Neuro Rehabilitation in India

Neuro-Rehabilitation is a combination of interventions that assist patients in recovering maximally from neurological injury or disease. These are personalized programs that involve a multidisciplinary approach focused on improving functions, reducing symptoms, and optimizing the overall well-being of the patients with neurological disorders or injuries.

Technology

HAL: A Smarter Neuro Rehabilitation Approach

A neurological device called Hybrid Assistive Limb; HAL Lower Limb (HAL-ML) assists patients in regaining the ability to move their paralyzed or paretic legs naturally, depending on their intended goals. The purpose of this device is to enhance locomotor activity in patients with spinal cord injuries, strokes, and various neuromuscular diseases, even if their conditions are chronic.

Mechanism of Action

The bioelectric signals (BES) from the brain get weaker in paralyzed patients that leads to impaired nerve conduction and improper body movements. However, HAL can detect even the faint BES from the skin, process it, and simultaneously assists in performing the desired movements. The brain learns the movements correctly through repetition of specific HAL gait training.

Principles Behind HAL Activity:

Why is Neuro Rehabilitation needed?

For following conditions patients may require neuro-rehabilitation:

Patients with vestibular dysfunction, spinal cord dysfunction, cognitive impairment, and upper or lower limb paralysis or weakness due to any other neurological condition can also be rehabilitated by the Neuro rehabilitation programme.

• Send: When an individual attempts to move his/her body, the brain sends the necessary signals to the muscles via the nerves.
• Receive: When a muscle receives a correct command signal from the brain via the nerves, it contracts to move that specific joint.
• Read: Brain signals to the muscles seep onto the skin's surface as extremely weak bio-electrical signals (BES). HAL determines the type of joint movement the wearer intended by using sensors applied to the skin's surface to identify these BES.
• Move: Based on these BES, HAL regulates the power units at each joint, enabling the wearer to carry out the intended movements by giving voluntary commands.
• Feedback: The experience gets stored in the brain after HAL has suitably aided the desired motion. The ability of the wearer to walk independently improves with active engagement with these neural pathways for voluntary movement with physical feedback to the brain.
  • Stroke: It is a medical emergency condition that occurs due to deprivation of blood flow to a part or parts of the brain. This leads to lack of supply of oxygen as well as nutrients in the affected area of the brain. Ultimately, brain cell death starts happening within minutes, leading to loss of functions associated with that part of the brain.
  • Multiple Sclerosis (MS): It is a disorder in which the outer protective layer of the brain and spinal cord is damaged by the body's own immune system. If the condition is not timely and appropriately managed, this can lead to troubled nerve conduction, resulting in physical and mental disabilities in the patient.
  • Parkinson’s Disease: It is a degenerative nervous system disorder affecting the motor system which regulates the body movements. Beginning gradually with minor shaking or trembling, it can progress to slowing of movements, stiffness, and speech problems. These symptoms usually worsen as time passes.
  • Cerebral Palsy: It is a neurological disorder that impairs motor abilities, body movement, and muscle tone. This disorder may develop during the first three to five years of life or may be present from birth.

• The neuro-rehabilitation program begins with a comprehensive assessment of your psychosocial, cognitive, and physical health. Your rehabilitation team will create a care plan with practical functional objectives for you.
• Your doctor will gather all the information regarding the onset and treatment of your neurological disorder.
• You will undergo a complete neurological examination for the assessment of motor functions, reflexes, sensation, coordination, and other neurological activities. 
• Your doctor will evaluate your functional abilities in performing daily activities such as eating, dressing, and moving. This is done to know about the routine functions that are impaired due to the disorder.
• You will undergo an assessment for cognitive functions like executive abilities, attention, memory, and problem-solving abilities. This is generally done if the neurological disorder is associated with cognitive impairment.
• Your doctor will evaluate your emotional and psychosocial factors such as mood and socializing abilities.
• Your joint movements and muscle strengths are evaluated.
• There will be an assessment of deficits in balance and coordination that may enhance the risk of falls.
• Gait analysis will be done to identify the deficits.
• Assessment of the location and severity of the pain associated with the neurological disorder will be done.
• An assessment will be done to analyze the need of assisting devices like walkers, orthotics, or canes.
• After a thorough assessment of your neurological health status, the doctor plans a multi-disciplinary targeted and effective neuro rehabilitation program personalized for you. Then you will be introduced to the program modules and rehabilitation team.

