Contemporary issues in neuro rehabilitation


  • Muhammad Suleman Faculty of Rehabilitation & Allied Health Sciences, Riphah International University Islamabad Pakistan
  • Muhammad Ali Awan Malik Faculty of Rehabilitation & Allied Health Sciences
  • Muhammad Ramzan Sarki Isra Institute of Rehabilitation Sciences, Isra University Islamabad Pakistan



Stroke is prevailing as the third most common neurological condition on a global scale and an estimated 25.7 million people are those who have survived it. Stroke is one of the overburdening conditions in about 33% of all individuals affected by permanent disability. Because of the high incidence of risk factors especially in Asia (including Pakistan) with an approximation of 250 cases per one lac persons. Occurrence is mostly seen in the older population and is often found with certain other co-morbidities such as dementia. To enhance the post-stroke quality of life in the geriatric population, especially the ones with existing co-morbidities. Physical rehabilitation of stroke plays a vital role[1].

Studies have demonstrated that the rehabilitation of patients with stroke is a lifelong process during which the survivors sequentially develop new physical habits, and transform their activities of daily living[2]. Stroke rehabilitation treatment protocol lasts quite a long. Therefore, it is sometimes tiresome for the patients and their families because of frequent visits to healthcare settings. Additionally, due to a shortage of skilled and specialized rehabilitation professionals, there is a scarcity of quality treatment protocols and as a result, the objectives of most of the rehab programs are not practical and achievable. Thus, preventing the patients from making a significant recovery[3].

The evidence does not support guidelines that are being followed in the healthcare systems of our country regarding stroke management. While working with individuals recovering from stroke and other neurological disorders, rehabilitation generally focuses on strength training[4].

Despite the fact, that the urban population in developing nations like Pakistan has now access to medical facilities such as stroke rehabilitation, the country's rising population is resulting in an overburdening of the healthcare system leading to sloppiness of all the medical services including rehabilitation[3]. Although most rehabilitation professionals and physical therapists know the fact that the traditional techniques used in neuro rehab are not always effective, still they use them on their patients, this lack of evidence-based practice may be due to inaccessibility to authentic clinical practice guidelines and other physiotherapy databases[4]. For instance, relying on outdated techniques such as range of motion exercises and stretching exercises for treating stroke patients is not as effective as using proprioceptive neuromuscular facilitation exercises to improve the coordination and functional ability of patients, thereby improving motor function along with balance and gait[5].

Conventional approaches in rehabilitation management particularly in the domain of neurology are becoming ineffective due to the huge demand that chronic neurological illnesses are placing on our healthcare system. New creative techniques, including integrated care pathways, are needed to obtain better outcomes[6].

The process of governing skillful clinical and administrative pathways is needed to overcome situations associated with a rise in the number of admissions and long stays in hospitals or healthcare resources. Implementing more innovative approaches by management can achieve better outcomes with a reduction in admissions and shortened hospital stays. It will cohesively lead to effective treatment guidelines, greater patient satisfaction, and improved quality of life. Most of European countries are regulated by integrated rehabilitation services to help patients navigate healthcare services more effectively for an impressive, person-centered approach to rehabilitation care[6].

Unified rehabilitation at the current regional and national level with updated approaches and action plans along with evidence-based clinical practice guidelines is required to safeguard the delivery of person-centred rehabilitation care. Thus, we can conclude that there is a dire need to promote the development and implementation of standardized care in neuro-rehabilitation centers for enhancement in the quality of rehabilitation services. In addition to the use of digital media platforms for spreading awareness among the general masses, regulation and periodic reviews of rehabilitation services are also required. 


1.         Khan RSU, Nawaz M, Khan S, Raza HA, Nazir T, Anwar MS, et al. Prevalence of dyslipidemia in ischemic stroke patients: a single-center prospective study from Pakistan. Cureus. 2022;14(6). [CrossRef] [PubMed]

2.        Bogstrand A, Gramstad A, Anke AGW, Stabel HH, Arntzen C. Healthcare Professionals' Experiences with Rehabilitation Practices for Patients with Cognitive Impairment after Stroke in North Norway: A Qualitative Study. Rehabil Res Pract 2022. [CrossRef] [PubMed]

3.        Dutta D, Sen S, Aruchamy S, Mandal S. Prevalence of post-stroke upper extremity paresis in developing countries and significance of m-Health for rehabilitation after stroke-A review. Smart Health. 2022:100264. [CrossRef

4.        Tole G, Raymond MJ, Williams G, Clark RA, Holland AE. Strength training to improve walking after stroke: how physiotherapist, patient and workplace factors influence exercise prescription. Physiother Theory Pract . 2022;38(9):1198-206. [CrossRef] [PubMed]

5.        Nguyen PT, Chou L-W, Hsieh Y-L. Proprioceptive Neuromuscular Facilitation-Based Physical Therapy on the Improvement of Balance and Gait in Patients with Chronic Stroke: A Systematic Review and Meta-Analysis. Life (Basel) . 2022;12(6):882. [CrossRef] [PubMed]

6.        Bickenbach J, Stucki G, van Ginneken E, Busse R. Editorial: Strengthening Rehabilitation in Europe. Health Policy. 2022;126(3):151. [CrossRef] [PubMed]

Author Biographies

Muhammad Suleman, Faculty of Rehabilitation & Allied Health Sciences, Riphah International University Islamabad Pakistan

Physical Therapy Scholar of DPT program (Final Semester)

Muhammad Ali Awan Malik, Faculty of Rehabilitation & Allied Health Sciences

Assistant Professor

Muhammad Ramzan Sarki, Isra Institute of Rehabilitation Sciences, Isra University Islamabad Pakistan

Assistant Professor





11-08-2023 — Updated on 29-09-2023