Lean on Me: Rehabilitation and Durable Medical Equipment in Serious Neurologic Illness

Key Message: Serious neurologic illness is common and highly distressing for patients and caregivers, particularly due to focal deficits and functional decline. This session will review strategies for evaluating and treating these deficits, and for coordinating care with rehabilitation specialists.

Abstract:

Background: Neurologic illness is among the most common indications for palliative care referral and the most common principal hospice diagnosis (dementia) is neurologic.(1, 2) People affected by neurologic illness commonly experience cognitive, motor, and sensory deficits that are detrimental to quality of life (QoL) and amplify caregiver burden.(3, 4) These deficits may also lead to distressing symptoms such as pain, derangements in muscle tone (spasticity or flaccidity), anxiety, and mood disorders. Given recent calls for early, integrated palliative care in serious neurologic illness,(5) palliative medicine practitioners may increasingly encounter these burdensome symptoms in their patients. However, they may have limited training on non-pharmacologic strategies to address them.

Objectives: To review available strategies for identifying and ameliorating common deficits across the continuum of care, as well as determinants of access to rehabilitation services and durable medical equipment (DME).

Approach: We will present (1) the physiatry approach to setting rehabilitation goals, providing anticipatory guidance around functional decline, and evaluating for appropriate DME to maximize QoL and independence; (2) a head-to-toe overview of high-yield interventions and DME used to ameliorate common neurologic deficits; (3) the role of caregiver support and benefits of these interventions for caregivers; and (4) a framework for interdisciplinary collaboration between palliative medicine and rehabilitation specialists (e.g. physiatrists and speech, occupational, and physical therapists), including overcoming barriers to access. The authors include a physiatrist specializing in brain injury; an occupational therapist specializing in amyotrophic lateral sclerosis; a vascular neurologist with a previous career as a speech pathologist; a psychologist specializing in caregiver support; and a neuropalliative physician.

Implications: Palliative medicine practitioners have the opportunity to improve function and QoL for patients and caregivers with serious neurologic illness through care coordination with rehabilitation services. Session participants will gain knowledge enabling them to meet those opportunities across care settings.

References: 1. Liu Y, Kline D, Aerts S, et al. Inpatient Palliative Care for Neurological Disorders: Lessons from a Large Retrospective Series. J Palliat Med 2017;20:59-64.
2. National Hospice and Palliative Care Organization Facts and Figures, 2024 Edition. 2024. Available from: https://allianceforcareathome.org/resource/facts-and-figures-report-2024-edition/. Accessed July 10, 2025.
3. van der Ende NAM, den Hartog SJ, Broderick JP, et al. Disentangling the Association Between Neurologic Deficits, Patient-Reported Impairments, and Quality of Life After Ischemic Stroke. Neurology 2023;100:e1321-e1328.
4. Shamoun C, Harris MA. Impact of Stroke Survivors' Physical Disability on the Presence of Caregiver Burden: A Systematic Review. J Neurosci Nurs 2022;54:146-150.
5. Lau WK, Fehnel CR, Macchi ZA, et al. Research Priorities in Neuropalliative Care: A Consensus Statement From the International Neuropalliative Care Society. JAMA Neurol 2025;82:295-302.