Neuropalliative rehabilitationManaging neurological disability in the context of a deteriorating illness

Abstract

Although the concepts of ‘rehabilitation’ and ‘palliative care’ may seem paradoxical, the two approaches have a great deal in common. Rehabilitation for people with deteriorating, life-limiting neurological conditions can be organized into four distinct but overlapping categories: preventative, restorative, supportive, and palliative. Patients with neurological conditions can report palliative care needs from diagnosis; neuropalliative rehabilitation needs to be available within the context of whatever services are most appropriate for the patient’s circumstances at the time, requiring excellent coordination of care between neurology, palliative care, and rehabilitation services. Neuropalliative rehabilitation follows the same process that would be used in other conditions, but is underpinned by specific palliative care skills which include the ability to work flexibly with rapidly changing conditions, as well as understanding and being able to manage the tension between the patient’s active engagement in life and acknowledging loss and death.