The need for rehabilitation facilities for patients after neurological conditions in Vienna has increased in recent years, mainly for 2 reasons:
- Thanks to many new developments in the field of diagnosis and pharmacotherapy, acute-care neurology has made great progress in recent years. This results in a larger group of patients who benefit from specific neurological rehabilitation.
- The proportion of the population over 50 has significantly increased in recent years. This leads to an increase in neurological conditions such as stroke or movement disorders. At the same time, since 1960 a decrease in the average length of hospitalization, from 25 to 8 days, can be observed 1. The important early phase of the rehabilitation process must therefore be carried out externally.
1 Statistics Austria. Spitalsentlassungen und Aufenthaltsdauer 1960-2015
2 Winstein et al. Guidelines for adult stroke rehabilitation and recovery. A guideline for healthcare professionals from the American Heart association/American Stroke association. Stroke 2016; 47:e98-e169
3 Lauzé et al.. The effects of physical activity in Parkinson´s disease: a review. Journal of Parkinson´s Disease 6 (2016) 685-698
4 Fakolade et al.. Effect of comorbidities on outcomes of neurorehabilitation interventions in multiple sclerosis. Int J MS Care.2016; 18:282-290
According to Statistics Austria, in 2015, 31,644 patients with neurological conditions (G00–G99) and cerebrovascular diseases (I60–I69) were hospitalized in Viennese hospitals. Among these admissions, there were about 8,400 patients with the ICD coding I60–I69 (cerebrovascular disease). Judging from data in the literature, 5,600 of these patients have a neurological deficit requiring neuro-rehabilitative intervention 2. In other neurological disorders, such as Parkinson’s disease and multiple sclerosis, the need for rehabilitative treatment has likewise been demonstrated 3, 4.
With its rehabilitation facilities, VAMED is not only committed to providing the best possible care and treatment at the highest level – it is also a leader in innovation and development of new approaches to various types of rehabilitation. VAMED operates 15 rehabilitation clinics (12 in Austria, 2 in Switzerland and 1 in the Czech Republic) and is thus one of the leading private rehab providers.One focus is on neurology, for upon commencement of the operations of the neurological department in the Rehabilitation Clinic Wien Baumgarten already 8 VAMED rehabilitation facilities are providing neurological rehabilitation.
For this reason, it is a logical development to open a new neurological therapy center for phases C and D in Wien Baumgarten. Here an individual therapy concept is created according to the ICF criteria. This includes determination of the disease and its consequences, as well as consideration of the personality of the patient. Against this background, the measures defined have the objective of achieving restoration or improvement of the impaired functions. This is done with a view to re-integration into the patient’s life before the illness. This aspect also includes involvement of the family members into the rehabilitation process. A neurological disorder is not merely a condition of an individual, but also has impact on his or her family environment. The family members are taken care of via counseling sessions and regular information about the course of the therapy. Here we benefit from the location in Vienna. It enables us to perform neurological rehabilitation without removing the patient far from their usual family environment.
For the treatment of the patients, in addition to the established rehabilitation therapies there are also modern concepts such as therapeutic robots, computerized cognitive therapies and neuromodulatory techniques available.
The interdisciplinary approach is important. This starts upon admission and continues through the hospitalization until discharge. All professional groups working with the patient are involved here. This procedure allows ensuring a holistic approach and taking the patient’s individuality into account. The therapy is therefore structured into therapeutic components. The patient’s main problems determined in the appraisal are defined. In further consequence, the professional groups involved can now use different approaches specific to their respective disciplines to work on the deficiency identified.
The following therapeutic elements are available:
In motor therapy, in the team of physiotherapists and occupational therapists the training of functional movements and promotion of skills relevant to daily life are worked on. Depending on the impairment, as a base first initiation of movements is begun. Over the clinical course, among other things a “forced-use therapy” to promote the increased use of the affected region is established. In the further sequence, refinement of movements is addressed. This is done both in individual and in group therapy. In addition, computer-assisted therapies (SilverFit®, Amadeo®) are used.
In speech and language therapy, there is a cooperation of speech therapy and physiotherapy. This collaboration makes it possible that work is done not only on the “voice” as such, but on the necessary skills to produce articulation at all. Again, this is done both in individual and in group therapies. The goal is to restore the ability to communicate and thereby improve independence in everyday life.
In swallowing therapy, the patient is likewise treated jointly by speech therapy and physiotherapy. In addition, in this area there is cooperation with dietology and the medical field. The focus is on safe eating and drinking. Examination of a possible dysphagia can be performed on-site by a video-endoscopic swallowing examination (FEES – functional evaluation of swallowing). In case of pathological findings, the diet is adapted by the dietology experts. This finding helps to both recognize the problem and to assess the effectiveness of speech therapy intervention. The aim is to ensure eating without complications, thereby avoiding secondary complications.
Cognitive therapy is divided into a detailed diagnosis and a subsequent therapy. The interplay of neuropsychology and occupational therapy is important in the field of testing and training. Another profession involved is nursing, which provides support in the implementation of what has been learned in daily life. Through this system, with permanent feedback, the therapy program can be quickly and individually adapted to the clinical course. Among other things, here problems in the fields of attention, memory and planning are treated. The work is done both in 3 individual and in group therapy. In addition, computer-aided methods are included into the treatment.
As mentioned in the last item, it is important that the skills learned are applied in everyday life. Here it is important that the nursing staff monitors practice of the acquired skills in everyday life and provides support in case of any problems.
Through the mutual interaction of all professional groups, this concept offers the opportunity of not only recalling in the training situation what has been learned, but to use it in everyday life as well. This allows the therapy to be applied more efficiently for learning a function for use in daily life.
Rehabilitation Clinic Wien Baumgarten – a health facility of the VAMED Group