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Multidisciplinary approaches in progressive neurological disease: can we do better?
  1. C D Ward1,
  2. M Phillips1,
  3. A Smith2,
  4. M Moran3
  1. 1University of Nottingham Division of Rehabilitation & Ageing, and South Derbyshire Acute Hospitals NHS Trust, Derby, UK
  2. 2Southern Derbyshire Acute Hospitals NHS Trust, Derby, UK
  3. 3Derby City Social Services, Derby, UK
  1. Correspondence to:
 Professor C D Ward
 University of Nottingham Rehabilitation Research Unit, Derby City General Hospital, Derby DE22 3NE, UK;

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Progressive neurological disease (PND) is an important cause of disability in the community and hence a focus for the forthcoming National Service Framework on long term conditions.1 About 300 per 100 000 are affected by the two most common conditions in the group, multiple sclerosis (MS) and idiopathic Parkinson’s disease (PD). PND produces complex patterns of physical and cognitive impairment.

We will first consider the needs of people with PND. How can rehabilitation concepts be applied to people with PND? What problems do they face? The second section will outline the resources relevant to neurological rehabilitation and we will conclude by considering how services should be integrated. Inevitably, the article will highlight shortcomings in current services. Can we do better?


What do people with PND need? To understand the needs of any patient group we require a conceptual framework. Two questions arise. How can we use the term rehabilitation in PND? What should be expected from clinical neurologists?

Applying rehabilitation concepts in progressive disease

Two principles apply to all forms of rehabilitation (see Barnes on p iv3). Firstly, rehabilitation is an active process, distinguished both from spontaneous improvement in the patient (recuperation or convalescence) and from services supplied to the non-participating patient (care). Secondly, rehabilitation achieves change through person centred goals. Note that not everyone will desire change to the same extent, or in the same way. Professionals must be aware that most disabled people seek support and care without wishing for any form of rehabilitation, and many will have quite different aspirations from those conceived by their neurologist. With these principles in mind, we will now consider some of the special characteristics of rehabilitation in PND. Many characteristics are common to specific patient groups—for example, MS,2 neuromuscular disorders,3 and PD.4

Disease management or self management

Far from being an optional add-on, the rehabilitation approach is fundamental …

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