A paradigm shift in neurorehabilitation

The practice of neurorehabilitation in the clinic has undergone a paradigm shift as a result of influences from basic and clinical research. I have identified six areas of knowledge that by advancing so rapidly have brought about this paradigm shift: first, the increased understanding of how the CNS is reorganised after training or injury; second, the knowledge of how declarative and procedural memory operates and how this can influence rehabilitation therapy; third, a greater appreciation of the chemical factors that promote learning and neural remodelling; fourth, the fact that computational neuroscience can teach us how complex behaviour can emerge from the interaction of thousands of neurons; fifth, the influence of evidence-based medicine on neurorehabilitation; and sixth, the importance of reliable outcome measures for both injury and treatment. These are young scientific disciplines that offer great opportunities for further research. The complexity of neurorehabilitation will also require greater attention to a substantially neglected problem, the incorporation of techniques that have been proven effective in clinical trials into routine and effective clinical practice.