icon-contact-phone
icon-contact-mail
icon-contact-search
Menü
THERAPY Magazin
Changes demanda new view of things
Author
Jakob Tiebel
Business Owner, N+ Digital Health Agency
According to the demographic projections by the Federal Statistics Office, the population structure is steadily changing, with the proportion of older people growing. There is every prospect of this trend continuing over the coming decades [19].
Due to the structural changes of an ageing society, the increase in chronic diseases and rapidly-developing medical and technological progress, key tasks are emerging for physical medicine and rehabilitation [18]. The focus is on people with a wide range of illnesses. The one thing they all have in common is the aim of full rehabilitation of function, improvement in quality of life and reintegration into daily life wherever possible [7].
The shift in the morbidity spectrum towards chronic diseases means that neurological diseases and syndromes, in particular, are on the increase. Neurology departments across Germany treat around a million people a year. The most common treatments are for age-related diseases such as stroke and widespread diseases such as polyneuropathy, neurodegenerative diseases including Parkinson’s disease and autoimmune diseases such as multiple sclerosis [2] [23] [20]. Stroke in particular is one of the most significant medical conditions in western industrialised nations, after cardiovascular diseases and tumours, and ranks amongst the most common causes for permanent restrictions on independence [17][10].
In Germany every year, there are around 196,000 first-time strokes and 66,000 recurrent
strokes [10]. As a result, most patients suffer from considerable restrictions of the motor system, leading to major deficits in their daily lives. For example, three months after a stroke 60% of all patients still have a significantly impaired ability to walk [8].
The epidemiological data on strokes and other neurological diseases forms an important basis for planning future care needs and potential opportunities for optimisation.
The costs for treatment, rehabilitation and care are a massive burden on the health care system [23][10][21]. Taking into account the costs incurred from the loss of productivity, stroke is the disease with the highest burden on the health care system [5]. These trends are similarly reflected in other comparable industrialised countries [1].
Against this background this background, questions relating to effectiveness and efficiency – particularly in rehabilitation – are becoming increasingly important in order to alleviate the consequences of neurological and geriatric diseases and to achieve the best possible reintegration into daily life, employment and society, whilst keeping costs at a reasonable level [23]. Experts overwhelmingly agree that this requires “thorough optimisation in terms of effectiveness, transparency and financial viability” [1] in order to guarantee high quality care, despite the tough financial conditions. A vital condition for achieving this objective is to carry out evidence-based quality assurance measures [1].
What does this mean for therapy?
Neurological rehabilitation, in particular, has undergone significant change in the past 25 years, in the course of new scientific findings on neuronal reorganisation and plasticity of the nerve system, and on the proof of effectiveness of various interventions. More than ever, the focus is on implementing an evidence-based and guideline-supported clinical approach. There has similarly been a paradigm shift in relation to motor therapy [11]. Traditional treatment methods are increasingly receding [12]. They are being replaced by evidence-based approaches to treatment that are scientifically investigated, heavily geared to models of learning theory and are far more effective [11][22].
The treatment spectrum has also expanded through the targeted use of device-based therapy and modern technologies [4]. Device-based standing and walking therapy is documented by sound evidence [13] [15] and has already developed into a core component in neurological rehabilitation. Despite being highly effective and despite sound evidence, however, the possibilities are not yet fully exhausted. In many cases, the devices are not used optimally, even where they are available. Firstly, there is often a lack of meaningful and targeted integration into day-to-day clinical care, and secondly – in terms of limited resources in therapy – all too often individual treatments are more valued as a form of therapy and are therefore preferred [9].
What is the role of the therapist?
The paradigm shift that is currently happening in neurorehabilitation and the new findings emerging in basic and intervention research are leading to a changed understanding of the role of therapists [4]. For many therapists, the structural changes in clinical practice are triggering a search for orientation. Familiar, learned approaches in treatment, which were considered correct, are now being called into question due to new findings, and concerns that the modern treatment robots might take over entirely in future and make therapeutic skills and expertic often lead to “rejection out of self-preservation” [3][16].
Individualised treatment continues to be a key component in the therapy strategy. In future, this approach is set to be supplemented and reinforced through the use and targeted application of device-based therapies and the latest technologies. Evidence-based concepts and, particularly, therapy equipment are, in the overall context, simply two – but highly important – complementary components.
We are seeing that the patient, with the support of the therapist, needs to move away from the role of the “treated person” and take personal responsibility for themselves and the rehabilitation process as early as possible [6]. Ultimately, goal-oriented rehabilitation should not only bring about the maximum achievable degree of independence, but should also teach the strategy for maintaining the abilities that have been regained following rehabilitation. “Neurological rehabilitation is on the one hand always a circumscribed, goal-oriented and thus finalised measure, but on the other hand it must not neglect the need to secure and develop for the long term the improvements in function achieved for patients through rehabilitation [4]”. In an ideal scenario, two experts are working together: the patient, as the expert for their own goals, and the therapist, as the process expert [6].

