Update: Early and gait rehabilitation

At the 9th THERA-Trainer Symposium in September 2019, the megatrends of demographic transition and digitalisation came into contact. The event focused on the use of robotics in modern gait rehabilitation and the associated digital transformation of working environments. Text: Jakob Tiebel Will modern treatment robots replace thera­pists in the future? What influence does the digital transformation have on the working environments of therapists? What will change and what will remain the same for a long time to come? The digital transformation has now encom­passed all aspects of daily life. An increasing trend in the use of modern technologies is also evident in the field of rehabilitation. The use of therapy equipment is now an integral part of everyday therapeutic practice. There is good evidence for robot-assisted gait therapy, which is now recommended by almost every professional association in both national and international guidelines. Yet despite its usefulness, technology still cannot replace the relationship between therapist and patient. On the one hand because therapy remains a complex activity that cannot be replaced with technologies. And on the other because the personal relationship with the patient has been proven to be one of the determining factors for successful treatment. Development companies should therefore focus less on the idea of substitution. They should think about how therapists can spend more time with their patients in the future through the digital transformation of their working environments. It is still the case that therapists spend up to 40 percent of their working time away from patients. They are overburdened with paperwork. Likewise, 40 percent still use pen and paper for their correspondence, for example in case management. 34 percent of all healthcare facilities still work with paper records. In contrast and after some initial scepticism, 90 percent of healthcare employees now agree that digitalisation provides an opportunity for improved patient care. Participants at the symposium were able to experience the potential of state-of-the-art technologies for rehabilitation as part of the event. The venue was Medical Park Bad Rodach, one of the most modern neurological rehabilitation centres in Germany. Gunter Hölig, Head of Therapy at the Medical Park, presented the range of services offered by the clinic and in the technical part of his presentation he particularly addressed the economic aspects of device-based therapies. Personalised therapies in a group within modern therapy worlds enable the clinic to offer the highest medical and therapeutic standards while taking into account efficiency and use of resources.

Tobias Giebler then discussed the possibilities of device-based therapy in early rehabilitation in intensive care units. He is a physiotherapist at Tübingen University Hospital specialising in the treatment of ICU patients. His conclusion: “If rehabilitation doesn’t start early, it will be expensive!” This is why guidelines have explicitly called for early mobilisation of critically ill patients. Using algorithm-based procedures, Giebler has proven that early mobilisation is “safe, feasible and effective”. Taking into account current evidence, the young physiotherapist particularly pointed out the use of technical support systems such as the bed bike.

Christian Zange, Head of Physiotherapy at the Vamed Klinik in Pulsnitz, made clinical decision-making the subject of his presentation. There are now increasing numbers of therapy robots. But how are they used for the greatest benefit to patients? Patient motivation is a key yet often neglected attribute. According to the neurorehabilitation specialist, the art of using modern therapy devices is “to enable patients to experience movement in a positive and targeted way in order to encourage pleasure in learning”. To this end, Zange firstly presented some basic scientific studies on device-supported gait training and, based on these, gave the audience numerous practical recommendations for everyday use. The focus in the afternoon on the first day of the event was treatment practice. In alternating workshops, the participants gained a deeper insight into the treatment processes in the clinic and learned about different robotic systems in everyday clinical practice. Dr Carsten Clewig opened the second day of the congress. The Head of MEDIAN Saale Klinik Bad Kösen discussed setting up device-based group therapies in a geriatric setting, where care management is particularly complex and generally ill-defined on a diagnostic level. As part of his presentation, the experienced neurologist gave a differentiated meaning to the term multimorbidity and explained: “Gait rehabilitation in geriatrics only works if it is clear where the disorder is coming from.” This is where doctor and therapist at the specialist clinic in Bad Kösen work closely together to design an effective dual care approach. Sabine Lamprecht then pointed out that therapists must see themselves more in the role of a coach during the treatment process. “Patients themselves are the key to success,” according to Lamprecht. The experienced physiotherapist and Master of Science in Neurorehabilitation with her own practice near the city of Stuttgart made it unmistakeably clear that modern physiotherapy must move away from “measures to integrate the pelvis” and go over to “practising walking under participatory aspects”. She referred, among other things, to the ICF framework and said: “The implementation of guidelines in everyday practice is possible if we deal with it!” Gabriele Buchstein then bridged the gap between evidence and empiricism. The lead physiotherapist at Sauerlandklinik Hachen and her team specialise in the treatment of patients with multiple sclerosis. The therapists there combine traditional treatment approaches with modern procedures using gait trainers. Movement analysis systems are used to examine different gait qualities. The results are used for continuous adjustment and therapy optimisation. Dr Christian concluded the presentations. He highlighted new potential in the treatment of stroke patients in neurological rehabilitation, while taking into account the guideline on Rehabilitation of Mobility after Stroke (ReMoS). The ReMoS guideline was first published in 2015 and forms the basis for an evidence-based design of motor therapies to improve walking ability, walking speed, walking distance and balance in post-stroke patients. Unfortunately, the recommendations in the guideline are not always used systematically in practice. A digitisation project, officially launched in early 2019 by the authors’ group, intends to make the recommendations accessible via a “smart” app and at the same time serve as a framework for continuous updating to make it a living guideline.