ABSTRACT
The process of rehabilitation facilitates both recovery following a single pathological insult, and longer term management of disablement over months or years. In both cases, an important consequence of the process is the prevention of secondary deterioration and disability. In the context of neurological disease, secondary deterioration may be a consequence of a primary feature of the disorder-for example, the contractures following spastic hypertonus or aspiration pneumonia following dysphagia. Other complications may result from immobility alone, such as pressure sores and osteoporosis, or from medical treatment, such as the extrapyramidal side effects of neuroleptic medication or the gum hypertrophy due to phenytoin. Whatever the cause, the whole rehabilitation team must be sensitive to the prevention of further damage, since most of these secondary conditions are difficult or impossible to correct once established. This chapter emphasises the adverse consequences of immobility and the growing recognition of the role of exercise in counteracting the secondary effects of chronic neurological disability.