What goals do patients have?
One vital factor for long-term success is patient motivation to work on the defined objectives, including working independently, well beyond the designated rehabilitation process [4]. Here, too, device-based therapy offers possible solutions, too. With the continuous development of the devices and the use of modern computer technology, patients can always be offered differentiated therapy adapted to their individual needs. Self-training increases therapy frequency as well as patient self-confidence in their own motor skills. This increases confidence in being able to improve one’s own condition through active practice and exercise.
The patients develop a strong sense of self-efficiancy.
The use of therapy equipment combined with forms of therapy such as individual and group therapy will increase the effectiveness of rehabilitation. The greatest possible success can be achieved by cleverly combining these aspects.
Ambulante Rehabilitation
Dialyse Trainings-Therapie
Fachkreise
Intensiv- & Akutpflege
Stationäre Rehabilitation
Therapy & Practice
THERAPY Magazine
Training zu Hause
Wohnen im Alter & Langzeitpflege
Author
Jakob Tiebel
Business Owner, N+ Digital Health Agency
Jakob Tiebel studied applied psychology with a focus on health economics. He has clinical expertise from his previous therapeutic work in neurorehabilitation. He conducts research and publishes on the theory-practice transfer in neurorehabilitation and is the owner of Native.Health, an agency for digital health marketing.
References:
  1. Bassler M, Nosper P, Follert L, et al. (2007). Datenquellen für eine kontinuierliche Qualitätsverbesserung in der medizinischen Rehabilitation. Rehabilitation; 46 (3):155-163.
  2. Berger K, Heuschmann PU (2006). Epidemiologie neurologischer Erkrankungen. In: Günnewig T, Erbguth F (Hrsg.): Praktische Neurogeriatrie: Grundlagen-Diagnostik-Therapie-Sozialmedizin. Stuttgart: Kohlhammer 33-41.
  3. Cabana MD (1999). Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 282:1458–1465.
  4. Dettmers C, Stephan KM (2011). Motorische Therapie nach Schlaganfall. Von der Physiologie bis zu den Leitlinien. Bad Honnef: Hippocampus Verlag.
  5. Diener HC (2008). Leitlinien zur multiprofessionellen neurologischen Rehabilitation. Stuttgart: Thieme Verlag.
  6. Faller H, Reusch A, Vogel H, Ehlebracht-König I (2005). Patinetenschulung. Die Rehabilitation 44:2131
  7. Fialka-Moser V (2013). Kompendium Physikalische Medizin und Rehabilitation. Diagnostische und therapeutische Konzepte. 3. überarbeitete und erweiterte Auflage, Wien NewYork: Springer.
  8. Hesse S, Werner C, Bardeleben A, Barbeau H (2001). Body weight-supported treadmill training after stroke. Curr Atheroscler Rep; 3(4):287-294.
  9. Hesse S, Köhler U, Schnaack S, Werner C (2015). Das Lokomotionsstudio: eine effektive und effiziente Lokomotionstherapie in der der Gruppe für Patienten der Phasen B, C und D der neurologischen Rehabilitation. Neurol Rehabil; 21(4):195-200.
  10. Heuschmann P, Busse O, Wagner M, et al. (2010). Schlaganfallhäufigkeit und Versorgung von Schlaganfallpatienten in Deutschland. Akt Neurol 37(07):333–340.
  11. Kollen BJ, Lennon S, Lyons B, et al. (2009). The Effectiveness of the Bobath Concept in Stroke Rehabilitation. What is the Evidence? Stroke 40(1).
  12. Kwakkel G (2010). Bobath under Fire. Frontline (The Chartered Society of Physiotherapy) 16 (1) Paci (2003) Physiotherapy based on the bobath concept for adults with post-stroke hemiplegia: a review of effectiveness studies. J Rehabil Med 35:2-7.
  13. ReMoS Arbeitsgruppe (2015). S2e-Leitlinie. Rehabilitation der Mobilitat nach Schlaganfall (ReMoS).
  14. Robert Koch-Institut (2013). Studie DEGS1, Erhebung 2008–2011.
  15. Royal Dutch Society for Physical Therapy (2014). KNGF Guideline, Stroke.
  16. Salbach N, et al. (2009). Physical therapists’ experiences updating the clinical management of walking rehabilitation after stroke. Physical Therapy 89:556–568.
  17. Sitzer M, Steinmetz H (2011). Lehrbuch Neurologie. München: Elsevier.
  18. Schöffski O, Schulenburg JM (2000). Gesundheitsökonomische Evaluationen. Berlin: Springer Verlag.
  19. Statistisches Bundesamt (2015). Bevölkerung Deutschlands bis 2060. Tabellenband Ergebnisse der 13. koordinierten Bevölkerungsvorausberechnung.
  20. Statistisches Bundesamt (2014a). Diagnosedaten der Patienten und Patientinnen in Vorsorge- oder Rehabilitationseinrichtungen. Fachserie 12, Reihe 6.2.2
  21. Statistisches Bundesamt (2014b). Gesundheitsausgaben in Deutschland nach Ausgabenträgern, Leistungsarten und Einrichtungen. Fachserie 12, Reihe 7.1.1.
  22. Veerbeek JM, et al. (2014). What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis. PLoS One 9(2):e87987.
  23. Walbert T, Reese JP, Dodel R (2007). Krankheitskosten neurologischer Erkrankungen in Deutschland. Nervenheilkunde 4:260-264.

Related contents

Find related exciting contents in our media library.

 

This is not what you are searching for? Knowledge
Icon_Call_sized

Meet our specialists.

Are you interested in our solutions? Schedule a meeting with a Consultant to talk through your strategy and understand how TEHRA-Trainer can help you to advance rehabilitation.








    * Required fields

    Keep up to date.
    Subscribe to the THERA-Trainer newsletter and get all the latest news.