Long Term Disability in Neurological Disease: A Rehabilitation Perspective

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Background

Neurological diseases are often associated with a significant burden of disability, which can severely affect different aspects of patients’ autonomy, including notably motor and cognitive impairments. These impairments can arise in a progressive and long-term manner such as expected in neurodegenerative diseases, but also after acute conditions such as strokes, traumatic brain injuries or spinal cord injuries. The clinical and social impact of these conditions are critical.

In particular, strokes represent the second cause of mortality worldwide, drawing most of the attention on the improvement of the acute care of disease successfully leading in the recent years to a significant reduction in mortality.
However, due to this main focus, the long-term effects have been left aside, leaving strokes to be a major cause of disability. In fact, even if strokes are generally considered, and managed, as a transient condition, most of stroke survivors suffers for persistent critical limitations in activities of daily living. 50% of stroke survivors report unmet needs such as incontinence, emotional problems, mobility, pain, and speaking problems, but most of them do not receive a rehabilitative follow up or some additional therapeutic approaches.
It is known that recovery is a complex process, which probably implies a combination of spontaneous and learning-dependent processes, as well as adaptive behavior. Current evidence suggests that several mechanisms are involved, including restoring the functionality of damaged neural tissue (e.g. restitution), reorganisation of spared neural pathways (e.g. substitution), and improvement of impaired skills in activities of daily living (e.g. compensation)
Considering these aspects, there is a cumulative evidence that interdisciplinary rehabilitation treatment improves the outcomes of stroke survivors when applied in acute and subacute phases after the event. Indeed, the “formal” post-stroke motor rehabilitation ends usually 3-4 months after the event, based on the fact that motor and functional recovery reaches a still debated plateau 3-6 months after stroke. However, current evidence supports the hypothesis that cognitive, language, and motor skills may improve at any time after stroke. In addition, long-term unmet needs are observed in many domains, including social reintegration, health-related quality of life, maintenance of activity, and self-efficacy. From this point of view, stroke should be considered as a chronic disease, and rehabilitation processes should be designed considering also these aspects.
In this regard, rehabilitation services must have a proper patient management, in the form of a dedicated clinical pathway considering the many different factors of each individual including clinical, social and economic aspects.

This research topic will focus on all the aspects related to the long-term management of chronic stroke, specifically related to the rehabilitative implications.

We are interested in original articles (RCTs, observational studies, prospective cohort studies, retrospective analysis, literature reviews). Opinion papers might be considered in cases of exceptional interest.

In particular, these aspects will be considered:
• Exercise-based Neuroplasticity
• Musculoskeletal consequences in chronic stroke survivors
• motor training and motor learning
• Spasticity and related problems
• Psychological distress in chronic stroke survivors and caregivers
• Nutritional aspects of chronic stroke
• Speech therapy in the long-term management of chronic stroke
• Occupational therapy for autonomy in chronic stroke survivors
• New technology in long-term management of chronic stroke (e.g. robotics, neuromodulation, non-invasive brain stimulation)
• Telemedicine in long-term management of chronic stroke
• Impact of pandemic emergency in clinical management of chronic patients

Keywords: Neurologic disorders, Disabiliy, Rehabilitation, Long term care

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