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The World Health Organization (WHO) International Classification of Functioning, Disability, and Health (ICF) provides a foundation for discussing the tenets of traditional rehabilitation and its social but is limited as a descriptive tool for the broader view of neurorehabilitation, which incorporates plasticity and repair of the nervous system. The makeup of the rehabilitation team and the requirements for qualification vary from one country to another, although in most cases, the basic principles are similar. The best guideline to apply to a patient requiring neurorehabilitation is to provide the environment with the most intense therapy that the patient can tolerate. The model of stroke rehabilitation best illustrates this concept. When compared with conventional or less intensive care, stroke rehabilitation in an inpatient rehabilitation facility (IRF) with coordinated, transdisciplinary care significantly reduced the statistical risk of death or institutionalization, or death or dependency, independent of age, sex, or stroke severity.
Comprehensive rehabilitation improves the functional abilities of the stroke survivor, despite age and neurologic deficit, and decreases long-term patient care costs. Motor recovery usually occurs in well-described patterns after stroke. A number of methods are currently used to facilitate movement in affected extremities and teach compensatory techniques to perform activities of daily living (ADL). Stroke survivors usually do not place the same degree of importance on improving upper extremity performance as that of the lower extremity. Complications involving the upper extremity may prevent the stroke survivor from reaching patient's maximal potential. Speech and language disorders may be diagnosed by both formal testing and conversational interaction. Impaired content of speech suggests aphasia or cognitive-communication impairment. Good communication between the neurorehabilitation physician, the patient, and the family will facilitate optimal care, and provide the patient with the opportunity to reach his maximal functional potential.
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