Introduction

The purpose of this chapter is to place neurological rehabilitation in a historical context and outline some of the basic underlying principles. Neurological rehabilitation is a relatively new subject and has grown up in a hospital-orientated environment. The need for a new community emphasis will be explored and some theoretical models of delivery discussed. However, first it is important to review briefly the epidemiology of disability in order for the importance of this subject to be placed in an appropriate context.

Epidemiology

The roots of neurology lie in late nineteenth century psychiatry but over the years a rather false distinction has slowly been made between neurological disorders and psychiatric disorders, even though many important disorders such as schizophrenia, manic-depressive illness and senile dementia almost certainly involve an organic disturbance of brain function. In recent years the false distinction between neurology and psychiatry has been made more apparent by the emergence of neurological rehabilitation units in which it is increasingly recognized that the clear distinction is unhelpful. People with traumatic brain injury will nearly always have a combination of physical, psychological, emotional and behavioural problems, which require the expertise of a full multidisciplinary team and one that is preferably trained in both the physical and psychological consequences of disease and injury. Many rehabilitation specialists now also have some training in psychiatry and increasing help is given by the emerging speciality of neuropsychiatry.