Importance of novel and innovative solutions for persons
with disabilities
With such a large burden of people affected around the globe, it is rational to assume that rehabilitation needs are plentiful.
According to the World Health Organization’s Global Burden of Disease study, 2019, 2·41 billion individuals had conditions that would benefit from rehabilitation, contributing to 310 million Years of Living with Disabilities (YLD).
This number had increased by 63% from 1990 to 2019.
With rehabilitation often being seen as a disability-specific service, needed by only a few, it has, despite its individual and societal benefits, not been prioritised in countries and is traditionally under-resourced.
With neurology and psychiatry being closely linked, there exists a continuum of needs between these conditions, often with considerable overlap.
Rehabilitation services must, therefore, be designed to address the wide spectrum of neurological and mental health problems as opposed to being narrow in concept and specialist led.
There is a need to build awareness in the community that disablement does not need to be endured and can be treated, even reversed, in a proportion of cases.
There is also a need to encourage medical professionals, medical service providers (government, private and non-profit) as well as public health professionals to consider rehabilitation as an essential service.
Beyond doctors and nurses, rehabilitation across the lifespan requires a range of professionals: physical and occupational therapists, speech and language therapists, psychological therapists and professional caregivers.
Enhancing these professional profiles, improving training, creating mainstream opportunities for career development and empowering their professional growth is important in order for services to develop and evolve.
Further, it is widely understood today that rehabilitation services need to be multidisciplinary, multicomponent and holistic.
Various neuropsychiatric disorders that affect individuals across the lifespan
There are unique paradigms of care that have emerged through scientific advances that we must consider.
A host of non-invasive brain stimulation (NIBS) procedures have proved themselves to be very useful in the care and rehabilitation of neurological and mental health conditions.
Repetitive Transcranial Magnetic Stimulation (rTMS) as a mainstream treatment for both depression and obsessive compulsive disorder and as an adjuvant treatment for diverse conditions.
An allied technique, Functional (or peripheral) Magnetic Stimulation (FMS), is also available today for pain, spasticity, incontinence and other disabling neurological symptoms.
Another NIBS technique with great promise is transcranial electrical stimulation (TES) with its many sub-types (direct current, alternate current and random noise).
The treatment has shown itself to be successful in improving memory and cognition, mood and behaviour, anxiety, tremors, confusion and delirium, and sleep disorders.
It has the advantage of being portable and bedside.
In the post-COVID-19 era, another treatment that has assumed importance is transcutaneous auricular vagus nerve stimulation (tA-VNS), vagus
nerve abnormalities being responsible for a host of long COVID-19 symptoms.
Developed as a treatment for epilepsy, this is currently being investigated for depression, migraine and dysautonomia.
Non-invasive brain stimulation (NIBS) procedures
Non-invasive brain stimulation (NIBS) refers to a group of techniques that use magnetic or electrical fields to modulate brain activity without surgery or implantation.
It's a rapidly evolving field with potential applications in various neurological and psychiatric conditions.
Types of NIBS:
Transcranial magnetic stimulation (TMS): Uses a magnetic coil placed near the head to generate brief, pulsating magnetic fields that stimulate specific brain regions.
Transcranial direct current stimulation (tDCS): Uses weak electrical currents delivered through electrodes placed on the scalp to increase or decrease activity in targeted brain areas.
Applications,
Neurological disorders: Stroke, Parkinson's disease, chronic pain, depression, tinnitus, and more.
Psychiatric conditions: Major depressive disorder, schizophrenia, anxiety disorders, obsessive-compulsive disorder, and addiction.
Cognitive enhancement: Memory, attention, and learning.
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