Why does neurorehabilitation fail?
Following neurorehabilitation, many patients show limited benefit, generalization, or maintenance of gains over time. Some of the reasons that account for modest outcomes are discussed with particular reference to the differences between patients' needs and aspirations, the nature of patient-clinician interactions, and patients' rehabilitation readiness. The role of a more client-centered approach is reviewed, as well as the importance of facilitating patients' capacity to identify problems, develop goals, consider options, and make choices. It is proposed that effective outcomes depend on the clinicians' success in harnessing patients' intrinsic motivation to change.
van den Broek
M D
MD
Wolfson Neurorehabilitation Centre and St. George's Hospital, Regional Neuroscience Centre, Copse Hill, Wimbledon, London, Great Britain. martin.vandenbroek@stgeorges.nhs.uk
D001294:Attitude to Health; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D001523:Mental Disorders / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation*; D009483:Neuropsychological Tests; D010349:Patient Compliance; D018579:Patient Selection; D018570:Risk Assessment; D012720:Severity of Illness Index; D017211:Treatment Failure