New development of functional neurorehabilitation in neurosurgery

Conference paper
Part of the Acta Neurochirurgica Supplements book series (NEUROCHIRURGICA, volume 87)

Summary

Objectives

Today, increasingly more patients with severe brain and spinal cord lesions mainly secondary to accidents, violence, stroke, and tumours survive their injuries, in many cases, however, suffering from severe functional impairments of functioning as described by the WHO-ICF criteria. New developments of functional neurorehabilitation in neurosurgery could significantly improve the patients’ quality of life (QoL) in terms of brain and body functioning and certain health-related components of well-being (such as social activities and leisure).

Methods

Functional rehabilitation is an original task of neurosurgery from the very outset. Advances in biotechnology regarding both basic research and clinical application have opened up a new and very promising field to restore or compensate impaired or definitively lost organic functions in addition to the conservative rehabilitation methods.

Results

Along with the scientific progress in biotechnology and functional MRI and PET, neurosurgeons have become increasingly interested and actively involved in rehabilitation science and neurosurgical re-engineering of the damaged brain and spinal cord. Some of them have developed new specially designed institutions for early (acute) and subacute neurorehabilitation. Attached to the acute services, neurosurgeons thus become responsible for neurorehabilitation and at the same time for the management of all kinds of complications, which significantly improves the early and late functional outcome. At the same time microelectronics, biotechnology, and genetic engineering are being introduced into the field of neurosurgical rehabilitation in a step-by-step manner.

Discussion

Progress in the fields of microelectronics, computer technology, and genetic engineering along with rehabilitation science is opening up a new field of unknown chances to partially restore lost body functions and to help improve the quality of life of disabled patients in the sense of ICF. Functional neurosurgery plays a major role in neurosurgical rehabilitation, e.g. functional electrostimulation, brain-stem implants, pain and epilepsy control, restoration of locomotion and grasp faculties, and the use of potent substances such as botulinum toxin (Btx). This demands the capacity of time work and the realization of the necessity to draw up a detailed plan for the restoration of impaired functions prior to enacting a neurosurgical intervention in the sense of a complex neurorehabilitation, and consequently to assume the responsibility for the patient’s outcome. From the beginning of neurological surgery, the preservation and restoration of impaired brain and spinal-cord functions as an original task for neurosurgeons demand their involvement with issues of functional neurorehabilitation including neurosurgical re-engineering of the damaged brain and spinal cord. In this connection the close and trusting cooperation with the clinical neuropsychologist from the very outset is an indispensible factor.

