Neurologic rehabilitation at the end of the century in the United States

The end of the twentieth century has witnessed tremendous growth in clinical rehabilitation services for persons with neurologic conditions in the United States. However, changes in reimbursement are having profound effects on how and where rehabilitation services are delivered. The popularity of managed care and the enactment of the Balanced Budget Act of 1997 are two of the factors that have precipitated the dramatic changes under way as the twenty first century begins. On the other hand, interest in rehabilitation research has never been greater. Advances in cellular biology, neurochemistry, neuronal network integration, and neuroimaging are leading to a better understanding of recovery from neurologic illness and injury. New training paradigms are being developed, and pharmacologic enhancement of recovery is a strong possibility in the near future. This article presents a snapshot of the changing face of neurologic rehabilitation services in the United States, the forces of change, and their effect on delivery of rehabilitation services and rehabilitation personnel. Issues related to education and research are discussed, and predictions for the future of neurorehabilitation are presented.