Neurological rehabilitation aims to improve your physical, emotional, and social well-being while restoring independence and function to the greatest extent possible. Neurological rehabilitation programs may include the following to achieve these objectives:

• Enhance the ability to perform activities of daily living (ADLs) including eating, bathing, dressing, toileting, cooking, basic housekeeping, and handwriting
• Speech therapy to improve speaking, writing, reading, and even swallowing
• Programs for the management of anxiety, stress, and depression
• Retraining for bladder and bowel control
• Programs for the improvement of motions during movement, muscle control, walking style, and body balance
• Exercise programs for improving movement, reducing weakness of the affected areas, optimizing spasticity, managing pain, and betterment of the range of motion
• Redeveloping social and behavioral skills
• Counseling for the betterment of nutritional habits
• Participation in community support groups
• Activities aimed at improving cognitive impairments, including issues with focus, memory, attention, and poor judgment
• Providing assistive devices to enhance your independence
• Education, counseling, and suggesting measures to enhance safety and independence measures 
• Suggesting measures to you or your family to take care of home care needs
• Pain management therapies
• Stress management therapies
• Emotional support
• Vocational counseling

Neuro-rehabilitation is meant to minimize the complications associated with neurological disorders, injuries, as well as their treatments. So, the complications associated with these programs are rare. However, the following are certain complications you may come across:

1. Risk of falls
2. Exacerbation of certain neurological symptoms
3. Muscle Pains
4. Fatigue
5. Bone and joint problems
6. Cognitive fatigue or mental exhaustion
7. Communication misunderstandings with instructions
8. Poor adaptation to assistive devices

• You will have to undergo regular follow-up sessions to monitor the progress in your neurological health status.
• Certain therapies may continue even after the completion of the neuro rehabilitation program for improving your neurological abilities.
• You might be recommended to continue a certain set of strength and flexibility exercises at home due enhance your functional independence
• You may be advised to use assistive devices for a certain period of time based on your condition
• You may join support groups and counseling sessions to enhance your emotional health
• You may advised to take certain medications depending on your condition
• Reach out to your care provider immediately if you experience certain complications such as falls, breathing issues, or sores.

• Life after rehabilitation may pave your paths for improved body movements, overall independence to carry out your routine activities, betterment in self-care capabilities, and enhance in many more abilities
• You may have to continue attending the follow up sessions for a long duration of time
• Some individuals may have to continue maintenance therapy throughout their life
• Socialization after neuro-rehabilitation may contribute better emotional wellness
• You may be advised to perform certain exercises regularly for better long term outcomes

Its crucial to understand that there is no evidence to support the notion that rehabilitation can stop the progression of any neurological conditions. Enhancing independence, increasing functionality, and preventing secondary conditions are the main goals of rehabilitation, which raises quality of life overall. Individuals with multiple sclerosis can learn new skills and lessen the effects of their disability. Some studies reported improvements in upper limb function and gait control. One study found that this was more successful in individuals in the early stages of the disease. But according to another research investigation, improvements were even seen in those with the greatest degree of multiple sclerosis-related disability. Neuro-rehabilitation has an approximately 80% success rate.

The cost of neuro rehabilitation in India varies according to various factors which are discussed in the next section of this article. However, the approximate cost of the procedure  may range from 3000-9000

Following are the factors affecting the cost of neuro rehabilitation in India:

• Neuro-Rehabilitation Team’s Expertise: The number of successful cases accomplished by the neuro-rehabilitation provider may affect the cost of treatment. Generally, higher the expertise, higher will be the cost.
• Neuro-Rehabilitation Team’s Experience: The neuro-rehabilitation providers with more years of work experience in rehabilitation after neurological treatment and diseases will charge more.
• Extent of Neurological Damage: Greater damage will require a more extensive and long rehabilitation program, which will also increase costs. 
• Overall Health Status of Patients: People having prevailing illnesses and old-age people will be at risk of getting more complications. So, there will be more post-operative care for them which will increase the cost.
• Out of Pocket Expense: If your treatment is not being covered under your health insurance policy, then you may have to pay a higher out of pocket amount for the treatment. 
• Pre-Evaluation Expenses: Various neurological tests will be performed to assess your condition thoroughly. This will alter the total cost of the program on the basis of the pre-evaluation examination suggested.
• Neuro-Rehabilitation Providers Fees: You may have to pay more fees and increase your expenses if you are choosing extensive services. Moreover, providers who have higher success rates are likely to charge more than others.
• Type of Neuro-Rehabilitation Program: Depending upon your condition, your team will plan the neuro-rehabilitation program for you. This will also impact the cost depending on the program offered.
• The City where the Hospital is located: Hospitals located in bigger cities like Delhi, Mumbai, Chennai, Noida, Gurugram, etc. may charge comparatively more than the hospitals located in smaller cities. This is because hospitals in the metropolises can facilitate you better in every aspect.

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