Neurorehabilitation: a bridge between basic science and clinical practice

A true paradigm shift or revolution of thinking is taking place in the field of neurology. Earlier, it was regarded as the science of exact diagnosis of incurable illnesses, according to the resigned dogma that damage to the central nervous system could not be repaired: "Once development is complete, the sources of growth and regeneration of axons and dendrites are irretrievably lost. In the adult brain the nerve paths are fixed and immutable: everything can die, nothing can be regenerated" (Cajal, 1928). Even then one could have countered this with what holds today: "Rehabilitation does not take place in the test tube!", and one would have been supported only a short time later by a most authoritative source, if one had read and quoted what the professor of neurology and neurosurgery in Breslau, Otfried Foerster, wrote in a 100-page article about therapeutic exercises that appeared in the Handbuch der Neurologie. From his introduction, only three sentences are quoted, which illustrate his opinion of the importance of therapeutic exercises and are closer to our views of brain functions today (Foerster, 1936): There is no doubt that most motor disturbances caused by lesions of the nervous system are more or less completely compensated as a result of a tendency inherent to the organism to carry out as expediently as possible the tasks of which it is capable under normal circumstances, using all the forces still available to it with the remaining undamaged parts of the nervous system, even following injury to its substance. This happens spontaneously, when neither a reversal of the noxa nor a regeneration of the destroyed tissue is possible, simply by means of a reorganization of the remaining parts of the nervous system, which is not a machine composed of individual parts that stands still when one part fails; rather, it possesses an admirable plasticity and exhibits an astonishingly extensive adaptability, not only to changed external conditions but also to disruptions of its own substance. Therapeutic exercises influence the course of spontaneous restoration; they support it, strengthen it. Not infrequently, in fact, they actually set it in motion when the forces essential to restoration lie fallow and are not deployed by the organism.