6] Neurosurgeons have always been ahead of the curve; where a scientist sees lack of evidence, an opportunist sees the potential.[7]

While the book, in general, is comprehensive in its coverage of various disorders and rehabilitation therapies, there are certain improvements that may be considered in further editions of this book. The structure of each chapter needs to be tweaked to make it more appealing and less of a drag. The book tries to address a lot of subjects and thus misses out on the core message. Irrelevant theories of some disorders can be omitted with more emphasis being placed on the topic of rehabilitation. Novel techniques of neurorehabilitation, such as the mirror therapy,[8] and the role of artificial intelligence in rehabilitation [9] should have been discussed in details. Instead of presenting a collage of photographs, an illustrative step-by-step practical manual would be appreciated more. References in many chapters are not edited with multiple numbers for the same reference being presented, and sometimes altogether omitted. A seasoned copy-editor or publisher might be of help in this situation. Overall, considering the mammoth task that the authors had at hand while compiling this book, the dark side of the moon can be ignored. Similar productions focusing on pre-hospital care and rehabilitation are sorely needed and need to be incorporated into the curriculum of training of every clinician dealing with these ailments.

  References Top

Huang H, Young W, Chen L, Feng S, Zoubi Z, Sharma HS, et al. Clinical cell therapy guidelines for neurorestoration (IANR/CANR 2017). Cell Transplant 2018;27:310-24.  Back to cited text no. 1
Sharma A, Gokulchandran N, Sane H, Nagrajan A, Paranjape A, Kulkarni P, et al. Autologous bone marrow mononuclear cell therapy for autism: An open-label proof of concept study. Stem Cells Int 2013;623-875. http://dx.doi.org/10.1155/2013/623875.  Back to cited text no. 2
Sharma A, Gokulchandran N, Sane H, Kulkarni P, Nivins S, Maheshwari M, et al. Therapeutic effects of cellular therapy in a case of adult autism spectrum of disorder. Int Biol Biomed J 2018;4:98-103.  Back to cited text no. 3
Sharma A, Gokulchandran N, Chopra G, Kulkarni P, Lohia M, Badhe P, et al. Administration of autologous bone marrow-derived mononuclear cells in children with incurable neurological disorders and injury is safe and improves their quality of life. Cell Transplant. 2012;21(Suppl 1):S79–S90.  Back to cited text no. 4
Tandon PN, Seth P. Cell therapy for neurological disorders: The elusive goal. Neurol India 2016;64:612-23.  Back to cited text no. 5
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Dave SD, Patel CN, Vanikar AV, Trivedi HL. In vitro differentiation of neural cells from human adipose tissue derived stromal cells. Neurol India 2018;66:716-21.  Back to cited text no. 6
[PUBMED]  [Full text]  
Deora H, Tripathi M, Yagnick NS, Deora S, Mohindra S, Batish A. Changing hands: Why being ambidextrous is a trait that needs to be acquired and nurtutred in neurosurgery. World Neurosurg 2019;122:487-90.  Back to cited text no. 7
Arya KN. Underlying neural mechanisms of mirror therapy: Implications for motor rehabilitation in stroke. Neurol India 2016;64:38-44.  Back to cited text no. 8
[PUBMED]  [Full text]  
Ganapathy K, Abdul SS, Nursetyo AA. Artificial intelligence in neurosciences: A clinician's perspective. Neurol India 2018;66:934-9.  Back to cited text no. 9
[PUBMED]  [Full text]  

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[Pubmed] | [DOI]


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