The future of rehabilitation

Lies in retraining, replacement, and regrowth

Healthcare delivery continues to focus on acute illness and the threat of death, but contact with healthcare systems is dominated by people with chronic conditions. In the United States they account for nearly 50% of those in contact with healthcare but nearly 80% of healthcare costs.1 Neurological damage accounts for about 40% of those people most severely disabled, who require daily help, and the majority of people with complex disabilities resulting from a combination of physical, cognitive, and behavioural impairments. 2 3 In the United Kingdom until recently the involvement of neurologists in these patients' rehabilitation, was not obviously encouraged. However, there are positive signs of change, and combined therapies and restorative neurology are likely to attract more neurologists to the challenges of rehabilitation.

In the past senior representatives of rehabilitation medicine apparently considered it possible for doctors with little or no previous neurological exposure to manage such patients after 12 months' training in neurological rehabilitation. Dual accreditation in rehabilitation medicine and neurology was effectively discouraged, as it took eight and a half years compared with four in …