Identifying, measuring and standardizing most effective approaches to neuro rehab

Most people agree on the value of rehabilitation. The evidence seems clear enough: sick or injured people are admitted to hospitals such as Toronto Rehab. Often, a few weeks or months later they walk out and return to their daily lives. But the challenge is to understand exactly what happens in between.

"We need to be sure which components of rehab are the most effective," says Dr. Mark Bayley, Medical Director of Toronto Rehab's Neuro Rehabilitation Program where he treats people with stroke and other brain injuries and does research in the field of brain recovery.

Dr. Bayley and his colleagues are one of the first groups to study how to implement best practices in this area. It's not always easy to get firm evidence that a particular approach to rehab works. Often, researchers have to develop new ways to measure the efficacy of a treatment.

"We need to look at how we do treatment and amass evidence for what works best in the area of neuro rehab. Once we have that evidence, we need to translate it into standard practice. That way, we can deliver the best treatment consistently instead of having different approaches."

Dr. Bayley - whose special interests include stroke, multiple sclerosis and neuro pharmacology - is also studying patients who are unusually slow to recover after some kind of brain injury. "We've found that people continue to recover for a considerable amount of time after an injury," he observes.

In a recent pilot study, Dr. Bayley and his colleagues also observed there seems to be a trade-off between brain-injured patients' ability to relearn cognitive skills and motor skills over a given time. The more cognitive skills they relearn, the fewer motor skills they reacquire, and vice-versa.

"We theorize that the brain may have limited resources for recovery and that different areas of the brain are competing to get those resources," says Dr. Bayley. The researchers now want to do a larger study involving more patients. The findings, says Dr. Bayley, could have important implications for rehab.

Although trained as a medical doctor, Dr. Bayley also likes to look at rehabilitation from a systems engineering perspective. "I'm especially interested in how you put together a system of rehab that really works and is responsive to the needs of clients," he says.

"I enjoy the challenge of juggling administration, research and clinical practice. We see people at their worst and they get better. And it's a fascinating process to study, because everyone is a bit different."