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Figure 3. Increase in publications on neuropsychological rehabilitation. A PubMed search was conducted to identify articles published between 1980 and 2004 on rehabilitation of cognitive functions key words: (neuropsychological OR aphasia) AND (rehabilitation OR therapy); aphasia (therapy OR rehabilitation); and neglect rehabilitation. The titles of the included publications were then checked for appropriateness.

Year

Figure 3. Increase in publications on neuropsychological rehabilitation. A PubMed search was conducted to identify articles published between 1980 and 2004 on rehabilitation of cognitive functions key words: (neuropsychological OR aphasia) AND (rehabilitation OR therapy); aphasia (therapy OR rehabilitation); and neglect rehabilitation. The titles of the included publications were then checked for appropriateness.

such as aphasia, apraxia, visual agnosia, or neglect, have been identified in the second half of the 19th and the first half of the 20th century. Many of the original reports described the course of spontaneous recovery and proposed specific rehabilitative measures. During the last 25 years the field of rehabilitation of cognitive functions has expanded rapidly. The annual number of publications concerning neu-ropsychological rehabilitation, including aphasia therapy, has increased from about 100 in 1980 to over 500 in 2004, with a steep increase beginning around 1987 (Fig. 3). A small but important part of this increase can be accounted for by studies of specific neuropsychological syndromes. Most of the studies published in the early 1980s concerned aphasia, which continued to be investigated and experienced a 2-fold increase between 1980 and 2004. In recent years, research in other cognitive syndromes has grown even faster. Unilateral neglect, very little investigated in the 1980s, witnessed a 10-fold increase by 2004. This current expansion of rehabilitation studies of specific syndromes is linked to the application of cognitive models to rehabilitation and to a better understanding of post-lesional plasticity as apparent in functional imaging studies.

However, most of the impressive increase in studies of neuropsychological rehabilitation was due to studies of disease-specific rehabilitation. Thus, rehabilitation of traumatic brain injury, stroke, tumors, degenerative diseases such as Parkison's disease or progressive diseases such as multiple sclerosis are increasingly investigated in their own rights. This type of research requires more than ever a multidis-ciplinary approach to neuropsychological rehabilitation, with close interactions between physicians, neuropsychologists, speech therapists, and physiotherapists and occupational therapists.

The chapters on rehabilitation of cognitive functions and on disease-specific rehabilitation demonstrate the necessity and the putative strength of evidence-based approaches. Although we need to understand the mechanisms underlying recovery from cognitive deficits, we also must have proof of the efficacy of our interventions. Specific fields, such as aphasia and neglect rehabilitation, have started accumulating this type of evidence. However, many more studies, and in particular large-scale multicenter investigations, are needed and should be carried out during the next decade.

7 Purpose and organization of this book

If most severely disabling disorders are neurological, why write a separate textbook of neurorehabilitation rather than incorporating it with the rest of rehabilitation medicine into a general rehabilitation textbook? The editors believe that it is time for rehabilitation medicine to go beyond optimizing function based on what is left to the body after an injury or illness. Rather, the goal should be full restoration of function by any means necessary, including actual repair of the injured tissues and organs. By focusing on the nervous system, we can present a cogent and intellectually rigorous approach to restoration of function, based on principles and professional interactions that have a deep vertical penetration. This requires two additions to the traditional rehabilitation approach, which had considered disabilities and handicaps in the abstract, apart from the specific disease processes that underlay them. First, there is a need to understand the pathophysiological bases of disabling neurological disorders. Second, there is a need to apply basic scientific knowledge about the plastic properties of the nervous system in order to effect anatomical repair and physiological restoration of lost functions.

This book is presented in two volumes, designed to be used either separately or as an integrated whole. Volume I, Neural Plasticity and Repair, explores the basic science underpinnings of neuro-rehabilitation and can be used as a textbook for graduate level courses in recovery of function after neural injury. It is divided into two sections. Section A, Neural plasticity, includes chapters on the morphological and physiological plasticity of neurons that underlie the ability of the nervous system to learn, accommodate to altered patterns of use, and adapt to injury. Section B, Neural repair, includes chapters on the neuronal responses to injury, stem cells and neurogenesis in the adult CNS, the molecular mechanisms inhibiting and promoting axon regeneration in the CNS, and strategies to promote cell replacement and axon regeneration after injury, the design of prosthetic neural circuitry, and trans-lational research, applying animal experimental results to human patients. Volume II, Medical Neurorehabilitation, will be of greatest interest to clinical rehabilitation specialists, but will be useful to basic scientists who need to understand the clinical implications of their work. The volume is divided into three sections. Section A, Technology of neurorehabilitation, contains chapters on outcomes measurement, diagnostic techniques such as functional imaging and clinical electrophysiology, rehabilitation engineering and prosthetics design, and special therapeutic techniques. Section B, Symptom-specific rehabilitation, considers rehabilitation approaches to neurological symptoms that are common to many types of neurological disorders; for example, spasticity and other motor dysfunctions, autonomic, and sexual dysfunctions, sensory disturbances including chronic pain, and cognitive dysfunctions. Section C, Disease-specific neurorehabilitation systems, considers the integrated approaches that have been developed to address the rehabilitation of patients with specific diseases and disease categories; multiple sclerosis, stroke, traumatic brain injury, neurodegenerative diseases, etc.

Throughout the two volumes, efforts have been made to relate the basic science to the clinical material, and to cross-reference relevant chapters where the integration is supported. In this way, we hope to stimulate basic scientists to broaden their understanding of the clinical relevance of their work. At the same time clinicians and clinical scientists in the various fields of rehabilitation medicine will be encouraged to enhance their curiosity and understanding of the mechanisms underlying their practice. Ultimately, we hope that encouraging communication between basic and clinical scientists in relevant areas of research will help to accelerate the translation of basic research into effective clinical treatments that will expand the degree of functional recovery of neurologically disabled persons.

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