Keyword

Neurorehabilitation neurosurgical re-engineering TBI SCI functional neurosurgery international classification of functioning (WHO-ICF) 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Aldridge D, Dembski M (eds) (2002) Music Therapy World Musiktherapie — Diagnostik und Wahrnehmung. Private University Witten-Herdecke gGmbH ISBN 3-9808248-0-2Google Scholar
  2. 2.
    Barnes MP (1999) Rehabilitation after traumatic brain injury. Br Med Bull 55(4): 927–943PubMedCrossRefGoogle Scholar
  3. 3.
    Berger E, Leven F, Pierente N, Bouillon B, Neugebauer E (1999) Quality of Life after traumatic brain injury: A systematic review of the literature. Restorat Neurolo Neurosci 14: 93–102Google Scholar
  4. 4.
    Boon P, Vonck K, Van Welleghem P, D’Have M, Caremaert J, De Reuck J (2001) Vagus nerve stimulation for epilepsy, clinical efficacy of programmed and magnet stimulation. Acta Neurochir (Wien) [Suppl] 79: 93–98Google Scholar
  5. 5.
    Bouillon B et al (1999) The Incidence and outcome of severe brain trauma-design and first results of an epidemiological study in an urban area. Restorat Neurol Neurosci 14: 85–92Google Scholar
  6. 6.
    Boyeson MG, Jones JL (1996) Theoretical mechanisms of brain plasticity and therapeutic implications. In: Horn LJ, Zasler ND (eds) Medical rehabilitation of traumatic brain injury. Hanley and Belfus Inc, Philadelphia, pp 77–102Google Scholar
  7. 7.
    Broos PL, Stappaerts KH, Rommens PM (1998) Polytrauma in patients of 65 and over. Injury patters and outcome. Int Surg 73(2): 119–122Google Scholar
  8. 7b.
    Brunelli GA, Brunelli GR (1996) Experimental Surgery in spinal cord lesions by connecting upper motoneurons directly to peripheral targets. J. Periphural Nerv Syst 1(2): 111–118Google Scholar
  9. 8.
    Christensen AL, Uzzel B (eds) (2000) International Handbook of neuropsychological rehabilitation. Kluver Academic/Plenum Publishers, New York Boston Dordrecht London MoscowCrossRefGoogle Scholar
  10. 8b.
    Campos da Paz Jr A, Willadino Braga L et al (2002) A preliminary functional brain study on amputees SARAH collection 3. SARAH-Letras press Brasilia, pp 5–14Google Scholar
  11. 9.
    Cope DN, Bryant ED, Sundance P (2001) Health management technology for catastrophic medical conditions. Acta Neurochir (Wien) [Suppl] 79:61–64Google Scholar
  12. 10.
    Diemath HE, Sommerauer J, von Wild KRH (eds) (1996) Brain protection in severe head injury. W Zuckschwerdt-Verlag, München, Bern Wien New YorkGoogle Scholar
  13. 11.
    Foerster O (1936) Übungstherapie. In: Bumke O, Foerster O (eds) Handbuch der Neurologie Bd 8. Springer, Berlin Heidelberg New York Tokyo, pp 316–414Google Scholar
  14. 12.
    Gonzales-Feria L, von Wild KRH, Diemath HE (eds) (2000) Quality management in head injuries care. Servido Canario de Salud, Santa Cruz de TenerifeGoogle Scholar
  15. 13.
    Griinwald V, Hofener H, Thon WF, Kuczyk MA, Jonas U (1999) Sacral electrical neuromodulation as an alternative treatment option for lower urinary tract dysfunction. Restor Neurol Neurosci 14: 189–193Google Scholar
  16. 14.
    Hellawell DJ, Taylor RT, Pentland B (1999) Cognitive and psychological outcome following moderate or severe traumatic brain injury. Brain Inj 13(7): 489–504PubMedCrossRefGoogle Scholar
  17. 15.
    Hesse S, Werner C, Bardeleber A, Brandl-Hesse B (2001) Management of upper and lower limb spasticity in neurorehabilitation. Acta Neurochir (Wien) [Suppl] 79: 117–122Google Scholar
  18. 16.
    Hoffmann B, Duwecke C, von Wild KRH (2001) Neurological and social long-term outcome after early rehabilitation following traumatic brain injury. 5 years report on 240 TBI PatientsGoogle Scholar
  19. 17.
    Horn LJ, Zasler ND (eds) (1996) Medical rehabilitation of traumatic brain injury. Hanely & Belfus, Philadelphia, USAGoogle Scholar
  20. 18.
    Kuchta J, Behr R, Walger M, Michel O, Klug N (2001) Rehabilitation of hearing and communication functions in patients with NF2. Acta Neurochir (Wien) [Suppl] 79: 109–111Google Scholar
  21. 19.
    Lotze M, Laubis-Hermann U, Topka H, Erb M, Grodd W (1999) Reorganization in the primary motor cortex after spinal cord injury — a functional magnetic resonance (fMRI) study. Restor Neurolog Neurosci 14: 183–187Google Scholar
  22. 20.
    Mazaux JM, Croze P, Quintard B, Rouxel L, Joseph P, Richer A, Debelleix E, Barat M (2001) Satisfaction of life and late psycho-social outcome after severe brain injury: a nine-year follow-up study in aquitaine. Acta Neurochir (Wien) [Suppl] 79: 49–51Google Scholar
