Letter from the Chair

May 18, 2012



Welcome to the home page of the Neural Repair and Rehabilitation Section of the American Academy of Neurology!

The purpose of the Neural Repair and Rehabilitation Section is to increase awareness of and interest in neurological rehabilitation as an important component of the comprehensive and continuing care of the neurologic patient. We aim to expand the responsibilities of neurologists by developing their expertise in neurological rehabilitation and to pursue and disseminate research and teaching in neural repair and rehabilitation through seminars, publications, and presentations at Scientific Sessions of the American Academy of Neurology. Finally, we aim to enhance the future role of Neurology by educating both newly certified and currently established neurologists in neural repair and rehabilitation, and to advise the American Academy of Neurology on issues related to our field.

The current Executive Committee of our Section, including the Chair of the Section and the Vice Chair, as well as the Section Leaders in Education and Research, are particularly focused on research and development in neural regeneration and repair, and in changing the field of neurological rehabilitation. Our aim is to change the focus of neurological rehabilitation – particularly as performed by neurologists - to the goal of curing diseases of the brain and spine through specific biological interventions. Such approaches as pharmacotherapy, cell and tissue transplantation, electrical and magnetic stimulation, devices, and similar efforts aimed at repairing the brain and spine directly, are enormously promising. Because such approaches target regeneration and repair, and depend on nervous system plasticity, they require concomitant behavioral interventions as well: Nervous system plasticity is inherently stimulus-dependent, and thus these novel repair mechanisms must be accompanied by carefully designed and specially targeted behaviors.

Thus, the future of neural regeneration and repair includes a combination of novel therapies targeting central nervous system tissue directly and speech and physical therapies providing the requisite stimuli for plasticity to occur. This means that the future of these therapeutic fields must be coordinated with neuroscience research on the types of stimuli that best serve the needs of the regenerating, repairing, and/or reorganizing brain. Such therapies may not be identical to those we use today, and may be targeted to specific individuals based on their personal profiles, whether genetic, behavioral, or anatomical. Our field therefore embraces research in biomarkers for recovery, to enable a true personalized medicine of neurological rehabilitation.

In addition to our goal of transforming neurological rehabilitation into a true neurological field of clinical neural repair, we aim to support active neurological rehabilitation clinicians of today, who use the tools currently available to help improve the lives of people with impairments and disabilities from stroke, brain injury, spinal cord injury, and other neurological diseases. To this end, we have two fundamental goals. One involves certification and accreditation of active practitioners. The second involves accomplishing reimbursement for novel tools and procedures.

Beginning this Fall, in collaboration with the United Council of Neurological Subspecialties (UCNS), we will administer the first certification examination in neural repair and rehabilitation. Such certification will serve as formal evidence of competency for purposes of hospital privileges, consumer selection, and even marketing for individuals or institutions that have certified specialists. Such certification will speak to a certain knowledge base and level of competency in a growing and developing subspecialty of neurology that emphasizes neural repair of the brain and spine. Ultimately hospitals and consumers will require such certification in their specialists.

In addition, we will actively try to grow the numbers of reimbursable procedures aimed at neural repair. For example, current evidence supports the use of single pulse or paired-pulse transcranial magnetic stimulation for assessment of the corticospinal tract after stroke. We aim to allow this procedure to be used for clinical prognosis and therapeutic selection after stroke and to be reimbursed. Other therapeutic modalities for which evidence is rapidly accumulating include various drug, cellular, electrical, and magnetic interventions, and it will be our focus to review the evidence and get these into practice as soon as the evidence warrants.

In summary, the field of neural repair and rehabilitation is changing fast, and will soon have advanced neurological tools to intervene directly in the regeneration and repair of the central nervous system. At the AAN Section on Neural Repair and Rehabilitation, we aim to promote the research, education, and clinical practice advances to make this a key neurological subspecialty in the coming years.

On behalf of the entire Executive Committee, I urge you to join us in this endeavor! Become a member of the Section and participate actively in our future.

Steven L. Small, Ph.D., M.D.
Chair, Section on Neural Repair and Rehabilitation
American Academy of Neurology

Stanley van den Noort Professor and Chair
Department of Neurology
University of California, Irvine