Neuroplasticity principles: rehabilitation outcomes depend on harnessing neuroplasticity - the brain's ability to reorganize structure and function in response to experience and injury. Kleim and Jones principles - 1) use it or lose it (atrophy of inactive circuits); 2) use it and improve it (training improves function); 3) specificity (training transfer is task-specific); 4) repetition matters (mass practice); 5) intensity matters (sufficient dose); 6) time matters (early vs late, critical periods); 7) salience matters (meaningful tasks); 8) age matters (younger generally better); 9) transference; 10) interference (maladaptive plasticity). Evidence supports task-specific training, constraint-induced movement therapy, robotics, FES, mirror therapy, virtual reality, and increasing intensity.
Multidisciplinary team and ICF assessment: team typically includes physiatrist, physiotherapist, occupational therapist, speech-language pathologist, neuropsychologist, social worker, rehabilitation nurse, orthotist, recreational therapist, dietitian. ICF framework structures evaluation - body functions/structures (motor, sensory, cognitive, autonomic), activities (mobility, self-care, communication), participation (work, leisure, family roles), environmental factors (assistive devices, social support), personal factors. Common assessments - FIM (Functional Independence Measure), Barthel Index, mRS, NIH Stroke Scale, Berg Balance Scale, Tinetti, FMA (Fugl-Meyer Assessment), MoCA, ASIA scale (SCI), EDSS (MS), UPDRS (Parkinson). Goal-setting follows SMART criteria with patient-centered shared decision-making.
Condition-specific approaches: 1) Stroke - intensive task-specific training, CIMT (constraint-induced movement therapy), mirror therapy, FES, robotic therapy, gait training (body-weight supported treadmill), aphasia therapy (SFA, melodic intonation), neglect interventions; 2) TBI - cognitive rehabilitation (attention, memory, executive function), behavioral management, return-to-school/work; 3) SCI - mobility training, transfers, wheelchair skills, bladder/bowel management, autonomic dysreflexia education, exoskeleton, FES cycling, pressure injury prevention; 4) MS - aerobic exercise, fatigue management, balance training, spasticity management; 5) Parkinson - LSVT-BIG (intensive amplitude-based exercise), LSVT-LOUD (voice), cueing strategies, dance, tai chi, gait training; 6) GBS/peripheral neuropathy - graded exercise, splinting, gait, ADL training. Adjuncts - botulinum toxin for spasticity, intrathecal baclofen, transcranial magnetic stimulation (TMS), tDCS, BCI (brain-computer interface) emerging.