  23. 21.
    Murray GD et al (1999) The European brain injury consortium survey of head injuries. Acta Neurochir (Wien) 141: 223–236CrossRefGoogle Scholar
  24. 22.
    Ortega-Suhrkamp E (2001) Early functional outcome in isolated (TBI) and combined (CTBI) brain injury. Acta Neurochir (Wien) [Suppl] 79: 31–32Google Scholar
  25. 23.
    Platz T, Hesse S, Mauritz K-H (1999) Motor rehabilitation after traumatic brain injury and stroke advances in assessment and therapy. Retor Neurol Neurosc 14: 161–166Google Scholar
  26. 24.
    Pagni C, Canavero S, Bonicalzi V, Nurissoi C (2001) The important role of pain in neurorehabilitation. The neurosurgeon’s approach. Acta Neurochir (Wien) [Suppl] 79: 67–74Google Scholar
  27. 25.
    Prigatano GP (1999) Working with interdisciplinary rehabilitation treams. In: Prigatano GP (ed) Principles of neuropsychological rehabilitation. Oxford University Press, pp 228–243Google Scholar
  28. 26.
    Sabel BA (1999) Neurotrauma and plasticity. A conference of the German BMBF-research Initiative. Restor Neurolog Neurosc 14: 209–236Google Scholar
  29. 27.
    Schumacher S, Bross S, Scheepe JR, Aiken P, Junemann K-P (1999) Sacral anterior root stimulation andposterior rhizotomy in spastic neuropathic bladder. Restor Neurolog Neurosci 14:195–199Google Scholar
  30. 28.
    Stein DG (1998) Brain injury and theories of recovery. In: Goldstein LB (ed) Restorative neurology. Futura Publishing Company, Armong, NY, pp 1–24Google Scholar
  31. 29.
    Vesper J, Klostermann F, Funk Th, Stockhammer F, Brock M (2001) Deep brain stimulation of the Globus Pallidus Internus (GPI) for torsion dystonia — a report of two cases. Acta Neurochir (Wien) [Suppl] 79: 83–88Google Scholar
  32. 30.
    Voss A et al (1983) Standards der neurologisch-neurochirurgsichen Fruhrehabilitation. In: von Wild KRH (ed) Spektrum der Neurorehabilitation. W Zuckschwerdt-Verlag, München Bern Wien New York, pp 112–120Google Scholar
  33. 31.
    von Wild KRH (1999) Are there standards in neurotraumatology? Acta Chir Austriaca 31 [Suppl] 159: 23–27Google Scholar
  34. 32.
    von Wild KRH, Rabischong P, Brunelli G, Benichou M, Krishnan K (2001) Computer added locomotion by implanted electrical stimulation in paraplegic patients (SUAW). Acta Neurochir (Wien) [Suppl] 79: 99–104Google Scholar
  35. 33.
    von Wild KRH (2002) Functional rehabilitation in neurosurgery and neurotraumatology. Acta Neurochir (Wien) [Suppl] 79Google Scholar
  36. 34.
    von Wild KRH (2001) Neurorehabilitation — a challenge for neurosurgeons in the 21st century concepts and visions of the WFNS-Committee on neurosurgical rehabilitation. Acta Neurochir (Wien) [Suppl] 79: 3–10Google Scholar
  37. 35.
    von Wild KRH (ed) (1998) Pathophysiological principles and controversies in neurointensive care. W Zuckschwerdt-Verlag, München Bern Wien New YorkGoogle Scholar
  38. 36.
    von Wild KRH (2000) Perioperative Management of severe head injuries in adults. In: Schmiedek HH (ed) Operative neurosurgical techniques, 4th edn, vol 1. W B Saunders Company, Philadelphia, pp 45–60Google Scholar
  39. 36b.
    von Wild K, Truelle JL (2004) Quality of life in brain injured (QOLIBRI) EFNS workshop of EMN, Paris, September 2Google Scholar
  40. 37.
    Yamamoto T, Fukaya T, Hirayama T, Katayama Y, Tsumokawa T (1992) Deep-brain and spinal stimulation therapy in persistent vegetative state: changes in PGD2, PGE2 and monoamine in cerebrospinal fluid. Proceedings of the 3nd Annual Meeting of the Society for Treatment of Coma, pp 51–56Google Scholar
  41. 38.
    Yamamoto T, Katayama Y, Osahima H, Fukaya C, Kamamata T, Tsubokawa T (2001) Deep brain stimulation therapy for a persistent vegetative state. Acta Neurochir (Wien) [Suppl] 79: 79–82Google Scholar
  42. 39.
    Yanagida N, Takahashi M, Kinzuka H, Hatazawa J, Uemura K (1999) Dorsal column stimulation for a vegetative patient with hypoxic encephalopathy an analysis of cerebral metabolism using PET, vol 8. In: Hori S, Kanno T (eds) Neuron Publishing Co, LTd, Tokyo, Japan, pp 37–42Google Scholar

Copyright information

© Springer-Verlag Wien 2003

Authors and Affiliations

  1. 1.Neurosurgical Clinic with Department for Early Rehabilitation of the ClemenshospitalMedical Faculty of the Westphalische Wilhelms UniversityMünsterGermany

Personalised recommendations