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The Past, Present, and Future of Neurorehabilitation: From NUSTEP Through IV STEP and Beyond

Harris, Susan R. PT, PhD, FAPTA, FCAHS; Winstein, Carolee J. PT, PhD, FAPTA, FAHA

Journal of Neurologic Physical Therapy: July 2017 - Volume 41 - Issue - p S3–S9
doi: 10.1097/NPT.0000000000000193
Special Interest Articles

Purposes: To present the history and aims of the STEP conferences; describe the interdependence of prevention, prediction, plasticity, and participation; reflect on where we stand today regarding those 4 Ps; and discuss how future neurorehabilitation should look for individuals with movement disorders.

Key Points: Physical therapists have focused primarily on tertiary prevention, emphasizing primary/secondary prevention far less. Predicting optimal response to intervention is essential for primary prevention. Research examining neurorehabilitation effects mediated by brain plasticity is evolving from an emphasis on impairment outcomes toward examination of participation outcomes.

Clinical Practice Recommendations: (1) Capitalize on primary and secondary prevention. (2) Administer simple, environmentally relevant predictive measures. (3) Partner with researchers to examine exercise-induced brain plasticity effects via neuroimaging. (4) Encourage physical activity to promote secondary prevention of lifestyle-related diseases and enhance participation. (5) Integrate psychological/social sciences with physiological sciences to move forward with advances in mindful health and patient-centered practices.

Department of Physical Therapy (Dr Harris), Faculty of Medicine, University of British Columbia, Vancouver, Canada; and Division of Biokinesiology & Physical Therapy, and Department of Neurology, Keck School of Medicine (Dr Winstein), and Motor Behavior & Neurorehabilitation Laboratory, Ostrow School of Dentistry, University of Southern California, Los Angeles.

Correspondence: Susan R. Harris, PT, PhD, FAPTA, FCAHS, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada (

The authors declare no conflicts of interest.

This work was previously presented at the IV STEP Conference, organized and sponsored by the Academies of Neurologic and Pediatric Physical Therapy of the American Physical Therapy Association, at Ohio State University in Columbus, Ohio, on July 14, 2016.

Reprinted with permission from Pediatric Physical Therapy, 29.3S, pp S2-S9.

© 2017 Academy of Neurologic Physical Therapy, APTA