Neurology and Neurorehabilitation – the difference in expert opinion
29 June 2017
Many solicitors tell us that they are confused about the expertise they are relying upon, particularly when asking for opinions from neurologists and neurological rehabilitation physicians.
Neurological rehabilitation physicians are specialist in the management of disabling conditions arising from disorders of the nervous system. They specialize in determining the functional consequences of neurological conditions. In plain terms it’s determining what someone is able to do now, and what they will be able to do in future. This includes the management and subsequent avoidance of complications of neurological conditions which will impact on function such as pain, mood, anxiety, contracture and spasticity.
Neurological rehabilitation physicians manage disabling conditions such as acquired brain injury long-term, observing how the condition develops and hence are ideally placed to comment on condition and prognosis. They are expert at working in multidisciplinary teams alongside colleagues from the therapies, nursing, neuropsychology, clinical psychology, care, augmented communication, orthotics and vocational rehabilitation. They spend most of their time looking after people with acquired brain injury, spinal cord injury, peripheral nerve injury (brachial plexus and Guillaine-Barre Syndrome) as well as chronic conditions like multiple sclerosis, and also functional conditions. Therefore, they see how these conditions affect people in the broadest sense in their community and how a wide range of professional interventions can optimize function and quality of life. These are the issues which are central to establishing quantum.
Neurologists in contrast are specialists in the primary diagnosis and treatment of disorders of the nervous system. They are expert in the investigation of symptoms and signs and the interpretation of scans and tests such as MRI, CT and nerve conduction studies. Neurologists focus primarily on the acute management of conditions in the short-term and rarely see the long-term outcomes. They are not concerned with functional assessment.
They spend most of their time investigating and treating headache, epilepsy, multiple sclerosis, Parkinson’s Disease, intracranial pathology such as tumour, and also excluding hard pathologies to reveal functional conditions. Their expertise does not therefore relate fundamentally to establishing condition and prognosis.
In answering the questions relating to condition and prognosis posed by solicitors, consider how often a report from a neurologist defers to the expertise of a neurological rehabilitation physician. It is more economical financially and timewise to instruct neurological rehabilitation physicians first in major personal injury or clinical negligence cases relating to acquired brain injury and to rely on their expertise to involve neurologists in the rare circumstances where it is absolutely necessary.