Neurorehabilitation and Recovery
Core concepts
Understand neuroplasticity - activity-dependent reorganization, critical periods, and the principle that task-specific, intensive, repetitive practice drives recovery. Know the multidisciplinary team (physiatry, PT, OT, speech, neuropsychology, nursing, social work). Understand disorders of consciousness (coma, vegetative/unresponsive wakefulness, minimally conscious) and that emergence is often gradual. Know spasticity management (positioning, stretching, botulinum toxin, intrathecal baclofen) and contracture prevention. Understand return-to-learn and return-to-play protocols for concussion (graduated, symptom-limited). Recognize that early mobilization improves outcomes but must respect medical stability.
Traps
Questions test whether you know more therapy is not always better without specificity - massed practice of the wrong task does not generalize. Do not confuse spasticity (velocity-dependent) with rigidity (lead-pipe). Remember that a minimally conscious state has reproducible evidence of awareness, unlike unresponsive wakefulness. Avoid assuming recovery plateaus at a fixed time - trajectories vary widely.
Rule of thumb
Rehabilitation prescription = specific task + sufficient dose + meaningful context. For concussion, progress stepwise and stop if symptoms worsen.
Worked example
A patient with severe TBI is medically stable but comatose. Early mobilization and positioning begin once stable; prognosis is discussed cautiously because recovery can continue for months to years.