Brain health, disability, and the need for broader thinking

According to WHO, disability is part of being human. Around 1·3 billion people have a disability, with neurological disorders being the leading cause. Disabilities can affect people of every age, ethnic background, and gender, yet people with disabilities still face many barriers, including in access to health care. As highlighted by several new initiatives and publications, health officials, health-care professionals, and the wider public all need to do more to reduce the negative effects of disabilities associated with neurological disorders. The theme of the tenth World Brain Day, held on July 22, 2023, was brain health and disability. World Brain Day has been organised annually since 2014 by the World Federation of Neurology (WFN) and this year was run jointly with the World Federation of Neurorehabilitation (WFNR); together, these organisations want to increase awareness and reduce barriers to health care for people with neurological disabilities. The campaign has five aims: prevention (both of neurological disorders and of social and environmental factors that contribute to disability, such as stigma); awareness (of the effects of neurological disabilities); access (calling for universal access to diagnosis, treatment, rehabilitation, and assistive technology); education (of the public as well as health-care professionals); and advocacy (to address discrimination, stressing that brain health is a human right). As a key part of the campaign, a webinar entitled Brain Health and Disability: Leave No One Behind featured powerful testimonies from people with neurological disabilities and speakers from WHO and the WFN, WFNR, African Academy of Neurology, American Academy of Neurology, Asian and Oceanian Association of Neurology, European Academy of Neurology, Pan American Federation of Neurological Societies, and Pan Arab Union of Neurological Societies. The aims of the World Brain Day 2023 campaign stress the need for rehabilitation. In 2019, 255 million people were estimated to have neurological conditions that would benefit from rehabilitation, most commonly stroke, followed by dementias, cerebral palsy, and traumatic brain injury. For example, rehabilitation for dysphagia after stroke is essential to reduce mortality and improve patients’ quality of life. The WHO Rehabilitation 2030 initiative states that rehabilitation is an essential health service that should be available for everyone throughout life, and in 2023 several steps have been taken towards that goal. On May 27, 2023, the World Health Assembly endorsed a resolution that calls for expansion and integration of rehabilitation services within healthcare systems and emphasises the importance of rehabilitation in primary care and emergency responses. The third Global Rehabilitation 2030 meeting (Geneva, Switzerland, held on July 10–11, 2023) saw the launch of several Rehabilitation 2030 resources, including a Package of interventions for rehabilitation, which outlines essential rehabilitation interventions for 20 health conditions; the package includes a neurological disorders module that covers stroke, Parkinson's disease, traumatic brain injury, spinal cord injury, cerebral palsy, and dementias, and a developmental disorders module that covers autism spectrum disorders and disorders of intellectual development. The meeting ended with the formal launch of the World Rehabilitation Alliance (WRA), a global network of stakeholders (including WHO members, governmental and non-governmental organisations, philanthropic foundations, and academic institutions) that aims to support implementation of Rehabilitation 2030 through evidence-based advocacy. Improving access to rehabilitation is crucial but other aspects of health care and perceptions also need to change. For example, access to other types of care, including palliative care, has to improve, and barriers to seeking care, including stigma, need to be removed. Health-care professionals, including neurologists, need to be aware of patients’ needs and the social context of disability, including to ensure that services are accessible to people with different mobility and communication needs. Health-care professionals also need to be sensitive to what their patients want and be mindful of the disability paradox, whereby the clinician's perception of quality of life can differ from that of the patient. According to the World Brain Day website, “Brain health is a human right that applies to everyone, everywhere”. Health officials, health-care professionals, and the wider public can all do more to ensure that this right is realised for people with disabilities, not only by taking steps to prevent disabilities and improve access to treatment and rehabilitation, but also by changing their perceptions of neurological disabilities and the people who have them. The assessment of dysphagia after stroke: state of the art and future directionsDysphagia is a major complication following an acute stroke that affects the majority of patients. Clinically, dysphagia after stroke is associated with increased risk of aspiration pneumonia, malnutrition, mortality, and other adverse functional outcomes. Pathophysiologically, dysphagia after stroke is caused by disruption of an extensive cortical and subcortical swallowing network. The screening of patients for dysphagia after stroke should be provided as soon as possible, starting with simple water-swallowing tests at the bedside or more elaborate multi-consistency protocols. Full-Text PDF Changing views of disabilityAs neurologists, we must broaden our understanding of disability. Generally, physicians think that disability is medical, and that if a patient's condition interferes with their daily life, they are disabled. This traditional, medical model of disability does not address societal factors that influence disability, nor does it recognise disability as a cultural identity.1 Viewing disability as an issue stemming from an impaired body can encourage physicians to view disabled patients’ quality of life negatively (regardless of the patients’ opinions) and to offer treatments aiming to fix the patient (make them non-disabled), disregarding therapies the patient might find more useful. Full-Text PDF