In January, the physiotherapy conferences "Physiokongress" and "Süddeutsche Verbände-Symposium" kicked off the year in Stuttgart. As in previous years, the TheraPro therapy and rehabilitation trade fair offered visitors a varied supporting programme.

As part of the neurorehabilitation day, the medical journal "neuroreha" celebrated its tenth anniversary and attracted physiotherapists and occupational therapists to the lecture halls of the Stuttgart trade fair centre with interesting, interdisciplinary topics. The opening event on the subject of digitisation and physiotherapy was a particular highlight of the congress.

Opening by Susanna Freivogel

Susanna Freivogel, neuroreha co-editor from the very beginning, looked back on the title topics of previous years in her keynote lecture "10 years of neuroreha – what has happened in this time and what are the next steps" and placed them in a well-founded professional context in relation to current findings from science and research.

She emphasised the need to focus on the practice of activities in central motor disorder therapy. She referred to basic mechanisms of neuronal reorganisation, Hebb's learning rules and essential principles of motor learning, such as repetition and shaping. She also made it clear that compensatory phenomena can be tolerated without concerns in the context of active practice and must not be equated with spasticity or the pathological increase of a plus symptomatology.

Last but not least, Freivogel asked that we do away with phrases like "standing before walking" and "core is more". Postural control and walking are two completely different categories of motor learning which are equally important for the success of mobility rehabilitation and should be practised in a targeted manner. No single therapy method is superior here, but rather an intelligent combination of several specific measures.

Freivogel ended her lecture with a personal conclusion. From her point of view, evidence-based physiotherapy has become established over the past ten years particularly in the clinical field. She criticised the quality of outpatient aftercare. There is still a lot of potential here, although the first results of an ongoing study fail, not so much due to the will of the therapists as to the framework conditions set by the healthcare system.

Plea for more sport in neurology

In the talk "Sport and exercise in neurology", Prof. Dr Jan Mehrholz demonstrated his own physical condition. In his 30-minute speaking time, he sprinted through a broad range of topics in his usual casual manner. He had already announced an "evidence update" in the programme booklet – and there certainly was one! First, he presented some basic research findings on the topic of fitness and the influences of a healthy lifestyle. From this it could be deduced that endurance sports not only improve physical fitness, but also mental fitness. "If you want to be smart, do some endurance sports," he summarily told the auditorium.

He then focused on the topic of endurance sports for stroke patients. Stroke patients have decreased fitness reserves, muscle atrophies, a higher intramuscular fat percentage, increased signs of tissue inflammation and often glucose intolerance. Endurance sports can effectively counteract this, but unfortunately cardiovascular training is still far too little considered in the context of rehabilitation after a stroke.
It is well known that a paradigm shift requires knowledge transfer. Mehrholz explicitly described to the audience how endurance training with patients can be structured – from performance measurement and training principles to concrete application protocols for the different phases of rehabilitation. He used the "FITT" criteria (cf. article on p. 56 in this issue) to describe the intervention and referred to the guidelines of the American Heart Association and the FAME Guideline of the Canadian Heart and Stroke Foundation with regard to training recommendations.

In the discussion that followed, the question arose as to whether cardiovascular fitness could be "caught up" if one was negligent in the past. According to Mehrholz, this is only possible to a limited extent. Another problem is that even after a stroke a couch potato will not turn into a fitness fanatic. The audience contributed that, for example, apps could have a stimulating effect and that under certain circumstances "psychological tricks" had to be used to motivate patients to be more active.

Participation is the goal

Occupational therapist Christina Janssen focused on the individual everyday life of patients. She said that ultimately participation is the goal and ICF, the International Classification of Functioning, Disability and Health, is the basis for neurorehabilitation. The editor of the magazine ergopraxis took up the ideas of previous speaker Susanna Freivogel and confirmed that pure functional improvement does not necessarily mean improved participation. An activity-oriented approach should be favoured. She focused on the idea of "enriched environments" and used experiments conducted by John Krakauer's research group to explain "why it is better to be a rat". In an entertaining way, she alluded to the high inactivity times of patients in rehab: the test rat in the laboratory has it better today with regard to activity than the patient in rehabilitation.

Janssen convincingly described how the transfer into everyday life – of which there is always much talk in therapy – actually succeeds by means of a patient example. From an occupational therapy point of view, the context factors according to ICF are of great importance. Environmental and personal factors can have beneficial and detrimental effects and should be consistently taken into account in therapy planning.

The idea of movement can complement motor learning

Martin Lotze, neurologist and neuroscientist at the Institute for Diagnostic Radiology and Neuroradiology at the University of Greifswald, described the advantages of mental strategies in the context of rehabilitation. On the basis of research results from his own and other research groups, he showed how mental strategies used professionally by athletes and musicians can be used in rehabilitation and what benefits result from this. In his conclusion, he presented mental training strategies as an effective addition to training. For example, by observing and imagining movement without the risk of physical overtraining, an increase in dosage can be achieved in therapy.

Music is effective in neurorehabilitation

Josephine Geipel, music therapist and research associate at the Faculty of Therapy Sciences of the SRH University Heidelberg, and Stefan Mainka, music therapist at the Beelitz-Heilstätten Parkinson's Centre, reported on the multifaceted application possibilities of music therapy in the context of neurorehabilitation. Using numerous patient videos, Mainka demonstrated the effect of music on the walking ability of Parkinson's patients and regretted that in many studies on rhythmic acoustic stimulation, music was reduced to the use of a metronome. In addition, he presented new methods of music therapy. An acoustic app developed by him, for example, improves the arm swing of Parkinson's patients.

When Siri and Alexa say what's what

Karmen Krewer, movement scientist and motor skills researcher at the Schön Clinic in Bad Aibling, reported on the REACH project, in which the Bad Aibling clinic is involved as a clinical partner and where sensors and wearables are central components. According to Krewer, the EU-funded research project is dedicated to topics such as motivation for more exercise in old age, the combined use of portable and environment-integrated sensors, data analysis for early detection and prevention (e.g. of falls) and personalised interventions, including maintaining mobility in old age.